Peach
Summary
Peach (Prunus persica) is the fruit of the Prunus trees, belonging to the Rosaceae family and is among the most desired fruits consumed worldwide. Peach-sensitive patients may suffer from allergic reactions such as oral allergy syndrome (OAS) symptoms, urticaria and in worst cases anaphylaxis. Individuals with Pru p 1 sensitization show milder symptoms than those sensitized to Pru p 3 and Pru p 7. Since Pru p 1 is heat-labile, those affected with an allergy to raw peach can instead consume pasteurized forms of peach. However, this cannot be followed for individuals sensitized to Pru p 3 a lipid transfer protein (LTP), which is heat stable. Cross-reactivity has been reported between Pru p 1 and birch pollen, Pru p 2 and plane pollen, Pru p 3 and various fruits of the Rosaceae family such as cherry and plum, and Pru p 7 with apricot, orange, and pomegranate. Pru p 7 is a marker for severe fruit-induced allergy and may be the link between severe allergic reaction to fruits and cypress pollen.
Epidemiology
Worldwide distribution
Two European based large surveys revealed the overall sensitization for fruits in Europe. In one survey, highest (13.4%) and lowest (2.3%) weighted prevalence of peach was reported in Zurich (Switzerland) and in Reykjavik (Iceland) respectively.In the other, the highest (11.7%) and lowest (0.3%) prevalence of sensitization to peach was in Germany and Iceland, respectively. Overall, the prevalence of sensitization to peaches increased from 5.4% (2010) to 7.9% (2014). Sensitization to peach is common in Western Europe, the USA, and Australia.
Ando et al. (2020) conducted a study using Japanese children and adolescents and suggested that individuals sensitized to Pru p 1 and Pru p 4 are likely to develop oral allergy symptoms. In contrast, those sensitized to Pru p 7 show severe systemic reactions such as anaphylaxis in the presence of factors like exercise.
Route Of Exposure
Main
Peach allergy occurs mainly through ingestion.
Clinical Relevance
Allergic reactions to peach sensitization may include symptoms of oral allergy syndrome (OAS) such as oropharyngeal symptoms (oral itching, swelling), anaphylaxis, systemic symptoms (gastrointestinal involvement - nausea, vomiting, and diarrhea, swelling, and sometimes severe asthma).
Oral allergy symptoms and Anaphylaxis
A cross-sectional study evaluated 127 OAS patients diagnosed using a skin prick test or a serum IgE test. Only 56 patients responded to the questionnaire regarding the allergy-causing foods and their associated symptoms (OAS or allergic rhino conjunctivitis (ARC)). Patients with OAS symptoms experienced itchiness and swelling in the oral mucosa, lips, and throat, systemic skin symptoms, respiratory symptoms, gastrointestinal symptoms, and shock (collapse). ARC patients complained of rhinorrhea, nasal congestion, sneezing, and eye itching. Forty-three of 56 patients (14 in the subcutaneous immunotherapy (SCIT) group and 29 in non-SCIT group) selected peach as the causative agent for OAS.
A retrospective chart review study conducted on 1,427 patients showed that peach was one of the frequent contributors (56%) for OAS manifestation. 96.2% of 26 patients developed OAS as a symptom of food allergy. Patients with OAS symptoms exhibited reactions such as itchiness or swelling of the mouth, face, lip, tongue, and throat. Of 25 patients with OAS, 72% had rhino conjunctivitis (n=18), 20% had asthma (n=5), 12% chronic urticaria (n=3), 12% anaphylaxis (n=3), 4% atopic dermatitis (AD), (n=1).
Anaphylaxis
One case reported a 62-year-old woman having an episode of anaphylaxis while eating a peach. She experienced nausea, vomiting, itchiness of the mouth, face and hands, facial edema, and dizziness. Though she did not complain of hives, but had redness on her hands, feet and face.
Another case study reported a 25-year-old woman developing an anaphylactic reaction upon moderate physical exertion after consuming peach. Additionally, massive facial swelling (particularly on the eyelids) and labored breathing, due to swelling of the lower throat was observed.
