f92 Banana

Allergens within Food of Plant Origin

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  • Latin name: Musa spp.
  • Family: Musaceae
  • Common names: Banana, Plantain
  • Source material: Ripe, fresh fruit
Food
A food, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Geographical distribution
Banana originated in Southeast Asia and was described in the first scientific botanical work by Theophrastus in 400 BC Greece. Bananas are now grown in a variety of tropical regions throughout the world, and the ease of harvesting, shipping and storing makes them the cheapest and most readily available fruits. “Ripening rooms” allow distributors to control the state of Bananas for optimum convenience. Banana production exceeds that of Apple and that of almost all the citrus fruits combined.
 
There are two main species. Common Banana (M. acuminata) is sweet and rather mealy and is most often eaten raw, whereas Plantain (M. paradisiaca) is hard and starchy and is eaten cooked. The colour, size and shape of the two, however, are similar.
 
Environment
Bananas eaten raw are an important natural convenience food in industrialised countries, not requiring (and in fact being spoiled by) refrigeration, and being very easy to peel and eat out of hand. Bananas are also found in fruit salads and many other deserts. Plantains are not a familiar food in the West, but in a number of other regions they form an important part of staple diets. Bananas are extremely nutritious, containing an especially high level of potassium, and several other important substances. Banana’s consistency makes it an ideal food to introduce into the diet of young infants.
 
Bananas have a very wide range of medicinal uses, including in the treatment of high blood pressure and constipation. Natural Banana essence is added to some processed foods and to some medicines as a flavourant. The peels have household uses such as cleaning and shining. Banana is a common ingredient of cosmetics and toiletries, but as in the case of edible products, the “Banana” may be artificial.
 
Unexpected exposure
See under Environment.
 
Allergens
Mus xp 1, a profilin, has been isolated. It demonstrated a 71-84% sequence identity to other known pollen and ingested profilins (1-4).IgE binding to the recombinant profilin was demonstrated in 7 of 16 Banana-allergic subjects (2).
 
Although no other allergens have been characterised to date, there have been a number of antigenic proteins identified. In a latex-allergic patient study, 16 allergenic components were identified in Banana, with molecular weights ranging from 17 to 128 kDa. Two were considered as major allergens: a 33 kDa protein was detected in 15 of 19 sera (88%), and a 37 kDa in 13 of 19 sera (76%) (3).
 
The 33 kDa allergen may be a chitinase similar to that reported in a study that described the isolation of 32 kDa and 34 kDa allergens, class I chitinases with an hevein-like domain, shown to be major allergens in Banana fruit. The two purified allergens detected Banana skin-specific IgE in more than 50% of 15 Banana-allergic patients (5-6). Proteins of 40, 52, 58, 88 and 94 kDa have also been detected (1). Other studies have isolated from Banana extract a 40 kDa protein showing strong IgE binding, and allergens of 52, 58, 88 and 94 kDa were detected (7). In a patient sensitised to Avocado, but not to latex or pollen, a single allergen of 70 kDa was detected (1).
 
In sera from 22 latex-allergic patients, 10 (45%) recognised 14 allergens in Banana. The most frequently identified Banana allergens were 23, 32, 36, 39 and 47 kDa proteins. Skin-specific IgE to Banana was found in 14 of 18 latex-allergic patients studied, and Banana RAST in 12 of 14 patient sera tested (8).
 
The pulp of ripe Bananas contains an abundant thaumatin-like protein (TLP) (9).
 
Thaumatin allergens have allergenic potential, but in Banana, TLP may be different and was not evaluated. Although the Banana thaumatin-like protein adopts an overall fold similar to that of thaumatin and thaumatin-like PR-5 proteins, and TLPs have antifungal properties, the Banana TLP was apparently devoid of antifungal activity. Pulp of Plantains also contains a very similar TLP, which is even more abundant than its Banana homologue (10).
 
One of the predominant proteins in the pulp of ripe Bananas and Plantains has been identified as a lectin. The clinical relevance of this Banana lectin to food safety is at present unknown (11).

Potential Cross-Reactivity

An extensive cross-reactivity among the different individual species of the genus, basically Banana and Plantain, could be expected (12).
 
Allergy to latex has become an increasing occupational and public health problem. Through the analysis of specific IgE against latex, the prevalence of latex sensitisation in the general population has been estimated to be approximately 4-7% (13). Certain groups are at higher risk. Approximately 24-60% of patients with spina bifida may be sensitised to latex. Between 3-25 % of healthcare workers may be sensitised (14, 15). Other high-risk groups include greenhouse and rubber workers. Approximately 42%-50% of patients with latex allergy have hypersensitivity to some foods; Avocado, Banana, Chestnut and Kiwi are those most frequently detected (16-28). In a study examining food items that led to anaphylactic reactions in latex-allergic individuals, several patterns of cross-reactivity have been demonstrated: Banana and Avocado; Banana, Avocado and Buckwheat; and Banana, Avocado and Tomato (29).
 
