Skip to main content

Advertisement

Log in

Classification of Food Allergens and Cross-Reactivity

  • Food Allergy (T Green, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Patients with specific food allergies are commonly sensitized to related foods, for example, shrimp with other shellfish and peanut with other legumes. In some instances, this represents a true allergy to the related food, defined as cross-reactivity, while in other instances, it represents a positive skin or IgE test only, in a patient who can eat the related food without difficulty. This is defined as cross-sensitization. It is extremely important that the clinician recognize these patterns of cross-sensitization and cross-reactivity, both to counsel patients on foods that should be avoided and to make sure that foods are not unnecessarily restricted from the diet. In fact, it is very common for patients to be instructed to avoid entire food groups based just on positive tests, which leads to unnecessary dietary restrictions with effects on food choices, nutrition, and quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Sicherer SH. Clinical implications of cross-reactive food allergens. J Allergy Clin Immunol. 2001;108(6):881–90.

    Article  CAS  PubMed  Google Scholar 

  2. Restani P, Gaiaschi A, Plebani A, Beretta B, Cavagni G, Fiocchi A, et al. Cross-reactivity between milk proteins from different animal species. Clin Exp Allergy. 1999;29(7):997–1004.

    Article  CAS  PubMed  Google Scholar 

  3. Vita D, Passalacqua G, Di Pasquale G, Caminiti L, Crisafulli G, Rulli I, et al. Ass’s milk in children with atopic dermatitis and cow’s milk allergy: crossover comparison with goat’s milk. Pediatr Allergy Immunol. 2007;18(7):594–8.

    Article  PubMed  Google Scholar 

  4. Bellioni-Businco B, Paganelli R, Lucenti P, Giampietro PG, Perborn H, Businco L. Allergenicity of goat’s milk in children with cow’s milk allergy. J Allergy Clin Immunol. 1999;103(6):1191–4.

    Article  CAS  PubMed  Google Scholar 

  5. Ehlayel MS, Hazeima KA, Al-Mesaifri F, Bener A. Camel milk: an alternative for cow’s milk allergy in children. Allergy Asthma Proc. 2011;32(3):255–8.

    Article  PubMed  Google Scholar 

  6. Alonso-Lebrero E, Fuentes V, Zapatero L, Perez-Bustamante S, Pineda F, Martinez-Molero MI. Goat’s milk allergies in children following specific oral tolerance induction to cow’s milk. Allergol Immunopathol (Madr). 2008;36(3):180–1.

    Article  CAS  Google Scholar 

  7. Martorell Aragones A, Martorell Calatayud C, Pineda F, Felix Toledo R, Cerda Mir JC, de las Marinas MD. Persistence of allergy to goat’s milk after specific induction of tolerance to cow’s milk. J Investig Allergol Clin Immunol. 2012;22(4):301–2.

    CAS  PubMed  Google Scholar 

  8. Rodriguez del Rio P, Sanchez-Garcia S, Escudero C, Pastor-Vargas C, Sanchez Hernandez JJ, Perez-Rangel I, et al. Allergy to goat’s and sheep’s milk in a population of cow’s milk-allergic children treated with oral immunotherapy. Pediatr Allergy Immunol. 2012;23(2):128–32.

    Article  PubMed  Google Scholar 

  9. Restani P, Fiocchi A, Beretta B, Velona T, Giovannini M, Galli CL. Meat allergy: III--Proteins involved and cross-reactivity between different animal species. J Am Coll Nutr. 1997;16(4):383–9.

    Article  CAS  PubMed  Google Scholar 

  10. Martelli A, De Chiara A, Corvo M, Restani P, Fiocchi A. Beef allergy in children with cow’s milk allergy; cow’s milk allergy in children with beef allergy. Ann Allergy Asthma Immunol. 2002;89(6 Suppl 1):38–43.

    Article  PubMed  Google Scholar 

  11. Fiocchi A, Restani P, Riva E, Qualizza R, Bruni P, Restelli AR, et al. Meat allergy: I—specific IgE to BSA and OSA in atopic, beef sensitive children. J Am Coll Nutr. 1995;14(3):239–44.

    Article  CAS  PubMed  Google Scholar 

  12. Fiocchi A, Restani P, Bouygue GR, Martelli A. Beef allergy in adults and children. Allergy. 2005;60(1):126.

    Article  CAS  PubMed  Google Scholar 

  13. Werfel SJ, Cooke SK, Sampson HA. Clinical reactivity to beef in children allergic to cow’s milk. J Allergy Clin Immunol. 1997;99(3):293–300.