In a prospective cross-sectional study, oral food challenge (OFC) using peach pulp were done in all patients, except one, as he had cardiopathy and developed anaphylaxis after consuming peach on two different occasions. Children presented allergic reactions such as mucocutaneous symptoms (angioedema, urticaria, OAS, conjunctivitis), vomiting, and respiratory symptoms (cough, bronchospasm, rhinitis, etc.).
Asthma
A study evaluated the allergic response to various inhalant allergens in 37 peach crop workers diagnosed with seasonal occupational ARC and asthma. This study showed that all patients had varying severity of ARC symptoms, and most reported (33/37) persistent rhino conjunctivitis. Six patients with both ARC and asthma underwent a specific bronchial challenge test with peach leaf extract. Four of these patients were sensitized to leaf extract. Two patients reported a decrease in decline in lung function. Twenty-five (67.5% of 37) patients reported asthma, of which 12 suffered from severe asthma.
Other diseases
A double-blind placebo-controlled food challenges (DBPCFCs) was conducted with peach and apple in 289 patients. In the DBPCFC group with peach-allergic patients, 92.9% had OAS (66/71), 19.7% abdominal pain (14/71), 7% vomiting (5/71), 1 patient complained of diarrhea, 14% showed skin pruritis (10/71), 9.8% had urticaria (7/71), 14% with rhino conjunctivitis (10/71), and 4.2% complained of cough (3/71).
Prevention And Therapy
Allergen immunotherapy
Gonzalez Perez et al. (2020) demonstrated tolerance in patients with LTP syndrome along with symptom burden using a sublingual Pru p 3 extract. These patients reported better quality of life after treatment.
Prevention strategies
The peach allergenic components differ from each other in their nature. Peach allergic patients with Pru p 1 sensitization can tolerate peach in the form of pasteurized juices and jams. This is because Pru p 1 is a member of PR-10 proteins family, which is heat labile and tend to lose its allergenicity upon heat treatment.
However, since LTPs are resistant to high temperature and pH changes, consumption of pasteurized peach product is ineffective in patients suffering from peach allergy due to Pru p 3 sensitization.
Avoidance
Patients sensitive to peach must try to avoid ingestion of the fruit and its product and/or permanently eliminate it from diet to prevent peach allergy.
Cross-Reactivity
Similar to clinical symptoms, cross-reactivity prevalence patterns seen with peach allergy are geographically influenced. For example, cross-sensitization with Pru p 1 is higher in countries with high pollen exposure of the birch trees (Central and Northern Europe).
Pru p 1
A study in Northern Europe showed that 19 of 30 patients sensitized to birch pollen (Bet v 1) reported cross-reactivity to peach via PR-10 proteins.
Pru p 2
Testing sera from 329 allergic patients showed that Pru p 2 tends to cross-react with chestnut and plane pollen.
Pru p 4
Sankian et al. (2005) revealed in their study that peach and melon profilins could cross-react.
Pru p 3
Peaches often cross-react with other members of the Rosaceae family such as cherry, plum, almond, apricot, due to non-specific LTPs.
Pru p 3 IgE antibodies can also cross-react with fruits from unrelated families like citrus fruits, grapes. It can also react with nuts such as walnut, hazelnut. Pru p 3 cross-reactivity with vegetables such as asparagus, lettuce, tomato, maize, onion, and carrot may also be seen.
Co-sensitization of Pru p 3 with either Pru p 1 or Pru p 4 may lower the risk of severe systemic reactions in peach allergic individuals.
Pru p 7
Pru p 7 in peach often cross-reacts with proteins from several fruits of the Rosaceae (Japanese apricots, pomegranate) and Rutaceae (orange) families. IgE-mediated cross-reactivity is seen between the fruit GRPs Pru p 7, Pru m 7 (Japanese apricot), Cit s 7 (orange) and Pun g 7 (pomegranate).
A study showed that high IgE-mediated cross-reactivity exists between Pru p 7 and the GRP BP14 allergens, present in the Cupressaceae family's pollens. Klingebiel et al. (2019) identified that sensitization to Pru p 7 is related with sensitization to cypress pollen in peach allergic patients. Cypress pollen acts as the primary sensitizer in Pru p 7 induced peach allergy.
