f25 Tomato

Allergens within Food of Plant Origin

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  • Latin name: Lycopersicon esculatum
  • Family: Solanaceae
  • Common names: Tomato, Garden Tomato, Love Apple
  • Source material: Fresh tomato
Food
A food, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Geographical distribution
Tomatoes are a vine fruit of the Nightshade family. They were used for food by the Indians of Peru before European arrival. Tomato is one of the most universally accepted vegetable in all cultural groups, and second only to Potato as a vegetable in world food production. A great variety of cultivars exist, from the tiny Cherry Tomato to giant prize varieties the size of Grapefruit; and though the sterotyped colour is red, colours can range from green to purple, and some varieties have stripes. Many wild forms are found, including the closely related species called currant Tomato (L. pimpinellifolium).
 
Environment
Wild forms are found, but are generally not good to eat. Tomatoes are eaten raw or cooked, but the great bulk are processed into juice, canned goods, etc. They can be used as a savoury vegetable, especially in salads, and as a flavouring in soups and other cooked foods. The fruit can also be dried and ground into a powder that can be used as a flavouring and thickening agent in soups, breads, pancakes, etc. An edible oil can be obtained from the seed. The fruit is rich in vitamins A and C, calcium and potassium.
 
The skin of Tomato fruits is a good source of lycopine. Tomato is used as a herbal remedy for a variety of conditions. The pulped fruit is a skin-wash for oily skin. The oil can be used in making soap.
 
All green parts of the plant are poisonous. A spray made from Tomato leaves is an effective but very poisonous insecticide.
 
Allergens
Although allergens have been isolated almost over 4 decades ago (1), none has been fully characterised to date. Allergenicity is dependant on the ripeness of Tomato.
 
Proteins similar to each other have been detected in skin and seed extracts, with protein bands discernible at molecular weights of 21, 33, and 43 kDa. one band appears to be a heat-stable allergen, as both patients in this study developed severe allergic reactions to cooked and fresh tomato. One patient reacted specifically to a 43 kDa protein band on IgE immunoblot (2).
 
An allergen belonging to the lipid transfer protein (LTP) family has been detected and is a potentially severe food allergen, in particular due to its extreme resistance to pepsin digestion. Cross-reactivity between foods containing LTP’s is often accompanied by clinical food allergy, frequently including systemic reactions (3).
 
In patients with oral allergy syndrome (OAS), 4 proteins binding with IgE from more than half of the patients' sera were found to be polygalacturonase 2A, [beta]-fructofuranosidase, superoxide dismutase (SOD) and pectinesterase (PE). The concentrations of PG2A, [beta]-fructofuranosidase and PE were highest in the red ripening stage with both SDS-PAGE and immunoblotting (4).
 
A cDNA clone encoding profilin from pollen grains (not fruit) of tomato has been isolated. (The clinical significance of this has not yet been determined.) Sequence analysis of the insert shows 87% similarity to Tobacco, 78% to Timothy grass profilin, 77% to Arabidopsis profilin, 77% to Maize ZmPro3, and 73% to Birch profiling (5).

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 Solanaceae (6). This has been shown in serum-specific IgE inhibition experiments where Tobacco, Mugwort pollen, and Tomato extracts inhibited the binding of a Tobacco-allergic patient's serum to Tobacco leaf. Tobacco (Solanaceae family) is often used as a contact insecticide in gardens (7).
 
Many studies have reported that patients with grass pollen-allergic respiratory disease report adverse food reactions more frequently than patients allergic to House Dust Mite (8-9). Positive skin-specific IgE to food allergens was shown to be more frequent in children with allergy to grass pollen (59.8%) than in children with allergy to Dermatophagoides (9.4%). A considerably high frequency of positive reactions to Tomato (39.2%), Peanut (22,5%), Green Pea (13.7%), and Wheat (11.7%) was observed in children with allergy to grass pollen (10). Other foods included Garlic, Onion, and fruits such as Peach (8-9). Whether this is due to a panallergen has not yet been clearly established. In inhibition studies with Tomato and extract from Birch pollen, Mugwort pollen, Apple, and Celery, significant inhibitions among all these allergens were found. Epitopes exclusive to grass pollen and Tomato were not detected. Cross-reactivity between Tomato fruit and grass pollen allergens was confirmed by the EAST inhibition assay, the structures responsible being a 16 kDa protein, which was identified as profiling (11).
 
Other studies have reported an association between grass pollinosis and sensitisation to Tomato, Potato, Green Pea, Peanut, Watermelon, Melon, Apple, Orange and Kiwi (12). A high frequency (50%) of food hypersensitivity occurs in patients with allergic rhinoconjunctivitis. Food allergens seen more frequently were shellfish, Tomato, Rice, and Peanut (13). A Polish study reported that 10-20% of children sensitised to grass pollens were also sensitised to Carrot, Celery, Apple, Tomato and nuts (14).
 
Tomato, Potato, and Latex contain a common protein of 44-46 kDa, probably corresponding to the proteins patatins. Patatins are storage proteins found in plants such as Potato and Tomato. This protein could be implicated in the high cross-reactivity between Tomato, Latex, and Potato observed in immunoblot and CAP inhibition studies (15). A 43 kDa Latex allergen, Hev b 7, has been purified from Hevea brasiliensis and shown to be highly homologous to patatins.
 
