Important allergen components families involved in cross-reactivity between aeroallergens and food allergens are presented in Table Table1. This traditional classification has a more modern changed approach from a molecular allergy point of view. In contrast to class 1 food allergy which mainly affects young children, class 2 food allergy is observed especially in adults as a consequence of sensitization to cross-reactive aeroallergens. Typically, pollen-food syndromes are produced by class 2 food allergens. Class 2 food allergens are more heat-labile and susceptible to digestion and therefore do not cause gastrointestinal sensitization, but instead provoke allergic reactions in already sensitized patients to cross-reactive aeroallergens through the respiratory route. This phenomenom should be distinguished from the common food allergy without sensitization to cross-reactive aeroallergens, in which heat- and enzyme-resistant class 1 food allergens induce allergic sensitization via the digestive tract, typically being responsible for systemic allergic reactions. This editorial underlines the importance of the IgE sensitization via the respiratory route to aeroallergens and food allergy due to cross-reactivities between some allergen components. Moreover, underlying asthma, regardless of severity, has been associated with increased risk of severe reactions and even death caused by food allergy. Evidence of respiratory allergy may indicate an increased risk of IgE-mediated food allergy. There is a high co-occurrence of food allergy with other atopic diseases, including allergic rhinitis and asthma. Allergic rhinitis, asthma and food allergies have significant detrimental effects on health-related quality of life, family economics, social interactions, school and work attendance. Respiratory allergies affect 10%-30% of adults and children worldwide, while food allergy is estimated to affect more than 1%-2% and less than 10% of the population. The use of molecular-based diagnosis improves the understanding of clinically relevant IgE sensitization to cross-reactive allergen components from aeroallergen sources and foods. The association between primary IgE sensitization with respiratory symptoms to inhaled allergens and food allergy due to cross-reactive allergen components is important to assess in allergy practice. Medical history and diagnosis approach may be guided by the knowledge about the diverse cross-reacting allergens involved, and by the understanding of these clinical entities which may vary significantly or may be overlapping.
Clinical cases of allergic reactions to ingestion of food products containing pollen grains of specific plants, in patients with respiratory allergy to Asteraceae pollen, especially mugwort and ragweed, are also mentioned, for honey, royal jelly and bee polen dietary supplements, along with allergic reactions to foods contaminated with mites or fungi in patients with respiratory allergy to these aeroallergens. Clinical entities due to IgE sensitization to cross-reactive aeroallergen and food allergen components are described for many sources of plant origin (pollen-food syndromes and associations, such as birch-apple, cypress-peach and celery-mugwort-spice syndromes, and mugwort-peach, mugwort-chamomile, mugwort-mustard, ragweed-melon-banana, goosefoot-melon associations), fungal origin ( Alternaria-spinach syndrome), and invertebrate, mammalian or avian origin (mite-shrimp, cat-pork, and bird-egg syndromes). In patients with respiratory allergy, cross-reactivity between aeroallergens and foods may induce food allergy, symptoms ranging from oral allergy syndrome to severe anaphylaxis.
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