Allergy to kiwi: A double-blind, placebo-controlled food challenge study in patients from a birch-free area

doi:10.1016/j.jaci.2003.11.043

Journal of Allergy and Clinical Immunology

Volume 113, Issue 3, March 2004, Pages 543-550

https://doi.org/10.1016/j.jaci.2003.11.043 Get rights and content

Abstract

Background

Allergy to kiwi fruit is being increasingly reported, but it has never been evaluated by means of a double-blind, placebo-controlled food challenge (DBPCFC) study.

Objective

We sought to assess kiwi allergy on the basis of a DBPCFC and identify the patterns of allergen recognition in sensitized patients from a birch-free area.

Methods

Forty-three patients with allergy symptoms who were sensitized to kiwi were evaluated by means of clinical history, skin tests, IgE determinations, and DBPCFCs. The pattern of allergen recognition was assessed by means of IgE immunoblotting. Sequence analysis of IgE-binding bands was performed by using Edman degradation.

Results

DBPCFCs were performed in 33 patients; 4 patients had experienced severe anaphylaxis, and 6 patients declined informed consent. DBPCFC results were positive in 23 patients and negative in 10 patients. The most frequent clinical manifestation was oral allergy syndrome. Twenty-one percent of the patients were not allergic to pollen. Forty-six percent of patients experienced systemic symptoms, and this happened with higher frequency in patients not allergic to pollen (100%). Twenty-eight percent of the patients were sensitized to latex. The IgE-binding bands in kiwi extract more frequently recognized by patient sera were those of 30, 24, 66, and 12 kd, and they could not be associated with any pattern of kiwi-induced allergic reactions.

Conclusion

The results provide evidence that kiwi allergy is not a homogeneous disorder because several clinical subgroups can be established. No definite allergen-recognition pattern was associated with the type of allergic reactions to kiwi. One of 5 patients with kiwi allergy was not allergic to pollen, and these patients had the highest risk of systemic reactions to kiwi.

Section snippets

Patients

Patients reporting symptoms on eating kiwi and IgE sensitization to kiwi (prick by prick) were recruited from the Allergy Department at Fundación Jiménez Díaz (Madrid, Spain). The clinical history of hypersensitivity reactions to kiwi was documented by a medical questionnaire. Written informed consent was obtained from all patients enrolled in the study.

DBPCFCs with kiwi fruit

DBPCFCs were performed following the recipe designed by Dr Cuesta-Herranz (Table I). Two different drinks were prepared for the test meal, an

SDS-PAGE

SDS-PAGE analysis was used to determine the protein composition of kiwi extract. The sample was run in SDS-PAGE gel (2.67% C and 15% T acrylamide), as described by Laemmli.⁹ An amount of 150 μg of lyophilized kiwi extract was diluted in reducing buffer containing β-mercaptoethanol (5%), denatured at 100°C for 10 minutes, centrifuged for 1 minute at 10,000 rpm, and loaded into the gels. Reference markers with known molecular weights (14.4, 21.5, 31, 45, 66.2, and 97.4 kd) from BioRad

Patients

Forty-three patients (31 female and 12 male patients) aged 5 to 54 years (median, 31.2 years) were enrolled in the study. Clinical history with regard to kiwi allergy revealed that 31 (72%) patients had experienced oral allergy syndrome (OAS) after consumption of kiwi fruit; 12 (28%) patients had urticaria, angioedema, or both; 5 (12%) patients had contact urticaria; 4 (9%) patients had anaphylaxis; 2 (5%) patients had abdominal cramps; and 1 (2%) patient had rhinitis, conjunctivitis, and

Discussion

In this study we have evaluated kiwi allergy on the basis of DBPCFC results among patients from a birch-free area. The results of this study point out that kiwi allergy is not a homogeneous disorder and that efforts should be made to improve the quality of kiwi extracts. Several clinical subgroups could be established: patients with kiwi allergy with mild or moderate-severe allergic reactions, with or without associated pollinosis, or with or without concomitant latex allergy. No definite

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Kiwifruit has a high nutritive and health value. Commercial plantings of kiwifruit started a few decades ago and in the last 30 years, it has become a widely consumed fruit. Nowadays, it is one of the most common causes of food allergy. Symptoms vary between mild symptoms in the oral cavity to severe anaphylactic reactions. To date, 13 kiwifruit allergens have been identified and are termed as Act d 1 through Act d 13. The use of kiwifruit components improves the diagnostic performance compared to skin prick-test and immunoCAP with kiwifruit extract. Kiwifruit allergen sensitization patterns differ across Europe with patients from Iceland, mainly sensitized to Act d 1 (actinidin), those from western/central and eastern Europe mainly sensitized to the birch pollen-related Act d 8, and patients from southern Europe mainly sensitized to Act d 9 (profilin) and Act d 10 (nsLTP). Act d 1 and having kiwifruit allergy in Iceland are independent risk factors for a severe kiwifruit allergy. Some kiwifruit cultivars (the common gold kiwifruit Hort16A and the more recently introduced green kiwifruit Summer 3373) may be less allergenic than the common green kiwifruit Hayward and may be a safe alternative for (part of) kiwifruit allergic patients.
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^☆: Supported by a grant from Red Temática de Investigación Cooperativa (G03/094), Spanish Ministry of Health.

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Food and Drug Reactions and AnaphylaxisAllergy to kiwi: A double-blind, placebo-controlled food challenge study in patients from a birch-free area☆

Abstract

Background

Objective

Methods

Results

Conclusion

Section snippets

Patients

DBPCFCs with kiwi fruit

SDS-PAGE

Patients

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allegy

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Purification, cloning and characterization. J Biol Chem

Food and Drug Reactions and Anaphylaxis
Allergy to kiwi: A double-blind, placebo-controlled food challenge study in patients from a birch-free area☆