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Diagnosi di allergia al kiwi in età pediatrica: utilità della diagnostica molecolare

  • Daniela VisentiniEmail author
  • Silvia Zago
  • Laura Meroi
  • Fiorenza Pesente
  • Francesca Saretta
  • Lolita Fasoli
  • Maria Elisabetta Conte
  • Danilo Villalta
Articolo originale
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Riassunto

Premesse.

L’allergia al kiwi è attualmente una delle più comuni cause di allergia alimentare e offre un chiaro esempio degli effetti dell’introduzione di un nuovo alimento nella catena alimentare. In recenti studi epidemiologici europei risulta essere tra le prime dieci fonti di allergia. Spesso si associa a sensibilizzazione a polline di betulla e si manifesta con sintomatologia localizzata al cavo orale (sindrome orale allergica, SOA). Alcuni pazienti presentano, invece, sintomi sistemici come orticaria acuta, angioedema, manifestazioni gastroenteriche, sintomi cardiovascolari o anafilassi. Sono stati a oggi identificati 13 allergeni molecolari di kiwi, di cui 4 disponibili per la ricerca di IgE specifiche nel pannello del test microarray: 3 sono componenti specifiche di origine nativa (Act d 1, Act d 2, Act d 5) e 1 è una proteina ricombinante cross-reattiva appartenente alla famiglia delle PR-10 (Act d 8). Scopo dello studio è stato identificare il profilo di sensibilizzazione allergenica in un gruppo di pazienti pediatrici con sospetto di allergia al kiwi, che presentavano sintomi, nella maggioranza dei casi, di tipo sistemico.

Metodi.

Tra gennaio 2012 e dicembre 2017 sono giunti presso il Laboratorio di Allergologia di Udine 25 pazienti (età 1–14 anni; 19 maschi/6 femmine) per sospetta allergia al kiwi. I sintomi più frequentemente associati all’ingestione, o al solo contatto con il frutto, erano angioedema e orticaria acuta, seguiti da SOA, sintomi gastrointestinali, rinocongiuntivite, tosse/dispnea, dermatite e, in 6 casi, anafilassi. Nei campioni di siero sono state determinate le IgE specifiche per allergene estrattivo ed è stato eseguito un test microarray per la ricerca IgE per componenti molecolari (ISAC, Thermo Fisher Diagnostics, Uppsala, Svezia).

Risultati.

Tutti i pazienti sono risultati positivi per l’allergene estrattivo. Il profilo per gli allergeni molecolari ha evidenziato in 22 sieri (88%) positività per l’allergene maggiore Act d 1, in 4 (16%), sensibilizzazione per Act d 2 e in 2 (8%), per Act d 5. In 4 soggetti sono state riscontrate sensibilizzazioni multiple (Act d 1 + Act d 2/ o Act d 5). Tre pazienti presentarono sensibilizzazione verso Act d 8 associata ad Act d 1; un bambino con SOA risultò positivo per PR-10 di betulla (Bet v 1), ma non per quella di kiwi (Acd d 8).

Conclusioni.

In caso di sospetta allergia al kiwi in età pediatrica è fondamentale eseguire i test IgE utilizzando l’allergene estrattivo e il profilo molecolare allargato con il test microarray. La presenza di IgE per uno degli allergeni specifici, anche se associata a positività per PR-10, rafforza la diagnosi di rischio di allergia severa e raccomanda l’allontanamento dell’alimento. Lo studio conferma che nell’infanzia l’allergia al kiwi è causata da sensibilizzazione primaria e che la positività per Act d 1, allergene maggiore, è indicatore e fattore di rischio per allergia severa.

Parole chiave

Allergia al kiwi Allergeni del kiwi Act d 1 Act d 2 Act d 5 

Diagnosis of kiwi fruit allergy in children: utility of molecular allergens

Summary

Background.