References
- Zhao X, Zhang W, Yin X, Su M, Sun C, Li X, et al. Phenolic composition and antioxidant properties of different peach [Prunus persica (L.) Batsch] cultivars in China. Int J Mol Sci. 2015;16(3):5762-78.
- Kant R, Shukla KR, Shukla A. A Review on Peach (Prunus persica): An Asset of Medicinal Phytochemicals. International Journal for Research in Applied Science and Engineering Technology. 2018;6(1):2186-200.
- Haleema R, Shenoy A, Shabraya AR. A Review on Pharmacological Activities of Prunus persica. Int J Pharm Sci Rev Res 2020;60(2).
- Giesberger G. GROWING DECIDUOUS FRUIT TREES IN THE TROPICS - A NEW APPROACH TO AN OLD PROBLEM. Acta Horticulturae. 1975(49):109-12.
- CABI. Prunus persica (Peach) 2019 [27-Nov-2020]. Available from: https://www.cabi.org/isc/datasheet/44340.
- Carnes J, Fernandez-Caldas E, Gallego MT, Ferrer A, Cuesta-Herranz J. Pru p 3 (LTP) content in peach extracts. Allergy. 2002;57(11):1071-5.
- Asero R, Mistrello G, Amato S, Roncarolo D, Martinelli A, Zaccarini M. Peach fuzz contains large amounts of lipid transfer protein: is this the cause of the high prevalence of sensitization to LTP in Mediterranean countries? Eur Ann Allergy Clin Immunol. 2006;38(4):118-21.
- Perez-Calderon R, Gonzalo-Garijo MA, Rodriguez-Velasco FJ, Sanchez-Vega S, Bartolome-Zavala B. Occupational respiratory allergy in peach crop workers. Allergy. 2017;72(10):1556-64.
- Tuppo LA, C. , Pomponi D, Picone D, Tamburrini M, Ferrara R, Petriccione M, et al. Peamaclein--a new peach allergenic protein: similarities, differences and misleading features compared to Pru p 3. Clin Exp Allergy. 2013;43(1):128-40.
- Ballmer-Weber B, Hoffmann-Sommergruber K. B15. ALLERGY TO FRUITS AND VEGETABLES. In: Matricardi P. M. K-TJ, Hoffmann H. J., et al., editor. MOLECULAR ALLERGOLOGY USER'S GUIDE. Switerland: EAACI; 2016.
- Burney PGJ, Potts J, Kummeling I, Mills ENC, Clausen M, Dubakiene R, et al. The prevalence and distribution of food sensitization in European adults. Allergy. 2014;69(3):365-71.
- Burney P, Summers C, Chinn S, Hooper R, van Ree R, Lidholm J. Prevalence and distribution of sensitization to foods in the European Community Respiratory Health Survey: a EuroPrevall analysis. Allergy. 2010;65(9):1182-8.
- Ando Y, Miyamoto M, Kato M, Nakayama M, Fukuda H, Yoshihara S. Pru p 7 Predicts Severe Reactions after Ingestion of Peach in Japanese Children and Adolescents. Int Arch Allergy Immunol. 2020;181(3):183-90.
- van Ree R, Aalberse CR. A02. ALLERGENS AND THE ALLERGENIC COMPOSITION OF SOURCE MATERIALS. In: Matricardi P. M. K-TJ, Hoffmann H. J., et al., editor. Molecular Allergology User's Guide. Switzerland: The European Academy of Allergy and Clinical Immunology (EAACI); 2016. p. 11-20.
- Kleine-Tebbe J, Ballmer-Weber B, Brieteneder H, Vieths S. Bet v 1 and its homologs: Triggers of Tree-Pollen Allergy and Birch Pollen-Associated Cross-Reactions. In: Kleine-Tebbe J, Jakob T, editors. Molecular Allergy Diagnostics Innovation for a Better Patient Management: Springer; 2017. p. 21-43.
- van Ree R, Aalberse CR. ALLERGENS AND THE ALLERGENIC COMPOSITION OF SOURCE MATERIALS. In: Matricardi P. M. K-TJ, Hoffmann H. J., et al., editor. Molecular Allergology User's Guide. Switzerland: The European Academy of Allergy and Clinical Immunology (EAACI); 2016. p. 11-20.
