The presence of aeroallergens in food products: a potential risk for the patient with allergic rhinitis

Open access


Clinical entities of food allergy in allergic rhinitis patients due to IgE-sensitization to cross-reactive aeroallergen and food allergen components are well described, but less data are available regarding allergic reactions to foods containing aeroallergens, either due to food contamination, such as oral mite anaphylaxis, or due to their natural presence in the edible products, such as pollen grains in honey and bee products. There are some potential risks for allergic rhinitis subjects due to ingestion of food products containing domestic mite, insect, fungal and pollen allergens. The knowledge of these risks is useful for the allergists and ENT specialists, especially in the context of climate changes with warmer periods facilitating mite growth in flours, and of increase use of phytotherapy and apitherapy products containing pollen grains.

1. Popescu FD. Cross-reactivity between aeroallergens and food allergens. World J Methodol. 2015;5(2):31-50. DOI: 10.5662/wjm.v5.i2.31. eCollection 2015 Jun 26.

2. Sánchez-Borges M, Suárez Chacón R, Capriles-Hulett A, Caballero-Fonseca F, Fernández-Caldas E. Anaphylaxis from ingestion of mites: pancake anaphylaxis. J Allergy Clin Immunol. 2013;131(1):31-5. DOI: 10.1016/j.jaci.2012.09.026. Epub 2012 Nov 13.

3. Mangodt EA, Van Gasse AL, Bridts CH, Sabato V, Ebo DG. Simultaneous oral mite anaphylaxis (pancake syndrome) in a father and daughter and a review of the literature. J Investig Allergol Clin Immunol. 2015;25(1):75-6.

4. Garcia ME, Sánchez-Borges M, Capriles-Hulett A, Fernandez-Caldas E. Oral mite anaphylaxis mimicking acute asthma. Allergol Immunopathol (Madr). 2016;44(5):484-5. DOI: 10.1016/j.aller.2016.02.005. Epub 2016 May 27.

5. Sánchez-Borges M, Fernandez-Caldas E, Thomas WR, Chapman MD, Lee BW, Caraballo L, et al. International consensus (ICON) on: clinical consequences of mite hypersensitivity, a global problem. World Allergy Organ J. 2017;10(1):14. DOI: 10.1186/s40413-017-0145-4. eCollection 2017.

6. Sánchez-Borges M, Fernández-Caldas E, Capriles-Hulett A, Caballero-Fonseca F. Mite-induced inflammation: More than allergy. Allergy Rhinol (Providence). 2012;3(1):e25-9. DOI: 10.2500/ar.2012.3.0025.

7. Suesirisawad S, Malainual N, Tungtrongchitr A, Chatchatee P, Suratannon N, Ngamphaiboon J. Dust mite infestation in cooking flour: experimental observations and practical recommendations. Asian Pac J Allergy Immunol. 2015;33(2):123-8. DOI: 10.12932/AP0484.33.2.2015.

8. Broekman HCHP, Knulst AC, de Jong G, Gaspari M, den Hartog Jager CF, Houben GF, et al. Is mealworm or shrimp allergy indicative for food allergy to insects? Mol Nutr Food Res. 2017;61(9). DOI: 10.1002/mnfr.201601061. Epub 2017 Jul 18.

9. Broekman HCHP, Knulst AC, den Hartog Jager CF, van Bilsen JHM, Raymakers FML, Kruizinga AG, et al. Primary respiratory and food allergy to mealworm. J Allergy Clin Immunol. 2017;140(2):600-3.e7. DOI: 10.1016/j.jaci.2017.01.035. Epub 2017 Mar 6.

10. Payne CLR, Van Itterbeeck J. Ecosystem services from edible insects in agricultural systems: a review. Insects. 2017;8(1). pii: E24. DOI: 10.3390/insects8010024.

11. Kung SJ, Fenemore B, Potter PC. Anaphylaxis to Mopane worms (Imbrasia belina). Ann Allergy Asthma Immunol. 2011;106(6):538-40. DOI: 10.1016/j.anai.2011.02.003. Epub 2011 Mar 4.