    Article  CAS  PubMed  Google Scholar 

  14. Fiocchi A, Restani P, Riva E, Mirri GP, Santini I, Bernardo L, et al. Heat treatment modifies the allergenicity of beef and bovine serum albumin. Allergy. 1998;53(8):798–802.

    Article  CAS  PubMed  Google Scholar 

  15. Szepfalusi Z, Ebner C, Pandjaitan R, Orlicek F, Scheiner O, Boltz-Nitulescu G, et al. Egg yolk alpha-livetin (chicken serum albumin) is a cross-reactive allergen in the bird-egg syndrome. J Allergy Clin Immunol. 1994;93(5):932–42.

    Article  CAS  PubMed  Google Scholar 

  16. Anibarro B, Garcia-Ara C, Ojeda JA. Bird-egg syndrome in childhood. J Allergy Clin Immunol. 1993;92(4):628–30.

    Article  CAS  PubMed  Google Scholar 

  17. Bausela BA, Garcia-Ara MC, Martin Esteban M, Boyano Martinez TB, Diaz Pena JM, Ojeda Casas JA. Peculiarities of egg allergy in children with bird protein sensitization. Ann Allergy Asthma Immunol. 1997;78(2):213–6.

    Article  CAS  PubMed  Google Scholar 

  18. Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol. 2011;127(3):594–602.

    Article  PubMed  Google Scholar 

  19. Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of seafood allergy in the United States determined by a random telephone survey. J Allergy Clin Immunol. 2004;114(1):159–65.

    Article  PubMed  Google Scholar 

  20. Sharp MF, Lopata AL. Fish allergy: in review. Clin Rev Allergy Immunol. 2014;46(3):258–71.

    Article  CAS  PubMed  Google Scholar 

  21. Saptarshi SR, Sharp MF, Kamath SD, Lopata AL. Antibody reactivity to the major fish allergen parvalbumin is determined by isoforms and impact of thermal processing. Food Chem. 2014;148:321–8.

    Article  CAS  PubMed  Google Scholar 

  22. de Martino M, Novembre E, Galli L, de Marco A, Botarelli P, Marano E, et al. Allergy to different fish species in cod-allergic children: in vivo and in vitro studies. J Allergy Clin Immunol. 1990;86(6 Pt 1):909–14.

    Article  PubMed  Google Scholar 

  23. Ebo DG, Kuehn A, Bridts CH, Hilger C, Hentges F, Stevens WJ. Monosensitivity to pangasius and tilapia caused by allergens other than parvalbumin. J Investig Allergol Clin Immunol. 2010;20(1):84–8.

    CAS  PubMed  Google Scholar 

  24. Schulkes KJ, Klemans RJ, Knigge L, de Bruin-Weller M, Bruijnzeel-Koomen CA, Marknell deWitt A. Specific IgE to fish extracts does not predict allergy to specific species within an adult fish allergic population. Clin Transl Allergy. 2014;4:27.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bernhisel-Broadbent J, Scanlon SM, Sampson HA. Fish hypersensitivity. I. In vitro and oral challenge results in fish-allergic patients. J Allergy Clin Immunol. 1992;89(3):730–7.

    Article  CAS  PubMed  Google Scholar 

  26. Helbling A, Haydel Jr R, McCants ML, Musmand JJ, El-Dahr J, Lehrer SB. Fish allergy: is cross-reactivity among fish species relevant? Double-blind placebo-controlled food challenge studies of fish allergic adults. Ann Allergy Asthma Immunol. 1999;83(6 Pt 1):517–23.

    Article  CAS  PubMed  Google Scholar 

  27. Pascual C, Martin Esteban M, Crespo JF. Fish allergy: evaluation of the importance of cross-reactivity. J Pediatr. 1992;121(5 Pt 2):S29–34.

    Article  CAS  PubMed  Google Scholar 

  28. Bernhisel-Broadbent J, Strause D, Sampson HA. Fish hypersensitivity. II: Clinical relevance of altered fish allergenicity caused by various preparation methods. J Allergy Clin Immunol. 1992;90(4 Pt 1):622–9.

    Article  CAS  PubMed  Google Scholar 

  29. Leung PS, Chow WK, Duffey S, Kwan HS, Gershwin ME, Chu KH. IgE reactivity against a cross-reactive allergen in crustacea and mollusca: evidence for tropomyosin as the common allergen. J Allergy Clin Immunol. 1996;98(5 Pt 1):954–61.

