ALLERGY TO ROSACEAE FRUITS WITHOUT RELATED POLLINOSIS

Background: Rosaceae fruit allergy is frequently associated with birch pollinosis in Central and Northern Europe and with grass pollen aller gy in Central Spain. The main cross-reactive structures involved for b irch pollinosis are Bet v 1 and profilin, and for grass pollinosis the y are profilin and carbohydrate determinants. Rosaceae fruit allergy c an occasionally be observed in patients without pollinosis. Objective: We investigated the clinical presentation and the allergens involved in allergy to Rosaceae fruit without pollinosis. Methods: Eleven patie nts from Central Spain allergic to apples, peaches, and/or pears but n ot to pollens were compared with 22 control subjects with combined gra ss pollen and fruit allergy. Skin prick tests and RASTs to apple, peac h, and pear were performed. Cross-allergenicity was studied by RAST in hibition. Bet v 1 was tested,vith an indirect RAST, and profilin was t ested in skin prick tests, histamine release, and RAST. Results: Rosac eae fruit allergy without pollinosis is severe with 82% of patients re porting systemic symptoms, mainly anaphylaxis (73%), whereas oral symp toms are less frequent (64%). Anaphylactic shock was observed in 36% o f patients. The fruit allergens involved showed cross-reactivity among Rosaceae species but were not related to profilin or Bet v 1. Ninety- one percent of patients with combined grass pollinosis and fruit aller gy reported oral allergy, 45% reported systemic symptoms, 18% reported anaphylaxis, and 9% reported anaphylactic shock. Conclusion: Allergy to Rosaceae fruits in patients without a related pollen allergy is a s evere clinical entity. Profilin- and Bet v 1-related structures are no t involved in Rosaceae fruit allergy without pollinosis.