w9 Plantain (English), Ribwort

Allergens within Weed Pollens

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  • Latin name: Plantago lanceolata
  • Family: Plantaginaceae
  • Common names: English Plantain, Ribwort Plantain, Ribwort
  • Source material: Pollen
Closely related species:
  • Heartleaf Plantain (Plantago cordata)
  • Common Plantain (Plantago major)
  • Rugel Plantain (Plantago Rugelii)
  • Bracted Plantain (Plantago aristata)
  • Salt-and-Pepper Plant (Plantago Purshii)
  • Hoary Plantain (Plantago virginica)
A weed species producing pollen, which often induces hayfever, asthma and conjunctivitis in sensitised individuals.

Allergen Exposure

Geographical distribution
Plants in the genus Plantago, commonly known as Plantains, generally have a rosette of basal leaves and flowers on a dense, terminal spike. These green weedy plants are native to Europe and Asia, but now grow practically anywhere in the world. English Plantain is common in most temperate regions, and is considered a troublesome pollen weed in such diverse areas as New Zealand, Mauritania, Italy, Canada, Ecuador, Belgium, Germany, France and the USA.
 
English Plantain is an erect perennial growing 0.3 m to 0.5 m in height. The leaves are found at the base of the stalk, and are dark green, 5 to 40cm long, 8 to 25 mm wide, and 3-ribbed, with a smooth, wavy texture. The margins are slightly toothed. The leaves are oblong or lance-shaped, tapering at the base into a slender stalk. The leaf axils are often filled with long brownish cottony hairs.
 
The plant flowers from April to August. The spike is 2 to 7.5 cm long at the tip of the flower stalks, and each crowded flower has 4 parchment-like petals 3 mm long; 4 stamens on hair-like stalks ending in large, cream-coloured anthers; and bracts present under flowers. The flowers are hermaphrodite (have both male and female organs) and are pollinated by wind and insects. The plant is also self-fertilising. English Plantain produces more pollen than the other Plantains. Rugel Plantain has the potential to cause hay fever, but the pollen is produced in such small quantities that it is considered of less importance as an allergen. The seeds ripen from June to September. The 3 mm-long seedpods are globe-shaped, dry and papery, and contain 2 seeds. They open by the upper half falling off as a lid. The seeds are boat-shaped, the surface usually shiny, and greenish brown to dark brown.
 
Environment
Plantain is found on grasslands, roadsides, and cultivated ground. The English Plantain is a troublesome weed; it often invades lawns and gardens.
 
Unexpected exposure
The leaves and stems are used in salads or for herbal therapies.
 
Allergens
Initially at least 16 different antigens were detected in Plantain pollen, and at least 6 of these antigens may be allergenic (1). Two cytochrome c allergens have been identified (2). Subsequent studies isolated 3 specific allergens of 17, 19, and 40 kDa (3).
 
Recently, Pla I 1, a major allergen, and a number of 16 to 20 kd isoforms, were isolated. Pla I 1 shares a partial sequence identity with Ole e 1. The prevalence of specific IgE to purified Pla l 1 in Plantain-allergic patients was demonstrated to be 86%, and this represents about 80% of the total specific IgE-binding capacity of the Plantain extract (4).

Potential Cross-Reactivity

An extensive cross-reactivity among the different individual species of the genus could be expected, as well as to a certain degree among members of the family Plantaginaceae (5). However, contrary to the taxonomical inferences, the results of two studies showed that there was little cross-allergenicity between English Plantain pollen and Psyllium (Plantago ovata), closely related members of the same genus (6-7). These studies are contrary to an earlier study which suggested that English Plantain may cross-react to Psyllium (8). Thus indicating the presence of both common and species specific allergens.
 
Cross-reactivity between grass and Plantain pollen is mainly caused by a 30-kDa protein in Plantain pollen. A Group 5 grass pollen allergen is probably responsible for most grass/Plantain cross-reactivity (3).
 
Immunoblotting inhibition experiments, performed with extracts of Melon, Plantago lanceolata pollen and Dactylis glomerata pollen, showed that all allergens of Melon blotting were almost completely inhibited by grass and Plantago pollen extracts. The results support the presence of structurally similar allergens in Melon, Plantago and grass pollens, and that all allergenic epitopes of Melon are present in these pollens (9-10). 
 
Sera from subjects diagnosed as allergic to White Cypress Pine, Italian Cypress, Ryegrass or Birch pollen were shown to have IgE antibodies that reacted with pollens from these four species and from Cocksfoot, Couch Grass, Lamb's Quarters, Wall Pellitory, Olive, Plantain and Ragweed. The authors concluded that the presence of pollen-reactive IgE antibodies might not necessarily be a true reflection of sensitising pollen species (11).
 