- Faber MA, Van Gasse AL, Decuyper II, Uyttebroek A, Sabato V, Hagendorens MM, et al. IgE-reactivity profiles to nonspecific lipid transfer proteins in a northwestern European country. J Allergy Clin Immunol. 2017;139(2):679-82 e5.
- Mothes-Luksch N, Raith M, Stingl G, Focke-Tejkl M, Razzazi-Fazeli E, Zieglmayer R, et al. Pru p 3, a marker allergen for lipid transfer protein sensitization also in Central Europe. Allergy. 2017;72(9):1415-8.
- Fernandez-Rivas M. Fruit and vegetable allergy. Chem Immunol Allergy. 2015;101:162-70.
- Breiteneder H, Kleine-Tebbe J. PR-10-LIKE ALLERGENS. In: Matricardi P. M. K-TJ, Hoffmann H. J., et al., editor. Molecular Allergology User's Guide. Switzerland: The European Academy of Allergy and Clinical Immunology (EAACI); 2016. p. 299-310.
- Kong N, Kim S, Lee SC, Park KH, Lee JH, Park JW. Subcutaneous Immunotherapy in Patients with Fagales Pollen-Induced Oral Allergy Syndrome. Yonsei Med J. 2019;60(4):389-94.
- Kim JH, Kim SH, Park HW, Cho SH, Chang YS. Oral Allergy Syndrome in Birch Pollen-Sensitized Patients from a Korean University Hospital. J Korean Med Sci. 2018;33(33):e218.
- Lenchner KI, Ditto AM. A 62-year-old woman with 3 episodes of anaphylaxis. Annals of Allergy, Asthma & Immunology. 2005;95(1):14-8.
- Ukleja-Sokolowska N, Zacniewski R, Gawronska-Ukleja E, Żbikowska-Gotz M, Lis K, Sokołowski L, et al. Food-dependent, exercise-induced anaphylaxis in a patient allergic to peach. Int J Immunopathol Pharmacol. 2018;32:2058738418803154.
- Boyano-Martinez T, Pedrosa M, Belver T, Quirce S, Garcia-Ara C. Peach allergy in Spanish children: tolerance to the pulp and molecular sensitization profile. Pediatr Allergy Immunol. 2013;24(2):168-72.
- Gonzalez-Mancebo E, Fernandez-Rivas M. Outcome and safety of double-blind, placebo-controlled food challenges in 111 patients sensitized to lipid transfer proteins. J Allergy Clin Immunol. 2008;121(6):1507-8.
- Gonzalez -Perez A. CMA, Escudero Pastor A. I. ea. Pru p 3 oral immunotherapy efficacy, induced immunological changes and quality of life improvement in patients with LTP syndrome. Clin Transl Allergy. 2020;10:20.
- Gaier S, Marsh J, Oberhuber C, Rigby NM, Lovegrove A, Alessandri S, et al. Purification and structural stability of the peach allergens Pru p 1 and Pru p 3. Mol Nutr Food Res. 2008;52 Suppl 2:S220-9.
- WHO/IUIS. International Union of Immunological Societies Allergen Nomenclature 2019 [27-Nov-2020]. Available from: http://www.allergen.org/search.php?allergensource=Prunus+persica
- van Rhijn BD, van Ree R, Versteeg SA, Vlieg-Boerstra BJ, Sprikkelman AB, Terreehorst I, et al. Birch pollen sensitization with cross-reactivity to food allergens predominates in adults with eosinophilic esophagitis. Allergy. 2013;68(11):1475-81.
- Palacin A, Rivas LA, Gomez-Casado C, Aguirre J, Tordesillas L, Bartra J, et al. The involvement of thaumatin-like proteins in plant food cross-reactivity: a multicenter study using a specific protein microarray. PLoS One. 2012;7(9):e44088.
- González-Mancebo E, Gonzalez-de-Olano D, Trujillo M, Santos S, Gandolfo-Cano M, Melendez A, et al. Prevalence of Sensitization to Lipid Transfer Proteins and Profi lins in a Population of 430 Patients in the South of Madrid. J Investig Allergol Clin Immunol. 2011;21(4).
