f44 Strawberry

Allergens within Food of Plant Origin

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  • Latin name: Fragaria vesca
  • Family: Rosaceae
  • Common names: Strawberry
  • Source material: Frozen berry
Other important Strawberry species: F. alpina, F. chiloensis, F. virginiana
 
Food
A food, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Geographical distribution
Strawberry plants make up about 12 species of low, runner-bearing perennial herbs. The Strawberry is the sweet red fruit borne on the runner. Most are native to north temperate regions. Strawberry plants are cultivated as ornamentals and, especially, for their fruit. Strawberry was cultivated in the days of the Greeks and Romans, and commercial cultivation began about 250 years ago in France. Most cultivated strawberries are derived from crosses between  F. chiloensis and F. virginiana.
 
Environment
Both cultivated and wild Strawberries are eaten raw and used in desserts. They are often used to make preserves, and are even dried. The leaves are eaten raw and cooked and used as a tea substitute. The root has been used as a coffee substitute in India.
 
The fruits contain salicylic acid. Both fruit and leaves are used in a variety of herbal treatments. External applications include as a remedy for chilblains and sunburn.
 
Unexpected exposure
The fruit is also used cosmetically in skin-care creams and tooth-whiteners. The flowers sometimes serve as a compost activator.
 
Allergens
No allergens from this plant have yet been fully characterised.
A Bet v 6-related food allergen, PCBER (phenylcoumaran benzylic ether reductase), has been detected (1-2).

Potential Cross-Reactivity

An extensive cross-reactivity among the different individual species of the genus could be expected. Extensive cross-reactivity occurs among various members of the family, but, to date, the degree of this cross-reactivity between Strawberry and other members of the Rosaceae family has not been evaluated (3).
 
Allergy to Rosaceae fruit is frequently associated with Birch pollinosis in Central and Northern Europe, and with grass pollen allergy in central Spain. The main cross-reactive structures involved in individuals who have Birch pollen allergy are Bet v 1 and profilin; in grass pollen-allergic individuals, profilin and carbohydrate determinants. Rosaceae fruit allergy can occasionally occur in patients without pollinosis. Eleven patients from central Spain allergic to Apples, Peaches, and/or Pears but not to pollen were compared with 22 control subjects with combined grass pollen and fruit allergy. Rosaceae fruit allergy without pollinosis was reported to be severe, with 82% of patients reporting systemic symptoms, mainly anaphylaxis (73%), whereas oral symptoms were less frequent (64%).
 
Anaphylaxis was seen in 36% of patients. The fruit allergens involved showed cross-reactivity among Rosaceae species but were not related to profilin or Bet v 1. Ninety-one percent of patients with combined grass pollinosis and fruit allergy reported oral allergy, 45% reported systemic symptoms, 18% reported anaphylaxis, and 9% reported anaphylactic shock. The study concluded that allergy to Rosaceae fruits in patients without a related pollen allergy is a severe clinical entity. Profilin- and Bet v 1-related structures are not involved in Rosaceae fruit allergy without pollinosis (4).
 
A recent study concluded that in pollen-allergic patients who frequently present with allergic symptoms after ingestion of several kinds of plant-derived foods, the majority of these reactions is caused by 4 distinct cross-reactive structures that are present in Birch pollen. Proteins that share common epitopes with Bet v 1, the major Birch pollen allergen, occur in pollens of several tree and other species: Apple, stone fruits, Celery, Carrot, nuts, and Soya beans. Approximately 70% of patients who are allergic to Birch pollen may experience symptoms after consumption of foods from these groups. In contrast, 2 minor allergenic structures, profilins and cross-reactive carbohydrate determinants (CCD), which sensitise approximately 10-20% of all pollen-allergic patients, are also present in grass pollen and weed pollen. IgE-binding proteins related to the Birch pollen minor allergen Bet v 6 (PCBER) are found in Apple, Peach, Orange, Lychee, Strawberry, Persimmon, Zucchini, and Carrot. However, the occurrence of cross-reactive IgE antibodies often does not correlate with the development of clinical food allergy (1-2). For example, in a DBPCFC study, reactions to Peach occurred in 22 patients, in 6 to Apple and in 5 to Apricot. The authors concluded that the presence of skin- or serum-specific IgE should not be taken as the only guide for multi-species dietary restrictions. Nevertheless, the potential clinical allergy to other Rosaceae should not be neglected. If the reported reaction is confirmed, current tolerance to other Rosaceae should be precisely established unless there has been ingestion without symptoms after the reaction (5).
 
IgE antibodies were found to Peach, Guava, Banana, Mandarin and Strawberry in a patient experiencing anaphylaxis after eating Peach. The cross-reactive protein was identified as a 30 kDa protein occurring in all of the fruits (6).

