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Food allergies resulting from immunological cross-reactivity with inhalant allergens

Guidelines from the German Society for Allergology and Clinical Immunology (DGAKI), the German Dermatology Society (DDG), the Association of German Allergologists (AeDA) and the Society for Pediatric Allergology and Environmental Medicine (GPA)

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Summary

A large proportion of immunoglobulin E (IgE)-mediated food allergies in older children, adolescents and adults are caused by cross-reactive allergenic structures. Primary sensitization is most commonly to inhalant allergens (e.g. Bet v 1, the major birch pollen allergen). IgE can be activated by various cross-reactive allergens and lead to a variety of clinical manifestations. In general, local and mild — in rare cases also severe and systemic — reactions occur directly after consumption of the food containing the cross-reactive allergen (e. g. plant-derived foods containing proteins of the Bet v 1 family). In clinical practice, sensitization to the primary responsible inhalant and/or food allergen can be detected by skin prick tests and/or in vitro detection of specific IgE. Component-based diagnostic methods can support clinical diagnosis. For individual allergens, these methods may be helpful to estimate the risk of systemic reactions. Confirmation of sensitization by oral provocation testing is important particulary in the case of unclear case history. New, as yet unrecognized allergens can also cause cross-reactions.

The therapeutic potential of specific immunotherapy (SIT) with inhalant allergens and their effect on pollen-associated food allergies is currently unclear: results vary and placebo-controlled trials will be necessary in the future. Pollen allergies are very common. Altogether allergic sensitization to pollen and cross-reactive food allergens are very common in our latitudes. The actual relevance has to be assessed on an individual basis using the clinical information.

Cite this as Worm M, Jappe U, Kleine-Tebbe J, Schäfer C, Reese I, Saloga J, Treudler R, Zuberbier T, Wassmann A, Fuchs T, Dölle S, Raithel M, Ballmer-Weber B, Niggemann B, Werfel T. Food allergies resulting from immunological cross-reactivity with inhalant allergens. Allergo J Int 2014; 23: 1–16 DOI 10.1007/s40629-014-0004-6

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Abbreviations

AD:

Atopic dermatitis

CCD:

Cross-reactive carbohydrate determinants

EAACI:

European Academy of Allergy and Clinical Immunology

FEV1:

Forced expiratory volume in one second

FVC:

Forced vital capacity

IgE:

Immunoglobulin E

IgG:

Immunoglobulin G

LFS:

Latex-fruit syndrome

LTP:

Lipid transfer protein

NSAID:

Nonsteroidal anti-inflammatory drug

PR-10:

Pathogenesis-related protein family 10

SCORAD:

Scoring atopic dermatitis

sIgE:

Specific immunoglobulin E

SIT:

Specific immunotherapy

TLP:

Thaumatin-like proteins (PR-5)

VCin:

Inspiratory vital capacity

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Authors and Affiliations

  1. Allergie-Centrum-Charité Klinik für Dermatologie, Allergologie und Venerologie Charité — Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Margitta Worm, Torsten Zuberbier & Sabine Dölle

  2. Klinik für Dermatologie, Allergologie und Venerologie, Universität Lübeck, Germany

    Uta Jappe

  3. Forschungsgruppe Klinische und Molekulare Allergologie, Forschungszentrum Borstel, Germany

    Uta Jappe

  4. Allergie- und Asthma-Zentrum Westend, Berlin, Germany

    Jörg Kleine-Tebbe

  5. Ernährungstherapie, Allergologische Schwerpunktpraxis, Hamburg, Germany

    Christiane Schäfer

  6. Ernährungsberatung und -therapie, Schwerpunkt Allergologie, München, Germany

    Imke Reese

  7. Hautklinik, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Germany

    Joachim Saloga

  8. Klinik für Dermatologie, Venerologie und Allergologie Universität Leipzig, Germany

    Regina Treudler

  9. Dermatologisches Ambulatorium Hamburg-Alstertal, Germany

    Anja Waßmann

  10. Hautklinik, Georg-August-Universität, Göttingen, Germany

    Thomas Fuchs

  11. Medizinische Klinik für Gastroenterologie, Pneumologie, Endokrinologie, Universitätsklinikum Erlangen, Germany

    Martin Raithel

  12. Dermatologische Klinik, Universitätsspital Zürich, Switzerland

    Barbara Ballmer-Weber

  13. Klinik für Pädiatrie, Charité — Universitätsmedizin Berlin, Germany

    Bodo Niggemann

  14. Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Germany

    Thomas Werfel

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  1. Margitta Worm
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  2. Uta Jappe
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  3. Jörg Kleine-Tebbe
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  10. Thomas Fuchs
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  11. Sabine Dölle
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  14. Bodo Niggemann
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  15. Thomas Werfel
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Corresponding author

Correspondence to Margitta Worm.

Additional information

Level of development

S1

AWMF-guidelineregister-number

061/019

Finalised

August 27, 2013

Valid until

Oktober 31, 2018

Check

Oktober 30, 2016

ICD-10-numbers

T78.1, T78.0, L27.2, T78.2

German version

www.springermedizin.de/allergo-journal

Methodology of guideline development

Literature reviews and expert consensus (February 20, 2013)

Coordinator

Prof. Dr. Margitta Worm

Cite this as Worm M, Jappe U, Kleine-Tebbe J, Schäfer C, Reese I, Saloga J, Treudler R, Zuberbier T, Wassmann A, Fuchs T, Dölle S, Raithel M, Ballmer-Weber B, Niggemann B, Werfel T. Food allergies resulting from immunological cross-reactivity with inhalant allergens. Allergo J Int 2014; 23: 1–16 DOI 10.1007/s40629-014-0004-6

Conflict of interests

The authors state that there are no conflicts of interest.

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Worm, M., Jappe, U., Kleine-Tebbe, J. et al. Food allergies resulting from immunological cross-reactivity with inhalant allergens. Allergo J Int 23, 1–16 (2014). https://doi.org/10.1007/s40629-014-0004-6

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  • DOI: https://doi.org/10.1007/s40629-014-0004-6

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