Approximately 45% of latex-allergic individuals are also allergic to Banana (30). In a study of 47 latex-allergic patients, immunological reactivity to foods was found in 33. Positive Banana skin-specific IgE was demonstrated most frequently with Avocado (53%) and 38% to Banana (25). In another study, 8 of 16 latex-allergic patients (50%) reported symptoms after eating Bananas, and skin-specific IgE was found to Banana in 5 of 14 patients (36%). Banana RAST results were positive in 12 of the 19 patients (63%). Seventeen of the 19 patients (89%) exhibited specific Banana IgE antibodies (3).
 
Other studies have had similar findings. In 82 adult patients with latex allergy, the presence of Banana skin-specific IgE was found in 17 patients (31).
 
Not all Latex-allergic individuals are also allergic to banana. In a study examining the sera of 47 latex-allergic individuals by RAST, 66% were positive to latex and 55% to Banana. Of the 31 latex-positive sera, 25 were also Banana-positive. Skin-specific IgE to Banana was found in 11 of the 31 patients tested, and symptoms after eating Bananas were reported by 16 (52%) of the 31 patients. Cross-reactivity between Banana and latex was demonstrated in inhibition studies and other studies (32). Similarly, in 2 children with latex hypersensitivity, Banana skin-specific IgE and skin-specific IgE to a number of other fruits were positive, but the children presented no symptoms after ingestion of these fruits (33).
 
The association between latex and Banana allergy has been shown to be due to a class I chitinase panallergen (5-6, 34). In a study of patients allergic to latex, 9 of 15 sera with IgE to hevein showed IgE binding to 32 and 33 kDa Banana proteins. The 33 kDa protein gave over 90% identity to endochitinases of several plants (35). The role of chitinase has been demonstrated in other studies (36). The Banana, Avocado, and Chestnut chitinases share 65-70 sequence identity with the latex hevein chitinase (37). Therefore, although Banana contains a number of allergens, individuals allergic to the class I chitinase allergen in Banana will likely be cross-reactive with other class I chitinase-containing foods, e.g., Avocado, Chestnut, Cherimoya, Passion fruit, Kiwi, Papaya, Mango, Tomato and Wheat. (These allergens are heat-inactivated and appear to be activated by "stress" to the plant.) (38)
 
The corollary holds, that in Banana-allergic children (or children with allergies to other fruits), co-existing latex allergy should be considered, in particular in cases of urticaria or anaphylaxis for which the cause is unknown (22, 39). In 57 fruit-allergic patients, immunologic latex sensitization occurred in 49 (85.9%). Six out of 57 (10.5%) suffered from clinically relevant latex allergy. In all patients, clinical symptoms to fruits preceded a history of latex allergy. The fruits most often associated were Melon, Peach, and Banana (40).
 
Banana contains a profilin panallergen. Cross-reactivity between pollen and exotic foods containing profilin is possible (2). Ten percent to 15% of Birch pollen-allergic individuals have specific IgE to the 35 kDa minor Birch pollen allergen, and there is cross-reactivity with comparable-size proteins from Litchi, Mango, Banana, Orange, Apple, Pear and Carrot (41). In a study of Birch pollen allergy, hypersensitivity to Bet v 2 was strongly associated with clinical allergy to citrus fruits, Melon or Watermelon, Banana and Tomato. The sensitivity of a history of allergy to gourd fruits, citrus fruits, Tomato, Banana, or a combination thereof as a means to detect profilin-hypersensitive patients was 85% (41/48). The study concluded that in clinical settings in which laboratory investigations are not easily accessible, allergy to Melon, Watermelon, citrus fruits, Tomato, and Banana can be used as a marker of profilin hypersensitivity once a sensitisation to Natural Rubber Latex and lipid transfer protein is ruled out (4).
 
In some instances, cross-reactivity has been described for which a panallergen had not been determined. In individuals sensitised to Ficus allergens, sensitisation to Kiwi fruit, Papaya, and Avocado as well as Pineapple and Banana may occur (42). Similarly, sensitisation to the latex of F. benjamina, H. brasiliensis, breadfruit and Banana was demonstrated in a patient allergic to Banana, F. benjamina and breadfruit. RAST inhibition studies showed that specific IgE to breadfruit latex cross-reacted more strongly with latex of H. brasiliensis and Banana than it did with latex of F. benjamina (43). Two of 4 patients with an allergy to Ficus benjamina had a cross-allergy to latex and the associated cluster of tropical fruit (Banana, Kiwi, Avocado) and Chestnut, implying that the panallergen chitinase is responsible for these items cross-reacting (44).
 
A positive allergenic correlation between Platanus (London Plane tree) pollen and Hazelnut, Peanut, Banana and Celery has been described. RAST inhibition experiments indicated an important cross-reactivity between the pollen of Platanus acerifolia and Hazelnut and Banana fruit, and an intermediate cross-reactivity with Celery and Peanut (45). Whether this cross-reactivity occurs as a result of the panallergen profilin was not determined.
 
