Arizona cypress pollen
Summary
Arizona cypress, indigenous to North America, has been extensively planted in the Mediterranean area, the Middle East, and Australia. It bears considerable resemblance with other members of the Cupressaceae family regarding pollen characteristics (small and anemophilous), pollination season (winter), symptoms (rhinitis and rhinoconjunctivitis with virtually no asthma), diagnosis (interchangeable whole allergens and molecular allergens), treatment, and prevention.
Epidemiology
Worldwide distribution
Pollen grains from Arizona cypress contain allergenic molecules able to induce sensitization and allergic diseases. The allergenicity of Arizona cypress pollen was reported to be higher than that of C. sempervirens. Arizona cypress pollinosis occurs mainly in Central and North America, where the tree is indigenous, and in the Mediterranean area, Iran, South Africa, and Australia.
Risk factors
The individual risk factors for being diagnosed with Cupressaceae allergy were addressed in 110 Cupressaceae-allergic consecutive outpatients from Southern France, as compared with grass pollen allergic patients from the same clinic. Significantly different features between the two patient groups were: equal gender distribution (vs a male/female ratio of 2 for grass pollinosis, p = 0.001), later age of symptom onset (32 vs 18, p = 0.0002), and relatively high prevalence of dry cough (16.5% vs 0%, p = 0.008) for Cupressaceae pollinosis. The later age of onset of Cupressaceae pollinosis, especially in monosensitized patients, is consistently retrieved in other studies.
Route Of Exposure
Main
The main route of exposure to Arizona cypress allergens is inhalation of allergenic pollen, which occurs mainly during the pollination season in January and February.
Secondary
Direct skin contact with Cupressaceae pollen or resin may result in contact dermatitis.
Clinical Relevance
Cupressaceae pollinosis, including Arizona cypress, manifests during wintertime, mainly as rhinitis or rhinoconjunctivitis, less often as asthma or cutaneous symptoms, and exceptionally as bronchitis. Its prevalence increases with exposure to Cupressaceae pollens, which has plummeted during the second half of last century, due to the extended use of Cupressaceae as ornamental trees next to housing units. In fact, Cupressaceae pollinosis was underestimated until the end of the 20th century, because of the lack of physician and patient awareness and lack of performant Cupressaceae pollen extracts for diagnostic testing. Due to the similar morphology of Cupressaceae pollens, to their allergenic cross-reactivity and to the interchangeable use of pollen extracts for diagnosis, such as Juniperus ashei, Arizona cypress, C. sempervirens, and more recently the molecular allergen Cup a 1, Arizona cypress pollinosis is not distinguished from pollinosis induced by other Cupressaceae genera or species.
For further details on the clinical relevance of Cupressaceae pollinosis, the reader is referred to the Cupressus sempervirens section.
Diagnostics
Arizona cypress extracts have been consistently found more potent than C. sempervirens for the diagnosis of Cupressaceae sensitization and allergy with skin prick tests and in vitro assays. Following the characterization of the major allergen Cup a 1 and the demonstration of its sequence identity and cross-reactivity with other Cupressaceae pectate lyases Cup s 1 (C. sempervirens), Jun a 1 (Juniperus ashei), Cry j 1 (Cryptomeria japonica), and Cha o 1 (Chamaecyparis obtusa), this allergen has become widely used as a marker of genuine sensitization to Cupressaceae pollen.
Prevention And Therapy
Allergen immunotherapy
Allergen immunotherapy for Cupressaceae pollinosis proved efficient in several studies using Arizona cypress or other Cupressaceae extracts, but the number of patients included in each of these studies was low (reviewed in ref 1).
Prevention strategies
Avoidance
During the pollination season, exposure to Cupressaceae pollen can be reduced by using a few precautionary measures, such as avoiding outdoor exercise, keeping doors and windows closed, washing hair before sleeping, using protective sunglasses and a mask for outdoor activities, and avoiding drying of linen clothes outside. If the patient’s health condition deteriorates, moving to an area with lower pollen counts may be advised.
Cross-Reactivity
There is extensive cross-reactivity between Arizona cypress pollen and other members of the Cupressaceae family, due to high sequence identity and similarity between molecular allergens. Cross-reactivity with pollens outside the family is possible, mainly through polcalcin sensitization, but relatively infrequent for this minor allergen (9.6% Cup a 4 sensitization in cypress-allergic patients, ref 29). The carbohydrate moieties present on pectate lyase Cup a 1 and other major allergens of Cupressaceae family contribute to IgE binding, but their pathogenic role is not established. Pollen-food syndrome due to Cupressaceae primary sensitization has been suspected for a long time. Although multiple allergens could be involved, e.g. polygalacturonase, thaumatin-like protein, and gibberellin-regulated protein, formal demonstration has only been provided for the latter.
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