http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482820/
CROSS-REACTIVITY BETWEEN AEROALLERGENS OF FUNGAL ORIGIN AND FOOD ALLERGENS
Respiratory allergy to environmental molds is relatively common, fungi representing a prominent source of aeroallergens[90]. Alternaria alternata is one of the most common molds associated with allergic diseases, and 80% of Alternaria-sensitive patients produce IgE antibodies to Alt a 1, a major allergen with an unique, dimeric beta-barrel structure. Alt a 1 and homologous proteins are characteristic for the Dothideomycetes class of ascomycetes[91].
The Alternaria-spinach syndrome, in which Alt a 1 is mentioned as an involved allergen component (Table (Table3),3), was recently recognized[11]. This cross-reactivity between aeroallergens from fungi imperfecti and allergens from spinach and mushroom Agaricus bisporus as foods is mentioned. In the first report of anaphylaxis to spinach and concomitant oral allergy syndrome to mushrooms, cross-reactivity was suggested to be due to common epitopes[92]. A further study identified the cross-reactive 30 kDa protein, probably the Alt a 1 allergen component, present both in spinach and mushroom extracts[93]. This syndrome is different from another possible association between IgE sensitization to mannitol, naturally present in cultivated mushrooms and pomegranate, and anaphylaxis to this sugar alcohol as a drug excipient[94].
Table 3
].Examples of syndromes due to cross-reactivity between aeroallergens of animal and fungal origin and food allergens[9,11]
In addition, non-fatal anaphylaxis was reported after mycoprotein burger eating, in a young female patient with respiratory IgE-allergy to Alternaria alternata, the edible mycoprotein being produced from the fungus Fusarium venenatum. Cross-reactivity studies revealed that it shares allergenic determinants with Alternaria alternata and Cladosporium herbarum[95]. Sensitization to mold allergens via the respiratory tract and subsequent oral ingestion of cross-reactive fungal proteins may lead to severe food-allergic reactions, such as those caused by Fusarium venenatum acidic ribosomal protein P2 allergen[96]. An unusual case of fatal anaphylaxis was also reported due to heavy mold contamination of a pancake mix with Fusarium, Penicillium, Mucor, and Aspergillus spp, in a teenager allergic to molds[97]. It is also possible that bee products, such as bee pollen supplements, to be contaminated with fungi such as Aspergillus and Cladosporium spp, and may cause severe allergic reactions in patients sensitized to these molds[81
Moreover, yeasts should be considered as possible ingestive allergens in mold-allergic patients. A patient with a clustered respiratory IgE sensitization to fungi (Alternaria alternata, Cladosporium herbarum, Aspergillus fumigatus, and Penicillium notatum) and baker’s yeast (Saccharomyces cerevisiae), developed multiple anaphylactic reactions after ingesting pasta yeast sauces containing cross-reacting fungal allergens[98].
CROSS-REACTIVITY BETWEEN AEROALLERGENS OF FUNGAL ORIGIN AND FOOD ALLERGENS
Respiratory allergy to environmental molds is relatively common, fungi representing a prominent source of aeroallergens[90]. Alternaria alternata is one of the most common molds associated with allergic diseases, and 80% of Alternaria-sensitive patients produce IgE antibodies to Alt a 1, a major allergen with an unique, dimeric beta-barrel structure. Alt a 1 and homologous proteins are characteristic for the Dothideomycetes class of ascomycetes[91].
The Alternaria-spinach syndrome, in which Alt a 1 is mentioned as an involved allergen component (Table (Table3),3), was recently recognized[11]. This cross-reactivity between aeroallergens from fungi imperfecti and allergens from spinach and mushroom Agaricus bisporus as foods is mentioned. In the first report of anaphylaxis to spinach and concomitant oral allergy syndrome to mushrooms, cross-reactivity was suggested to be due to common epitopes[92]. A further study identified the cross-reactive 30 kDa protein, probably the Alt a 1 allergen component, present both in spinach and mushroom extracts[93]. This syndrome is different from another possible association between IgE sensitization to mannitol, naturally present in cultivated mushrooms and pomegranate, and anaphylaxis to this sugar alcohol as a drug excipient[94].
Table 3
].Examples of syndromes due to cross-reactivity between aeroallergens of animal and fungal origin and food allergens[9,11]
In addition, non-fatal anaphylaxis was reported after mycoprotein burger eating, in a young female patient with respiratory IgE-allergy to Alternaria alternata, the edible mycoprotein being produced from the fungus Fusarium venenatum. Cross-reactivity studies revealed that it shares allergenic determinants with Alternaria alternata and Cladosporium herbarum[95]. Sensitization to mold allergens via the respiratory tract and subsequent oral ingestion of cross-reactive fungal proteins may lead to severe food-allergic reactions, such as those caused by Fusarium venenatum acidic ribosomal protein P2 allergen[96]. An unusual case of fatal anaphylaxis was also reported due to heavy mold contamination of a pancake mix with Fusarium, Penicillium, Mucor, and Aspergillus spp, in a teenager allergic to molds[97]. It is also possible that bee products, such as bee pollen supplements, to be contaminated with fungi such as Aspergillus and Cladosporium spp, and may cause severe allergic reactions in patients sensitized to these molds[81
Moreover, yeasts should be considered as possible ingestive allergens in mold-allergic patients. A patient with a clustered respiratory IgE sensitization to fungi (Alternaria alternata, Cladosporium herbarum, Aspergillus fumigatus, and Penicillium notatum) and baker’s yeast (Saccharomyces cerevisiae), developed multiple anaphylactic reactions after ingesting pasta yeast sauces containing cross-reacting fungal allergens[98].