12. Verhoeckx KC, van Broekhoven S, den Hartog-Jager CF, Gaspari M, de Jong GA, Wichers HJ, et al. House dust mite (Der p 10) and crustacean allergic patients may react to food containing Yellow mealworm proteins. Food Chem Toxicol. 2014;65:364-73. DOI: 10.1016/j.fct.2013.12.049. Epub 2014 Jan 9.

13. Mattison CP, Khurana T, Tarver MR, Florane CB, Grimm CC, Pakala SB, et al. Cross-reaction between Formosan termite (Coptotermes formosanus) proteins and cockroach allergens. PLoS One. 2017;12(8):e0182260. DOI: 10.1371/journal.pone.0182260. eCollection 2017.

14. US Food and Drug Administration (FDA). Defect Levels Handbook. The Food Defect Action Levels: Levels of natural or unavoidable defects in foods that present no health hazards for humans. [Internet]. Available from: Revised February 2005.

15. Tettey E, Jonfia-Essien WA, Obeng-Ofori D. The impact of insect infestation on stored purpled cocoa beans. JENRM. 2014;1(3):176-81.

16. Armentia A, Lombardero M, Blanco C, Fernández S, Fernández A, Sánchez-Monge R. Allergic hypersensitivity to the lentil pest Bruchus lentis. Allergy. 2006;61(9):1112-6.

17. Van Huis A, Van Gurp H, Dicke M. The insect cookbook - food for a sustainable planet. New York: Columbia University Press; 2014, p.19.

18. Gawlik R, Pitsch T, Dubuske L. Anaphylaxis as a manifestation of horse allergy. World Allergy Organ J. 2009;2(8):185-9. DOI: 10.1097/WOX.0b013e3181b2fe51.

19. Brito FF, Mur P, Leal JA, Galindo PA, Gómez E, Borja J, et al. Penicillium nalgiovense as an occupational and contact allergen. J Allergy Clin Immunol. 2003;112(1):213-5.

20. Merget R, Sander I, Rozynek P, Heinze E, Imoehl M, Raulf-Heimsoth M, et al. Occupational immunoglobulin E-mediated asthma due to Penicillium camemberti in a dry-sausage packer. Respiration. 2008;76(1):109-11. Epub 2006 Nov 4.

21. Steinman H, Ruden S. Native & recombinant allergen components: Allergy - Which allergens? Allergy Resources International: Phadia AB; 2008, p.5-201.

22. Katona SJ, Kaminski ER. Sensitivity to Quorn mycoprotein (Fusarium venenatum) in a mould allergic patient. J Clin Pathol. 2002;55(11):876-7.

23. Hoff M, Ballmer-Weber BK, Niggemann B, Cistero-Bahima A, San Miguel-Moncín M, Conti A, et al. Molecular cloning and immunological characterization of potential allergens from the mould Fusarium culmorum. Mol Immunol. 2003;39(15):965-975.

24. Hoff M, Trüeb RM, Ballmer-Weber BK, Vieths S, Wuethrich B. Immediate-type hypersensitivity reaction to ingestion of mycoprotein (Quorn) in a patient allergic to molds caused by acidic ribosomal protein P2. J Allergy Clin Immunol. 2003;111(5):1106-10.

25. Bennett AT, Collins KA. An unusual case of anaphylaxis. Mold in pancake mix. Am J Forensic Med Pathol. 2001;22(3):292-5.

26. Greenberger PA, Flais MJ. Bee pollen-induced anaphylactic reaction in an unknowingly sensitized subject. Ann Allergy Asthma Immunol. 2001;86(2):239-42.

27. Choi JH, Jang YS, Oh JW, Kim CH, Hyun IG. Bee pollen-induced anaphylaxis: a case report and literature review. Allergy Asthma Immunol Res. 2015;7(5):513-7. DOI: 10.4168/aair.2015.7.5.513.

