Inhalative occupational and ingestive immediate‐type allergy caused by chicory (Cichorium intybus)

Abstract

We report a first case of occupational allergy to chicory (Cichorium intybus) in a vegetable wholesaler. Symptoms occurred after oral, cutaneous or inhalatory exposure. The patient also reported reactions after ingestion of botanically related endive (Cichorium endivia) and lettuce (Lactuca sativa). We identified the responsible allergen by SDS-PAGE and immunoblot to be a 48-kDa protein, confined to the non-illuminated parts of the plants. No cross-reactivity was found with mugwort (Artemisia vulgaris), ryegrass (Lolium perenne), and birch (Betula verrucosa) pollen, which suggests that the vegetable is the primary allergenic material.

Lettuce anaphylaxis: identification of a lipid transfer protein as the major allergen

“…Previous cases of systemic reactions after lettuce ingestion have been reported (17, 24–28). In these studies, the IgE binding components of lettuce extracts were investigated, and all the IgE binding protein bands found had molecular weights ranging from 14 to 100 kDa, but no 9 kDa proteins have been described as lettuce allergens so far (17, 24, 27, 28).…”

“…It has been identified mainly as a cause of occupational contact dermatitis (18–23). In last years, very few case reports of systemic reactions after its ingestion have been published (17, 24–28). Only in some of these reports the IgE binding components of lettuce extracts have been investigated showing IgE binding protein bands between 14 and 100 kDa (17, 24, 27, 28).…”

Study of a case of hypersensitivity to lettuce (Lactuca sativa)

“…Crossreactivity of lettuce sensitivity has been assayed with respect to related foods and pollens from the same Asteraceae or Compositae family, like chicory [ 3], mugwort [ 4] and ragweed [ 1]. There has also been evidence of the presence of common allergens with respect to a more distant vegetable food like carrot [ 1, 2].…”

“…[ 1], and it is possible that the 50 kDa allergen observed in the present case could be coincident with the one reported by Cadot et al . [ 3] as a crossreactive allergen (48 kDa) between lettuce and chicory ( Cichorium intybus ). However, the comparison of our data with the mentioned ones is only tentative if we take into consideration three differences between both studies: (i) the type of lettuce was iceberg in Hebling's study and loose leaf in ours; (ii) they used sera from ragweed pollen allergic patients, and (iii) they applied an isotopic developing to the western blot (instead of a chemiluminiscence one) which gives rise to a more amplified signal but less defined bands, avoiding the accurate definition of overlapping bands.…”

Lettuce allergy

“…It is known to provoke allergic contact dermatitis ( 1), which is sometimes made worse by ingestion ( 2). IgE‐dependent allergy is less frequent and has more recently been reported among workers handling lettuce, but also among other people sensitized to various pollens ( 3–5). We report the case of a man presenting with a digestive and respiratory form of food allergy to lettuce confirmed by oral challenge test and identification of specific IgE to a 40‐kDa protein.…”