    Article  CAS  PubMed  Google Scholar 

  30. Daul CB, Morgan JE, Waring NP, McCants ML, Hughes J, Lehrer SB. Immunologic evaluation of shrimp-allergic individuals. J Allergy Clin Immunol. 1987;80(5):716–22.

    Article  CAS  PubMed  Google Scholar 

  31. Waring NP, Daul CB, deShazo RD, McCants ML, Lehrer SB. Hypersensitivity reactions to ingested crustacea: clinical evaluation and diagnostic studies in shrimp-sensitive individuals. J Allergy Clin Immunol. 1985;76(3):440–5.

    Article  CAS  PubMed  Google Scholar 

  32. Vidal C, Bartolome B, Rodriguez V, Armisen M, Linneberg A, Gonzalez-Quintela A. Sensitization pattern of crustacean-allergic individuals can indicate allergy to molluscs. Allergy. 2015;70(11):1493–6.

    Article  CAS  PubMed  Google Scholar 

  33. Sicherer SH, Munoz-Furlong A, Burks AW, Sampson HA. Prevalence of peanut and tree nut allergy in the US determined by a random digit dial telephone survey. J Allergy Clin Immunol. 1999;103(4):559–62.

    Article  CAS  PubMed  Google Scholar 

  34. Roux KH, Teuber SS, Sathe SK. Tree nut allergens. Int Arch Allergy Immunol. 2003;131(4):234–44.

    Article  CAS  PubMed  Google Scholar 

  35. Sicherer SH, Furlong TJ, Munoz-Furlong A, Burks AW, Sampson HA. A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants. J Allergy Clin Immunol. 2001;108(1):128–32.

    Article  CAS  PubMed  Google Scholar 

  36. Asero R, Mistrello G, Roncarolo D, Amato S. Walnut-induced anaphylaxis with cross-reactivity to hazelnut and Brazil nut. J Allergy Clin Immunol. 2004;113(2):358–60.

    Article  PubMed  Google Scholar 

  37. Robotham JM, Hoffman GG, Teuber SS, Beyer K, Sampson HA, Sathe SK, et al. Linear IgE-epitope mapping and comparative structural homology modeling of hazelnut and English walnut 11S globulins. Mol Immunol. 2009;46(15):2975–84.

    Article  CAS  PubMed  Google Scholar 

  38. Goetz DW, Whisman BA, Goetz AD. Cross-reactivity among edible nuts: double immunodiffusion, crossed immunoelectrophoresis, and human specific igE serologic surveys. Ann Allergy Asthma Immunol. 2005;95(1):45–52.

    Article  CAS  PubMed  Google Scholar 

  39. Savvatianos S, Konstantinopoulos AP, Borga A, Stavroulakis G, Lidholm J, Borres MP, et al. Sensitization to cashew nut 2S albumin, Ana o 3, is highly predictive of cashew and pistachio allergy in Greek children. J Allergy Clin Immunol. 2015;136(1):192–4. This paper reports on the identification of a major cashew allergen and its utility in diagnosing cashew and pistachio allergy.

    Article  CAS  PubMed  Google Scholar 

  40. Maloney JM, Rudengren M, Ahlstedt S, Bock SA, Sampson HA. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol. 2008;122(1):145–51.

    Article  CAS  PubMed  Google Scholar 

  41. Bock SA, Atkins FM. The natural history of peanut allergy. J Allergy Clin Immunol. 1989;83(5):900–4.

    Article  CAS  PubMed  Google Scholar 

  42. Bernhisel-Broadbent J, Taylor S, Sampson HA. Cross-allergenicity in the legume botanical family in children with food hypersensitivity. II. Laboratory correlates. J Allergy Clin Immunol. 1989;84(5 Pt 1):701–9.

    Article  CAS  PubMed  Google Scholar 

  43. Martinez San Ireneo M, Ibanez MD, Fernandez-Caldas E, Carnes J. In vitro and in vivo cross-reactivity studies of legume allergy in a Mediterranean population. Int Arch Allergy Immunol. 2008;147(3):222–30.

    Article  CAS  PubMed  Google Scholar 

  44. Martinez San Ireneo M, Ibanez MD, Sanchez JJ, Carnes J, Fernandez-Caldas E. Clinical features of legume allergy in children from a Mediterranean area. Ann Allergy Asthma Immunol. 2008;101(2):179–84.

    Article  PubMed  Google Scholar 

  45. Moneret-Vautrin DA, Guerin L, Kanny G, Flabbee J, Fremont S, Morisset M. Cross-allergenicity of peanut and lupine: the risk of lupine allergy in patients allergic to peanuts. J Allergy Clin Immunol. 1999;104(4 Pt 1):883–8.