Allergy to kiwi is currently one of the most common causes of food allergy, and offers a clear example of the effects of the introduction of a new food in the food chain. In recent European epidemiological studies it was shown to be among the top ten sources of allergy. It is often associated with sensitization to birch pollen with symptoms localized to the oral cavity (oral allergy syndrome, OAS). Some patients, however, experience systemic symptoms such as acute urticaria, angioedema, gastrointestinal and/or cardiovascular symptoms or anaphylaxis. 13 kiwi allergens were identified, 4 of which are available for specific IgE testing on the microarray test panel: 3 are kiwi specific components (Act d 1, Act d 2, Act d 5), and 1 is a cross-reactive protein, belonging to the PR-10 protein family (Act d 8). The aim of the study was to identify the allergenic sensitization profile in a group of pediatric patients with suspected allergy to kiwi, who showed symptoms, in almost all cases suggestive of severe allergy.

Methods.

Between January 2012 and December 2017 25 patients (aged 1–14 years; 19 Males/6 Females), presented specific IgE test requests for kiwi to the Allergology Laboratory of Udine. The symptoms most frequently associated with ingestion, or to mere contact with the fruit, were facial angioedema and acute urticaria, followed by OAS, gastrointestinal symptoms, rhinoconjunctivitis, respiratory symptoms, dermatitis and, in 6 patients, anaphylaxis. In all the sera, specific IgE to the whole extract and to the singular components were detected by using the ImmunoCAP and the ImmunoCAP ISAC assay, respectively (Thermo Fisher Diagnostics, Uppsala, Sweden).

Results.

All patients were positive for IgE to kiwi extract; the profile for molecular allergens, in 22 sera (88%) showed positivity for the major allergen Act d 1, in 4 (16%) for Act d 2, and in 2 (8%) for Act d 5. In 4 subjects multiple sensitizations (Act d1 + Act d 2 / or Act d 5) was shown. IgE anti-Act d 8 were detected in 3 cases, combined to anti-Act d1 presence. One child affected by OAS resulted positive to Bet v 1 (Birch PR-10), but not to Act d 8 (kiwi PR-10).

Conclusions.

In case of suspected kiwi allergy in the pediatric population, it is crucial to perform IgE tests using both the extractive allergen and the expanded molecular profile with the microarray test. The presence of IgE for one of the specific allergens, even if associated with positivity for PR-10, reinforces the diagnosis of risk of severe allergy and urges avoidance of the food. The study confirms that kiwi allergy in childhood is caused by primary IgE sensitization and that positivity for Act d 1 is an indicator and risk factor for severe allergy.

Keywords

Kiwi fruit allergy Kiwi allergens Act d 1 Act d 2 Act d 5 

Notes

Conflitti di interesse

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Studi condotti su esseri umani e animali

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Consenso informato

Non applicabile

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Copyright information

© Società Italiana di Patologia Clinica e Medicina di Laboratorio 2018

Authors and Affiliations

  • Daniela Visentini
    • 1
    Email author
  • Silvia Zago
    • 2
  • Laura Meroi
    • 1
  • Fiorenza Pesente
    • 3
  • Francesca Saretta
    • 4
  • Lolita Fasoli
    • 5
  • Maria Elisabetta Conte
    • 6
  • Danilo Villalta
    • 6
  1. 1.Immunopatologia e AllergologiaAzienda Sanitaria Universitaria IntegrataUdineItalia
  2. 2.Patologia ClinicaOspedale “S. Maria degli Angeli”PordenoneItalia
  3. 3.Patologia ClinicaAzienda Sanitaria Universitaria IntegrataUdineItalia
  4. 4.Pediatria, Ospedale di Palmanova-LatisanaAzienda per l’Assistenza Sanitaria n. 2 “Bassa Friulana-Isontina”PalmanovaItalia
  5. 5.Clinica PediatricaAzienda Sanitaria Universitaria IntegrataUdineItalia
  6. 6.Immunologia e AllergologiaOspedale “S. Maria degli Angeli”PordenoneItalia

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