Clinical Experience

IgE-mediated reactions
Strawberry may commonly induce symptoms of food allergy in sensitised individuals, and was reported to be a common cause of allergy in children (7-8). In a Polish study, most positive skin-specific IgE reactions to food allergens occurred with nuts, Celery, Rye flour, Carrot, Strawberry, Pork and beans (9). In a Mexican study, in 1,419 allergic patients aged between 1 year and 18 years, 442 (31%) had positive skin-specific IgE tests to 33 tested foods. Fish, Milk, seafood, Soy, beans, Orange, Onion, Tomato, Chicken, nut, Lettuce and Strawberry were responsible for 58% of all the allergic reactions (10).
 
Reactions reported include symptoms of food allergy (abdominal pain and cramping, nausea and vomiting), atopic dermatitis, asthma, rhinitis, and symptoms of oral allergy syndrome. Allergy to Strawberry has also been reported as part of a true multifood allergy in a 4-year-old child (11).
 
Food-dependant exercise-induced anaphylaxis attributed to Strawberry has been reported (12).
 
Contact urticaria to Strawberry has been documented (13-14). Contact urticaria to Cucumber pickle and Strawberry has been reported (15).
 
Other reactions
Allergic contact dermatitis to Strawberry lip salve has been reported (16).
 
Strawberry contains a variety of aromatic substances and vasoactive substances, e.g., histamine, that may result in non-IgE-related reactions. For example, urticaria may occur as a result of excess production of histamine triggered by the fruit.
 
Unripe Strawberry fruit may produce a triterpene phytoalexin, which appears to be involved in the resistance of Strawberry to a particular fungus. Phytoalexin may result in photosensitivity dermatitis (17).
 
Compiled by Dr Harris Steinman, harris@zingsolutions.com

References:

    1. Vieths S, Scheurer S, Ballmer-Weber B. Current understanding of cross-reactivity of food allergens and pollen. Ann N Y Acad Sci 2002;964:47-68
    2. Karamloo F, Wangorsch A, Kasahara H, Davin LB, Haustein D, Lewis NG, Vieths S. Phenylcoumaran benzylic ether and isoflavonoid reductases are a new class of cross-reactive allergens in birch pollen, fruits and vegetables. Eur J Biochem 2001;268(20):5310-20
    3. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09
    4. Fernandez Rivas M, van Ree R, Cuevas M. Allergy to Rosaceae fruits without related pollinosis. J Allergy Clin Immunol 1997;100(6 Pt 1):728-33
    5. Rodriguez J, Crespo JF, Lopez-Rubio A, De La Cruz-Bertolo J, Ferrando-Vivas P, Vives R, Daroca P. Clinical cross-reactivity among foods of the Rosaceae family. J Allergy Clin Immunol 2000;106(1 Pt 1):183-9
    6. Taylor S, White L, Kapels L, Nordlee J. et al. Identification of IgE binding proteins from peaches by immunoblotting. J Allergy Clin Immunol 1992;89:193
    7. Kim KT, Hussain H. Prevalence of food allergy in 137 latex-allergic patients. Allergy Asthma Proc 1999;20(2):95-7
    8. Kajosaari M. Food allergy in Finnish children aged 1 to 6 years. Acta Paediatr Scand 1982;71(5):815-9
    9. Hofman T, Buczylko K, Brewczynski P. Typical food allergens for pollinosis in selected regions of Poland. Multiagent studies. [Polish] Pol Merkuriusz Lek 1998;4(20):69-71
    10. Avila Castanon L, Perez Lopez J, del Rio Navarro BE, Rosas Vargas MA, Lerma Ortiz L, Sienra Monge JJ. Hypersensitivity detected by skin tests to food in allergic patients in the Hospital Infantil de Mexico Federico Gomez. [Spanish] Rev Alerg Mex 2002;49(3):74-9
    11. Pajno GB, Passalacqua G, La Grutta S, Vita D, Feliciotto R, Parmiani S, Barberio G. True multifood allergy in a 4-year-old child: a case study. Allergol Immunopathol (Madr) 2002;30(6):338-41
    12. Shadick NA, Liang MH, Partridge AJ, et al. The natural history of exercise anaphylaxis: survey results from a 10-year follow-up study. J Allergy Clin Immunol 1999;104;104:123-127
    13. Grattan CE, Harman RR. Contact urticaria to strawberry. Contact Dermatitis 1985;13(3):191-2
    14. Kashirskii IuM. Food allergy in patients with pruritic dermatoses. [Russian] Vopr Pitan 1984;(4):17-20
    15. Weltfriend S, Kwangsukstith C, Maibach HI. Contact urticaria from cucumber pickle and strawberry. Contact Dermatitis 1995;32(3):173-4
    16. Taylor AE, Lever L, Lawrence CM. Allergic contact dermatitis from strawberry lipsalve. Contact Dermatitis 1996;34(2):142-3
    17. Hirai N, Sugie M, Wada M, Lahlou EH, Kamo T, Yoshida R, Tsuda M, Ohigashi H. Triterpene phytoalexins from strawberry fruit. Biosci Biotechnol Biochem 2000;64(8):1707-12

2004