    Article  CAS  PubMed  Google Scholar 

  46. Tatham AS, Shewry PR. Allergens to wheat and related cereals. Clin Exp Allergy. 2008;38(11):1712–26.

    CAS  PubMed  Google Scholar 

  47. Battais F, Pineau F, Popineau Y, Aparicio C, Kanny G, Guerin L, et al. Food allergy to wheat: identification of immunogloglin E and immunoglobulin G-binding proteins with sequential extracts and purified proteins from wheat flour. Clin Exp Allergy. 2003;33(7):962–70.

    Article  CAS  PubMed  Google Scholar 

  48. Makela MJ, Eriksson C, Kotaniemi-Syrjanen A, Palosuo K, Marsh J, Borres M, et al. Wheat allergy in children - new tools for diagnostics. Clin Exp Allergy. 2014;44(11):1420–30. This study provides new information on the major wheat allergens and their implications in making an accurate diagnosis of wheat allergy.

    Article  CAS  PubMed  Google Scholar 

  49. Palosuo K, Varjonen E, Kekki OM, Klemola T, Kalkkinen N, Alenius H, et al. Wheat omega-5 gliadin is a major allergen in children with immediate allergy to ingested wheat. J Allergy Clin Immunol. 2001;108(4):634–8.

    Article  CAS  PubMed  Google Scholar 

  50. Jones SM, Magnolfi CF, Cooke SK, Sampson HA. Immunologic cross-reactivity among cereal grains and grasses in children with food hypersensitivity. J Allergy Clin Immunol. 1995;96(3):341–51.

    Article  CAS  PubMed  Google Scholar 

  51. Pourpak Z, Mesdaghi M, Mansouri M, Kazemnejad A, Toosi SB, Farhoudi A. Which cereal is a suitable substitute for wheat in children with wheat allergy? Pediatr Allergy Immunol. 2005;16(3):262–6.

    Article  PubMed  Google Scholar 

  52. Kazemi-Shirazi L, Pauli G, Purohit A, Spitzauer S, Froschl R, Hoffmann-Sommergruber K, et al. Quantitative IgE inhibition experiments with purified recombinant allergens indicate pollen-derived allergens as the sensitizing agents responsible for many forms of plant food allergy. J Allergy Clin Immunol. 2000;105(1 Pt 1):116–25.

    Article  CAS  PubMed  Google Scholar 

  53. Rodriguez J, Crespo JF. Clinical features of cross-reactivity of food allergy caused by fruits. Curr Opin Allergy Clin Immunol. 2002;2(3):233–8.

    Article  PubMed  Google Scholar 

  54. 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.

    Article  CAS  PubMed  Google Scholar 

  55. Berkner H, Neudecker P, Mittag D, Ballmer-Weber BK, Schweimer K, Vieths S, et al. Cross-reactivity of pollen and food allergens: soybean Gly m 4 is a member of the Bet v 1 superfamily and closely resembles yellow lupine proteins. Biosci Rep. 2009;29(3):183–92.

    Article  CAS  PubMed  Google Scholar 

  56. Mittag D, Vieths S, Vogel L, Becker WM, Rihs HP, Helbling A, et al. Soybean allergy in patients allergic to birch pollen: clinical investigation and molecular characterization of allergens. J Allergy Clin Immunol. 2004;113(1):148–54.

    Article  CAS  PubMed  Google Scholar 

  57. Mittag D, Akkerdaas J, Ballmer-Weber BK, Vogel L, Wensing M, Becker WM, et al. Ara h 8, a Bet v 1-homologous allergen from peanut, is a major allergen in patients with combined birch pollen and peanut allergy. J Allergy Clin Immunol. 2004;114(6):1410–7.

    Article  CAS  PubMed  Google Scholar 

  58. Sicherer SH, Wood RA. Advances in diagnosing peanut allergy. J Allergy Clin Immunol Pract. 2013;1(1):1–13. This review provides a detail, up to date approach to the diagnosis of peanut allergy, inlcuding the use of component resolved diagnostics.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert A. Wood.

Ethics declarations

Conflict of Interest

Dr. Wood reports grants from NIH, from DBV, and from Aimmune, and is an editor for Up to Date. Dr. Kazatsky reports a grant from NIH.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Food Allergy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kazatsky, A.M., Wood, R.A. Classification of Food Allergens and Cross-Reactivity. Curr Allergy Asthma Rep 16, 22 (2016). https://doi.org/10.1007/s11882-016-0601-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11882-016-0601-1

Keywords

Navigation