- Klingebiel C, Chantran Y, Arif-Lusson R, Ehrenberg AE, Ostling J, Poisson A, et al. Pru p 7 sensitization is a predominant cause of severe, cypress pollen-associated peach allergy. Clin Exp Allergy. 2019;49(4):526-36.
- Victorio Puche L, Somoza ML, Lopez-Sanchez JD, Garrido-Arandia M, Diaz-Perales A, Blanca M. Peach Tree Pollen and Prunus persica 9 Sensitisation and Allergy in Children and Adolescents. Int Arch Allergy Immunol. 2019;180(3):212-20.
- Victorio Puche L, López-Sánchez Db-L, N, Somoza-Alvarez ML, Diaz HE, Diaz-perales A, Canto GMB, M. Peach pollen sensitisation is highly prevalent in areas of great extension of peach tree cultivar. Journal of Allergy and Clinical Immunology. 2017;141(2).
- Inomata N, Miyakawa M, Aihara M. High prevalence of sensitization to gibberellin-regulated protein (peamaclein) in fruit allergies with negative immunoglobulin E reactivity to Bet v 1 homologs and profilin: Clinical pattern, causative fruits and cofactor effect of gibberellin-regulated protein allergy. J Dermatol. 2017;44(7):735-41.
- Carlson G, Coop C. Pollen food allergy syndrome (PFAS): A review of current available literature. Ann Allergy Asthma Immunol. 2019;123(4):359-65.
- Pastorello E, Barber D. NON-SPECIFIC LIPID TRANSFER PROTEINS (nsLTPs). In: Matricardi P. M. K-TJ, Hoffmann H. J., et al., editor. Molecular Allergology User's Guide. Switzerland: The European Academy of Allergy and Clinical Immunology (EAACI); 2016. p. 311-20.
- Ehrenberg AE, Klingebiel C, Ostling J, Larsson H, Mattsson L, Vitte J, et al. Characterization of a 7 kDa pollen allergen belonging to the gibberellin-regulated protein family from three Cupressaceae species. Clin Exp Allergy. 2020.
- Sankian M, Varasteh A, Pazouki N, Mahmoudi M. Sequence homology: a poor predictive value for profilins cross-reactivity. Clin Mol Allergy. 2005;3:13.
- Rodriguez J, Crespo JF, Lopez-Rubio A, De La Cruz-Bertolo J, Ferrando-Vivas P, Vives R, et al. Clinical cross-reactivity among foods of the Rosaceae family. J Allergy Clin Immunol. 2000;106(1 Pt 1):183-9.
- Lavilla M, Orcajo J, Díaz-Perales A, Gamboa P. Examining the effect of High Pressure Processing on the allergenic potential of the major allergen in peach (Pru p 3). Innovative Food Science & Emerging Technologies. 2016;38:334-41.
- Salcedo G, Sanchez-Monge R, Barber D, Diaz-Perales A. Plant non-specific lipid transfer proteins: an interface between plant defence and human allergy. Biochim Biophys Acta. 2007;1771(6):781-91.
- Inomata N, Miyakawa M, Aihara M. Gibberellin-regulated protein in Japanese apricot is an allergen cross-reactive to Pru p 7. Immun Inflamm Dis. 2017;5:469-79.
- Inomata N, Miyakawa M, Ikeda N, Oda K, Aihara M. Identification of gibberellin-regulated protein as a new allergen in orange allergy. Clin Exp Allergy. 2018;48(11):1509-20.
- Tuppo L, Alessandri C, Pasquariello MS, Petriccione M, Giangrieco I, Tamburrini M, et al. Pomegranate Cultivars: Identification of the New IgE-Binding Protein Pommaclein and Analysis of Antioxidant Variability. J Agric Food Chem. 2017;65(13):2702-10.
- Senechal H, Santrucek J, Melcova M, Svoboda P, Zidkova J, Charpin D, et al. A new allergen family involved in pollen food-associated syndrome: Snakin/gibberellin-regulated proteins. J Allergy Clin Immunol. 2017;141(1):411-4 e4.