28. Lombardi C, Senna GE, Gatti B, Feligioni M, Riva G, Bonadonna P, et al. Allergic reactions to honey and royal jelly and their relationship with sensitization to compositae. Allergol Immunopathol (Madr). 1998;26(6):288-90.

29. Fuiano N, Incorvaia C, Riario-Sforza GG, Casino G. Anaphylaxis to honey in pollinosis to mugwort: a case report. Eur Ann Allergy Clin Immunol. 2006;38(10):364-5.

30. Paola F, Pantalea DD, Gianfranco C, Antonio F, Angelo V, Eustachio N, et al. Oral allergy syndrome in a child provoked by royal jelly. Case Rep Med. 2014;2014:941248. DOI: 10.1155/2014/941248.

31. Atanassova J, Bozilova E, Todorova S. Pollen analysis of honey from the region of three villages in West Bulgaria. Phytologia Balcanica (Sofia). 2004;10(2-3):247-52.

32. Atanassova J, Yurukova L, Lazarova M. Pollen and inorganic characteristics of Bulgarian unifloral honeys. Czech J Food Sci. 2012;30(6):520-6.

33. Saarinen K, Jantunen J, Haahtela T. Birch pollen honey for birch pollen allergy - a randomized controlled pilot study. Int Arch Allergy Immunol. 2011;155(2):160-6. DOI: 10.1159/000319821. Epub 2010 Dec 23.

34. Reider N, Sepp N, Fritsch P, Weinlich G, Jensen-Jarolim E. Anaphylaxis to camomile: clinical features and allergen cross-reactivity. Clin Exp Allergy. 2000;30(10):1436-43.

35. de la Torre Morín F, Sánchez Machín I, García Robaina JC, Fernández-Caldas E, Sánchez Triviño M. Clinical cross-reactivity between Artemisia vulgaris and Matricaria chamomilla (chamomile). J Investig Allergol Clin Immunol. 2001;11(2):118-22.

36. Egger M, Mutschlechner S, Wopfner N, Gadermaier G, Briza P, Ferreira F. Pollen-food syndromes associated with weed pollinosis: an update from the molecular point of view. Allergy. 2006;61(4):461–76.

37. Andres C, Chen WC, Ollert M, Mempel M, Darsow U, Ring J. Anaphylactic reaction to camomile tea. Allergol Int. 2009;58(1):135-6. DOI: 10.2332/allergolint.C-08-63. Epub 2008 Dec 1.

38. Melioli G, Spenser C, Reggiardo G, Passalacqua G, Compalati E, Rogkakou A, et al. Allergenius, an expert system for the interpretation of allergen microarray results. World Allergy Organ J. 2014;7(1):15. DOI: 10.1186/1939-4551-7-15.

39. Don’t take echinacea if you’re allergic to ragweed. Consum Rep. 2012;77(2):12.

40. Gol’dman II. Anaphylactic shock after gargling with an infusion of Calendula. Klin Med (Mosk). 1974;52(4):142-3.

41. Arora D, Rani A, Sharma A. A review on phytochemistry and ethnopharmacological aspects of genus Calendula. Pharmacogn Rev. 2013;7(14):179-87. DOI: 10.4103/0973-7847.120520.

42. Anzai A, Vázquez Herrera NE, Tosti A. Airborne allergic contact dermatitis caused by chamomile tea. Contact Dermatitis. 2015;72(4):254-5. DOI: 10.1111/cod.12353. Epub 2015 Jan 27.

43. Paulsen E. Systemic allergic dermatitis caused by sesquiterpene lactones. Contact Dermatitis. 2017;76(1):1-10. DOI: 10.1111/cod.12671. Epub 2016 Aug 29.

44. Palma-Carlos AG, Palma-Carlos ML, Tengarrinha F. Allergy to sunflower seeds. Eur Ann Allergy Clin Immunol. 2005;37(5):183-6.

