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The peach, this fluffy-skinned fruit that we taste with delight. Sometimes, this greedy pleasure is shattered with the appearance of a myriad of allergic manifestations. It goes without saying that depending on the responsible allergen, the consequences can be dramatic. With Doctor Sébastien Lefèvre, head of the allergology department CHR Metz-Thionville, let’s take stock of these striking differences in allergy to this stone fruit.
A reservoir of allergens
Dr CQ: Plants are a source of different allergenic families ranging from PR10 (the most well-known) to the “little last” identified that of Snakin/gibberellin-regulated proteins.
Dr. S. Lefevre :
« In fact, there exists several allergenic proteins within an allergenic source and especially in fruit.
These are defense proteins, ubiquitous in the plant kingdom. Several of these proteins have been identified, and the main ones are :
– PR-10 : BetV1 like, i.e. similar to one of the major proteins1 birch pollen
– PR-5 : Thaumatine like proteins ou TLP
– PR14 : Lipid transfert proteins ou LTP »
1: the major allergen is a protein that triggers allergic reactions in more than 50% of allergy sufferers.
One fruit, many possibilities
The principle of allergenic differences applies to fishing. We are going to illustrate these disparities with short fiction and explain to you how the allergy to peach differs for Manon, Line, Tristan and Valentin.
Allergens are designated according to the IUIS denomination. This is to use the first three letters of the genus followed by the first letter of the species and the serial number of discovery. Peach = Prunus persica therefore Pru p
Manon and PR10 (Pru p1):
Manon lives near Lille. For 5 years, at the beginning of spring, she complains of rhino-conjunctivitis. His allergy to birch is confirmed by allergy tests. Moreover, it has been a year since she can eat raw peaches. His lips start to swell and his palate itches.
Dr. CQ: In a few words, can you also redefine the notion of cross-allergy and tell us regarding this phenomenon with the PR10s?
Dr. S. Lefevre:
« As I told you, there are structural homologies between the allergenic proteins of pollens and fruits. Sensitization to Betulaceae pollen, the leader of which is birch, therefore leads to cross-reactions with the fruits. In the case of Manon, the allergy to birch pollen, responsible for her rhino conjunctivitis, leads to an oral allergy syndrome, because of these homologies with the pollens. In summary, Manon’s initial sensitization to birch pollen leads to local symptoms (edema of the lips, itching in the mouth), ENT (sneezing), when eating raw fruit. PR-10 being thermolabile, cooking the fruit will cause the destruction of proteins and therefore its consumption. in compotes, jams or cakes is without symptoms
line and L.T.P. (Pru p3):
Line, 20, feels bad. She has just eaten a peach without having peeled it, . The young woman is covered with hives. She has difficulty breathing and swallowing. In addition, she begins to cough and vomit. His entourage quickly calls 15. The allergological assessment, carried out remotely from this episode, incriminates the LTP of fishing. During a consultation, she explains, being a regular cannabis user which, for some time, has made her sneeze.
Dr. CQ: It is a cross allergy with a different allergen family.
Dr S.Lefèvre:
« This case is typical of sensitization to LTP via cannabis. Indeed, there is also an LTP (Can s3) in hemp (and therefore in cannabis), which leads to cross-reactivity with fruits carrying an LTP. LTPs, unlike PR-10s, are not heat sensitive. Rhinitis during cannabis use is typical of LTP sensitization. Symptoms appear secondarily with a wide variety of fruit. Generally, stopping cannabis can reduce these symptoms.
Dr. CQ: What are possible and more frequent cross allergies with other plants?.
Dr. S. Lefevre.
“It must first be understood that the allergy to LTPs is often immediately severe and potentially fatal in the absence of any emergency treatment with adrenaline. Since allergenic proteins are resistant to heat, but also to gastric acidity, their ingestion can lead to anaphylactic shock. sin . Again, all fruits such as rosaceae, of which peach is a part, contain varying amounts of LTP, which can therefore trigger an allergic reaction”.
Tristan and T.L.P (Pru p2):
Tristan is originally from the south of France, he has long been known to be allergic to cypress. Around 4 p.m., he decides to eat a peach and the result is not long in coming. Quickly, he felt signs suggestive of anaphylactic shock and ended up in the emergency room.
Dr CQ: In this specific case, the TLP family “Thaumatin like proteins” is mentioned.
Dr. S. Lefevre:
“TLPs, like LTPs, can cause severe anaphylaxis. The number of patients sensitized to TPL seems to be lower than that sensitized to LTP. It is a cross allergy with cypress pollens. »
Valentine et snekin/gibberellin-regulated proteins(Pru p7).
Valentin 30 years old lives in the region of Marseille. At 4 p.m., he swallowed a squeezed orange juice and thirty minutes later, hives and facial edema appeared, as well as difficulty breathing. He will benefit from an injection of adrenaline and monitoring in a hospital environment for 24 hours. Atopic, it is known as allergic to cypress. Several months before, he presented a same episode of anaphylactic shock this time while eating a peach.
Dr CQHere we are faced with a new family of allergens.
Dr. S. Lefevre:
“This is a recently described allergen (BP14), present in cypress pollen. This small protein also crosses with peamaclein (Pru p 7) from peach and a citrus protein (lemon, orange, etc.), making it possible to describe Cypress/peach/citrus syndromes, as for Valentin. Once once more, these are heat-resistant allergens and may be responsible for severe clinical signs such as anaphylactic shock”
Dr. CQ: this new peach allergen is also found in the pulp and the skin of the fruit and can therefore lead to cross allergies with other fruits as you point out with orange but also pomegranate or Japanese apricot. We can say that peach allergy in the north of France (due to PR10) is potentially less serious than in the south (due to cross-allergys with cypress pollen). However, certain factors (exertion, taking alcohol or medication such as NSAIDs, beta blockers, and IEC) can aggravate the local symptoms classically observed in case of allergy to PR10.
references
https://www.sciencedirect.com/science/article/abs/pii/S1877032019303859
https://www.sciencedirect.com/science/article/abs/pii/S1877032015004716
https://www.sciencedirect.com/science/article/abs/pii/S1877032021004279
https://www.sciencedirect.com/science/article/abs/pii/S1877032019303586
https://hal.archives-ouvertes.fr/hal-01791653/document
illustrations Stocking pour freepik
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