Latex proteins show strong cross-reactivity with several proteins from fruit and vegetable grains such as Avocado, Potato, Banana, Tomato, Chestnut, and Kiwi (16-18). In a study of food allergy in Latex-allergic individuals, 18.4% (93 out of 505) were positive, and 69.9% of these positives were seen in a group of children with Latex-specific IgE, most frequently to Potato, Tomato, Sweet Pepper, and Avocado (19). In 137 patients with Latex allergy, 49 potential allergic reactions to foods in 29 (21.1%) patients were reported. Foods responsible for these reactions included Tomato in 3 (6.1%) (20). Class I chitinases appear to be the relevant cross-reacting proteins in Latex-fruit allergy in Cherimoya, Passion Fruit, Kiwi, Papaya, Mango, Tomato and Wheat. These allergens are activated by stress to the plant (21).
 
Japanese Cedar (Cryptomeria japonica) pollinosis is one of the most widespread diseases in Japan. Cross-reactivity between Japanese Cedar pollen and Tomato fruit could be demonstrated using RAST and immunoblot inhibition tests. IgE binding to Japanese Cedar pollen in the sera from 4/5 subjects was inhibited by more than 50% by preincubation of the serum with Tomato fruit extracts. Likewise, the IgE bindings to Tomato fruit discs were inhibited more than 50% by Japanese Cedar pollen extracts in 3/5 sera (22).
 
Cha o 2 from Japanese Cypress (Chamaecyparis obtuse) has been shown to share significant identity with polygalacturonases of Avocado, Tomato, and Maize as well as Cry j 2 from Japanese Cedar (Cryptomeria japonica) (23).

Clinical Experience

IgE mediated reactions
Tomato is a common cause of symptoms of food allergy in sensitised individuals (2, 24-27). For instance, the most common allergenic foods in 866 Finnish children aged between 1 and 6 years were citrus fruit, Tomato, Eggs, Strawberry and fish (28). In Mexico, in 1,419 allergic patients aged between 1 year and 18 years, 442 (31%) had positive skin-specific IgE to some 33 tested foods. Fish, milk, seafood, beans, Orange, Onion, Tomato, Chicken, nut, Lettuce and Strawberry were responsible for 58% of the total of allergic reactions (24).
 
Other allergic manifestations to Tomato include urticaria/angioedema, dermatitis, perioral dermatitis, oral allergy syndrome, asthma, rhinitis, and abdominal pain. Tomato pollen may trigger rhinitis and/or conjunctivitis (26, 29). In particular, OAS appears to be a common symptom (26, 30-31).
 
Although Tomatoes are a commonly consumed food, severe allergic reactions to Tomatoes are unusual or rarely reported. A study reports on two patients with significant immediate hypersensitivity reactions to Tomato. Both adults experienced laryngeal oedema and one had anaphylaxis (2).
 
Atopic dermatitis may be precipitated or aggravated by Tomato (32-34) and has been reported to be one of the commonest causes of contact dermatitis of the hands (35). Phytodermatitis as a result of contact with green Tomato has been recorded (36).
 
In 25 patients with recurrent otitis media with effusion and food allergy demonstrated by positive skin testing, the most common foods found to be associated were Milk, Egg, beans, citrus, and Tomato. An elimination diet led to a significant amelioration of the otitis in 22 patients. A subsequent challenge with the suspected offending food provoked a recurrence of the otitis problem (37).
 
Food-dependant exercise-induced anaphylaxis has also been commonly reported (38-44). Tomatoes, cereals and peanuts were said to be the most common foods resulting in food-dependent exercise-induced anaphylaxis (45).
 
Eosinophilic cystitis induced by the ingestion of specific foodstuffs (Tomatoes, Coffee, Carrots) has been reported (46).
 
Specific IgE to Paprika pollen, but not to Tomato pollen, was detected in the sera from 2 greenhouse workers who worked with Paprika plants. A greenhouse worker who cultivated Tomato plants had specific IgE against both Tomato and Paprika pollen. The authors conclude that the presence of IgE against Paprika or Tomato pollen is not restricted to workers in horticulture; IgE against this pollen can also be present in food-allergic patients who have serum IgE against Paprika and/or Tomato fruit (47).
 
Other reactions
In 33 patients with chronic urticaria as a pseudoallergic reaction to food (proved by means of an elimination diet and subsequent re-exposure with provocation meals), oral provocation tests were performed with field-grown Tomatoes. Of the group, 76% reacted to Tomato. The authors tested for salicylates, histamine, and other components, and attribute the reactions to aromatic volatile ingredients in food, which are novel agents that elicit pseudoallergic reactions. Histamine, salicylate, and a direct mast-cell histamine release were not involved in this reactivity to naturally occurring pseudoallergens (48).
 
Auriculotemporal syndrome (or gustatory flushing syndrome), has been reported to masquerader as food allergy (erythema alone), following ingestion of spicy food such as Tomato sauce (49).
 
Occupational asthma in greenhouse Tomato growers may occur as a result of Red Spider Mites, which inhabit the plant (50).
 
Compiled by Dr Harris Steinman, harris@zingsolutions.com

References:

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2004