Preliminary evidence for cross-reactivity between English Plantain and Paterson's Curse (Echium plantagineum) was demonstrated by RAST inhibition studies (2).
 
A French study reported that Plantain is frequently associated with sensitisation to Latex, but no common allergen was detected (12).

Clinical Experience

IgE mediated reactions
English Plantain pollen is an important cause of asthma, allergic rhinitis and allergic conjunctivitis, particularly in the temperate regions of North America, Australia and Europe (13-15).  
 
Plantain pollen has been shown to be present in relatively large amounts in Montpellier, in southern France, and was the second most important cause of allergy, after grass pollen allergy, in pollen-allergic patients (16).
 
Plantago pollen has been found in aerobiological studies of the air of Badajoz, in southwest Spain (17). Specific IgE to this pollen was demonstrated in Madrid in allergic individuals with Cupressaceae pollinosis (18). In Salamanca, in a study to evaluate allergy to plant-derived fresh foods among pollen-allergic patients from a Birch- and Ragweed-free area, in 95 pollen-allergic patients, the largest number were sensitised to grass (Lolium and Phleum; 97.9%), followed by tree (Olea; 82.1%) and Plantago (64.2%) (19). The flowering of grasses, along with Plantago, occurs earlier and lasts longer in the south than the north of Spain (20). 
 
Plantago pollen is also a prominent aeroallergen in Italy, depending on geographical location, as documented in a study involving 80 data-gathering stations and 40 clinical centres nationwide (21).
 
Several countries in Europe have documented the importance of Plantago pollen as an allergen. Plantago pollen has been shown to be a prominent allergen in aerobiological surveys in Cordoba, Salamanca and Seville, in Spain (22, 23, 24), In the north of France, this plant's pollen was the third most prevalent cause of pollinosis in children (25), and it was one of the most important pollens in Zurich, Switzerland (14, 26).
 
In a Polish study involving 22 patients between 13 and 53 years of age with seasonal allergic rhinitis, specific IgE determination demonstrated the importance of English Plantain as an aeroallergen (27).  In a second study from this country, in 2561 patients suffering from upper airway allergy symptoms, hypersensitivity to weed pollen allergens was found in 1069 patients with pollinosis. In patients sensitised to weeds, the most prevalent allergens were Wormwood (86.2%), Mugwort (82.9%), White Goosefoot (44.3%), and Narrowleaf Plantain (28.8%) (28).
 
Plantago pollen has also been found in aerobiological surveys in Athens (29),  in Balikesir, Turkey (30), and in the Canary Islands (31). A study measuring specific IgE in patients with allergic rhinitis in south Hungary showed Plantago pollen to be an important allergen in sensitisation (32).
 
In a study of Kibbutz Netzer Sereni, a rural community in Israel, air sampling demonstrated that English Plantain was one of the most prevalent allergenic pollens (33).
 
English Plantain has also been shown to be a very prevalent allergen in England. In Surrey, 34% of sera from subjects with respiratory allergy had specific IgE to Plantain (34).
 
In New South Wales, Australia, in 3 populations of schoolchildren aged 8 to 11 years and living in different climatic areas, 95 to 97% of all atopic children were sensitised to one of seven allergens, including English Plantain, House Dust, Dermatophagoides farinae, D. pteronyssinus, Cat dander, Plantain, Rye grass, and Alternaria tenuis (35).
 
Few studies on English Plantain have emanated from the USA. In St. Louis, Missouri, English Plantain was found to be present but not a prominent problem (36).  Similarly, a study of the United States Gulf Coast stated that Plantago pollen was very infrequently sampled (less than 0.1% in the air) even though several species were common in the area (37). Similarly, Plantago was detected in Alaska, but in low levels (38-39). 
 
In children with wheezing bronchitis on the small Pacific island of Niue, skin testing and serologic results indicated that hypersensitivity to House Dust mite (Dermatophagoides pteronyssinus) and Plantain (Plantago lanceolata) antigens were associated with the wheezing bronchitis (40).
 
An early study of atmospheric counts of aeroallergens in Tehran, Iran, documented the presence of English Plantain in the atmosphere (41).
 
Immediate and delayed cutaneous hypersensitivity are believed to be implicated in the physiopathology of atopic dermatitis. A study to evaluate Type I and Type IV allergy to aeroallergens in children with atopic dermatitis reported that of 59 children presenting with this condition and tested with common environmental aeroallergens, 9.8% were sensitised to Plantain pollen (42).
 
The measurement of specific IgE is one method of determining sensitisation to English Plantain. Various diagnostic tests may be required to confirm clinical sensitivity (43).
 
Compiled by Dr Harris Steinman, harris@zingsolutions.com

References:

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2002