In a study of 53 patients (19 positive on a DBPCFC) with Melon allergy, the most common foods associated with this allergy were Avocado (7), Banana (7), Kiwi (6), Watermelon (6), and Peach (5, 46).
 
Similarly, in a study investigating the prevalence of Avocado allergy, in 100 consecutive atopic patients with allergic rhinitis, 4 reported similar symptoms upon eating Banana (47).

Clinical Experience

IgE-mediated reactions
Banana may commonly induce symptoms of food allergy in latex-sensitised individuals, but may also induce symptoms of food allergy in non-latex sensitised individuals (1, 48). Allergenicity increases with ripeness.
 
In one of the earliest reports of adverse reactions to Banana, 2,067 allergic patients in 1968-1969 included 36 patients who complained of various symptoms after eating Banana. Among these symptoms were itching throat, “gassiness” and indigestion, cramps, diarrhoea, vomiting, sore mouth or tongue, “canker sores”, swollen lips, wheezing, hoarseness, urticaria and other rashes, and angioedema (48). Another report indicates that adverse reactions may include oral allergy syndrome, urticaria and, in severe instances, anaphylaxis (2). Various combinations of adverse effects are possible. For example, a study reported on a patient who developed itching of the mouth and throat followed 30 minutes later with urticaria, angioedema, and hypotension. A second patient reported only oral itching, and a third patient experienced urticaria, conjunctivitis and oral allergy syndrome (1).
 
In 142 adults among 7,698 patients visiting an outpatient clinic and reporting sensitisation to foods, 120 experienced clinical symptoms after consumption of 1 or more foods. The most frequently recorded symptoms were: urticaria/angioedema (70%), oral allergy syndrome (54%), asthma (37%) and anaphylaxis (27.5%). Banana sensitisation occurred in 12 patients (49).
 
Banana allergy may occur early in life, as reported in 2 infants. A 6-month-old girl developed vomiting, generalised urticaria with erythema, and wheezing an hour after ingesting fresh Banana with yogurt. Serum-specific IgE was 1.97 UA/ml. This was the 3rd time she had ingested Banana. The 2nd patient was a 6-month-old boy who developed urticarial rash on his whole body and erythema around the lips 1 hour after eating fresh Banana (with yogurt) for the 1st time. His mother had frequently eaten Banana since baby's birth, and she had been breastfeeding him. Serum-specific IgE was 1.25 UA/ml. The authors speculated that sensitisation may have occurred through the mother’s breast milk (50).
 
Anaphylaxis may occur to Banana (32). A 15-year-old girl developed anaphylactic shock, asthma, angioedema, and urticaria after eating a Banana. She had eaten Banana 2 weeks earlier without adverse effects (51). Anaphylaxis was reported in a 32-year-old woman. She experienced swelling of her lips, developed severe oro-pharyngeal symptoms and generalised urticarial rash, and had difficulty breathing. Skin-specific IgE to Banana and Kiwi was demonstrated. Serum Banana RAST was 0.68 ku/L. She had no latex-associated symptoms (52).
 
Anaphylaxis has been described in a 3-year-old boy with associated latex allergy. He had undergone 5 successive surgical operations during the first months of life and had had eaten Banana previously without any untoward effects. He developed generalised urticarial rash, difficulty in breathing and oro-pharyngeal symptoms, including itching and swelling of the lips, after eating a Banana. On interrogation, it was found that swelling of the lips had occurred after blowing up rubber balloons; and a week later, with periorbital oedema, after touching a balloon. Banana skin-specific IgE was positive, with serum-specific IgE of 6.10 kU/L. For latex, it was 5.2 kU/L (53).
 
Banana may be a “hidden” allergen. An IgE-mediated reaction to a Banana-flavoured drug additive was described in an 8-year-old girl who developed oral itching with wheals over her face and trunk and angiodema on both eyelids within 1 hour of her first oral dose of penicillin containing a Banana essence as a flavouring additive. Tests for penicillin allergy were negative, but serum- specific IgE to Banana was positive (1.25 kU/L). The presence of Banana proteins in the Banana essence was demonstrated (54). Similarly, a 42-year-old woman, with a history of 8 episodes of angiooedema over 2 years from latex gloves or from eating Banana, developed similar symptoms while working on a production line of a company manufacturing a natural Banana hair conditioner. Skin prick was positive to latex, Banana, Cucumber, Avocado, Kiwi, and Banana hair conditioner (55).
 
Adverse effects to Banana may manifest only in the skin. Symptoms include contact urticaria (56), urticaria-angioedema (57), and worsening of eczema (32). In a study investigating the prevalence of Natural Rubber Latex sensitisation and allergy in 74 children with atopic dermatitis, 12 had circulating IgE antibodies to latex. Twenty children without proven latex sensitisation showed increased food-specific IgE, most frequently to Potato, Banana, and Chestnut (58).
 
Other reactions
Banana has been reported to precipitate migraine in susceptible individuals (59-60). This may happen as a result of the normal presence of vasoactive substances such as serotonin and tyramine.
 
Compiled by Dr Harris Steinman, developer of Allergy Advisor, http://allergyadvisor.com/

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