45. Gruber P, Gadermaier G, Bauer R, Weiss R, Wagner S, Leonard R, et al. Role of the polypeptide backbone and post-translational modifications in cross-reactivity of Art v 1, the major mugwort pollen allergen. Biol Chem. 2009;390(5-6):445-51. DOI: 10.1515/BC.2009.063.

46. Berecz B, Clare Mills EN, Parádi I, Láng F, Tamás L, Shewry PR, et al. Stability of sunflower 2S albumins and LTP to physiologically relevant in vitro gastrointestinal digestion. Food Chem. 2013;138(4): 2374-81. DOI: 10.1016/j.foodchem.2012.12.034. Epub 2012 Dec 31.

47. Ukleja-Sokołowska N, Gawrońska-Ukleja E, Żbikowska-Gotz M, Bartuzi Z, Sokołowski Ł. Sunflower seed allergy. Int J Immunopathol Pharmacol. 2016;29(3):498-503. DOI: 10.1177/0394632016651648. Epub 2016 May 24.

48. Freeman GL. Oral corn pollen hypersensitivity in Arizona Native Americans: some sociologic aspects of allergy practice. Ann Allergy. 1994;72:415–7.

49. Popescu FD, Vieru M. Molecular allergology approach in a patient with corn silk (Stigma maydis) infusion and pollen allergy. Allergy. 2014;69(Suppl 99):462.

50. Popescu FD, Vieru M. Pooideae molecular sensitization profile in selected rhinitis patients with allergy to grass pollen and maize-derived edible products. Clin Transl Allergy. 2015;5(Suppl 4):P21.

51. Cohen SH, Yunginger JW, Rosenberg N, Fink JN. Acute allergic reaction after composite pollen ingestion. J Allergy Clin Immunol. 1979;64(4):270-4.

52. Geyman JP. Anaphylactic reaction after ingestion of bee pollen. J Am Board Fam Pract. 1994;7(3):250-2.

53. Martín-Muñoz MF, Bartolome B, Caminoa M, Bobolea I, Ara MC, Quirce S. Bee pollen: a dangerous food for allergic children. Identification of responsible allergens. Allergol Immunopathol (Madr). 2010;38(5):263-5. DOI: 10.1016/j.aller.2009.12.003. Epub 2010 May 5.

54. Pitsios C, Chliva C, Mikos N, Kompoti E, Nowak-Wegrzyn A, Kontou-Fili K. Bee pollen sensitivity in airborne pollen allergic individuals. Ann Allergy Asthma Immunol. 2006;97(5):703-6.

55. Jagdis A, Sussman G. Anaphylaxis from bee pollen supplement. CMAJ. 2012;184(10):1167-9. DOI: 10.1503/cmaj.112181.

56. Puente S, Iñíguez A, Subirats M, Alonso MJ, Polo F, Moneo I. Eosinophilic gastroenteritis caused by bee pollen sensitization. Med Clin (Barc). 1997;108(18):698-700.

57. Güç BU, Asilsoy S, Canan O, Kayaselçuk F. Does bee pollen cause to eosinophilic gastroenteropathy? Turk Pediatri Ars. 2015;50(3):189-192. DOI: 10.5152/TurkPediatriArs.2015.1105.

58. Palanisamy A, Haller C, Olson KR. Photosensitivity reaction in a woman using an herbal supplement containing ginseng, goldenseal, and bee pollen. J Toxicol Clin Toxicol. 2003;41(6):865-7.

59. Akiyasu T, Paudyal B, Paudyal P, Kumiko M, Kazue U, Takuji N, et al. A case report of acute renal failure associated with bee pollen contained in nutritional supplements. Ther Apher Dial. 2010;14(1):93-7. DOI: 10.1111/j.1744-9987.2009.00707.x.

60. Boppré M, Colegate SM, Edgar JA, Fischer OW. Hepatotoxic pyrrolizidine alkaloids in pollen and drying-related implications for commercial processing of bee pollen. J Agric Food Chem. 2008;56(14):5662-72. DOI: 10.1021/jf800568u. Epub 2008 Jun 14.

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 325 319 70
PDF Downloads 131 131 29