Cheese, mold type
Summary
Cheese is a milk-derived food product, obtained from raw or pasteurized, whole or semi-skimmed, milk from various species, following a variety of industrial or artisanal physico-chemical and microbiological procedures. Milk proteolysis takes place during cheese production. Mold-type cheese involves different fungal species during the cheese ripening process. A great diversity of molds and yeasts is present at the surface and in some cases inside the mold-type cheeses. Food-related and occupational IgE sensitization to mold-type cheese has been reported.
Epidemiology
Risk factors
Milk allergy is a risk factor for cheese allergy, due to shared allergenic components [1]. Atopy is a risk factor for occupational allergy to cheese [7].
Route Of Exposure
Main
The main route of exposure to cheese is ingestion.
Secondary
Occupational exposure in cheesemakers is an alternative route exposure.
Clinical Relevance
Depending on the route of exposure, allergy to cheese may present as food or respiratory allergy.
Milk
Proteolysis of milk allergens retained following cheese coagulation, i.e. mainly casein, results in cheese displaying lower allergenicity than milk, albeit higher than baked milk [2, 8, 9]. The corresponding categorization of milk-allergic patients in three groups is relevant for better diagnostic and management stratification of milk allergic patients [8].
Mold
Molds used for cheese manufacture are saprophytic and usually not associated with human disease except in occupational settings. Hypersensitivity pneumonitis or extrinsic allergic alveolitis have been reported in patients occupationally exposed to Penicillium spp used during cheese manufacturing, such as P. roqueforti [10] or P. verrucosum [11]. Exceptionally, they may however cause infections, as reported in an immunocompetent 40-year old female who developed a typical fungus ball with Penicillium roqueforti [12].
Enzymes and dyes
Occupational rhinitis and asthma may be caused by ingredients added during cheese manufacture such as enzymes (e.g. calf chymosin) from natural or artificial rennet [7].
Food allergy to dyes used for cheese (e.g. annatto) has been reported as anaphylaxis in a 58-year old atopic patient [13].
Cross-Reactivity
Severe clinical reactions to ewe’s milk cheese and goat’s milk cheese may occur upon consumption by patients otherwise tolerant to cow’s milk products [15].
Reports of allergenic cross-reactivity involving fungal species used for cheese manufacturing are scarce. However, a variety of allergenic fungal species may grow on cheese as a result of food spoilage, including Aspergillus flavus, Aspergillus niger, and various Penicillium spp [6].
IgE sensitization to molds and yeasts resulting in clinical reactions to wine, cider, and some beers together with skin reactivity to blue cheese, was reported in a 19-year old atopic patient [16].
References
- Matricardi, P.M., et al., EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol, 2016. 27 Suppl 23: p. 1-250.
- Villa, C., et al., Bovine Milk Allergens: A Comprehensive Review. Compr Rev Food Sci Food Saf, 2018. 17(1): p. 137-164.
- Mane, A. and P.L.H. McSweeney, Proteolysis in Irish farmhouse Camembert cheese during ripening. J Food Biochem, 2020. 44(1): p. e13101.
- Kovacs, A.T., A fungal scent from the cheese. Environ Microbiol, 2020. 22(11): p. 4524-4526.
- Bintsis, T., Yeasts in different types of cheese. AIMS Microbiol, 2021. 7(4): p. 447-470.
- Banjara, N., M.J. Suhr, and H.E. Hallen-Adams, Diversity of yeast and mold species from a variety of cheese types. Curr Microbiol, 2015. 70(6): p. 792-800.
- Gomez Torrijos, E., et al., Occupational allergic respiratory disease (rinoconjunctivitis and asthma) in a cheese factory worker. J Allergy Clin Immunol Pract, 2018. 6(4): p. 1416-1417.
- Sackesen, C., et al., A new Luminex-based peptide assay to identify reactivity to baked, fermented, and whole milk. Allergy, 2019. 74(2): p. 327-336.
- Biscola, V., et al., Brazilian artisanal ripened cheeses as sources of proteolytic lactic acid bacteria capable of reducing cow milk allergy. J Appl Microbiol, 2018. 125(2): p. 564-574.
- Campbell, J.A., et al., Cheese worker's hypersensitivity pneumonitis. Am Rev Respir Dis, 1983. 127(4): p. 495-6.
- Guglielminetti, M., et al., Respiratory syndrome very similar to extrinsic allergic alveolitis due to Penicillium verrucosum in workers in a cheese factory. Mycopathologia, 2001. 149(3): p. 123-9.
- Radulesco, T., et al., A Case of Fungus Ball-Type Maxillary Sinusitis Due to Penicillium Roqueforti. Mycopathologia, 2018. 183(2): p. 439-443.
- Ebo, D.G., et al., Allergy for cheese: evidence for an IgE-mediated reaction from the natural dye annatto. Allergy, 2009. 64(10): p. 1558-1560.
- IUIS/WHO. IUIS/WHO Bos domesticus allergens. 2022 June 19]; Available from: http://allergen.org/search.php?allergenname=&allergensource=Bos+domesticus+%28Bos+taurus%29&TaxSource=&TaxOrder=&foodallerg=all&bioname=.
- Vinas, M., et al., Allergy to goat and sheep cheese with tolerance to cow's milk and its derivatives. Allergol Immunopathol (Madr), 2014. 42(3): p. 186-90.
- Bansal, R.A., S. Tadros, and A.S. Bansal, Beer, Cider, and Wine Allergy. Case Reports Immunol, 2017. 2017: p. 7958924.