Full text of DOI:10.1034/j.1398-9995.2000.00642.x

on the tongue of a 4-year-old boy. Pediatr
demonstration of their pathogenetic
relevance is still lacking (3, 4). The inability
to detect red-currant-speci®c IgE could be
due to the fact that excess IgG competitively
inhibited IgE binding in the RAST. On the
other hand, it is interesting to note that the
second documented case of anaphylaxis to
red currant with serologic data available
also lacked detectable IgE levels and
exhibited speci®c IgA and IgM antibodies
instead (1).
Swiss chard-induced asthma
Dermatol 1995;12:51±52.
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4. ARIAS J, FERNANDEZ-RIVAS M, PANADERO P.
Â
E. Gonzalez-Mancebo*, T. Alfaya, Z. Pulido, F. Leon,
Â
Selective ®xed drug eruption to amoxycillin.
M. Cuevas, B. de la Hoz
Clin Exp Dermatol 1995;20:339±340.
Â
Â
Â
5. JIMENEZ I, ANTON E, PICANS I, SANCHEZ I,
Ä
QUINONES MD, JEREZ J. Fixed drug eruption
Key words: allergen characterization; asthma;
from amoxycillin. Allergol Immunopathol
(Madr) 1997;25:247±248.
Swiss chard; vegetables.
6. LANDTHALER M, MICHALOPOULOS M,
SCHWAB U, DORN M. Erythema
Scarlatiniforme Desquamativum
Recidivans Localisatum. Hautarzt
1985;36:581±585.
. BELONGING to the Chenopodiaceae family,
Swiss chard (Beta vulgaris L. cicla) is a
vegetable widely used in Spain. Other
members of this family are spinach, beet,
and weeds such as chenopod (Chenopodium
album) and salsola (Salsola kali), the pollen
of which is allergenic.
In summary, this is, to our knowledge,
only the second case of anaphylaxis to red
currant documented by history, skin prick
tests, and serology. Although speci®c IgG
antibodies were detectable, we believe that
these antibodies interfere with the in vitro
detection of speci®c IgE and were not
directly involved in the pathogenesis of
anaphylaxis to red currants.
Anaphylaxis to red currants
Although hypersensitivity reactions to
T. M. Zollner, P. Schmidt, C. M. Kalveram,
A. C. Emman, W.-H. Boehncke*
food are much
A positive bonchial
more common
provocation was
after ingestion,
obtained with an extract
food antigens can
of Swiss chard.
also induce
Key words: allergy; anaphylaxis; IgE; IgG; red
currant.
*Department of Dermatology
University of Frankfurt
Theodor-Stern-Kai 7
D ± 60590 Frankfurt
Germany
. RED currant (Ribes rubrum) is a seemingly
rare cause of anaphylactic reactions (1). We
had the opportunity to perform allergy tests
in a 47-year-old woman who suffered
generalized urticaria, dysphagia, dyspnea,
pruritus of the palms and soles, hypotonia,
and tachycardia
symptoms throu-
gh inhalation, particularly in occupational
asthma. Asthma induced by inhaling the
vapor of cooking vegetables has been
described, but some clinical and
Tel. (+49) 69 6301 5743
Fax: (+49) 69 6301 5117
immunologic aspects are still unknown.
Our patient was a 50-year-old woman
who reported wheezy dyspnea within a few
minutes of handling, cutting, or inhaling the
vapor of Swiss chard cooked at home. She
did not have cutaneous symptoms after
contact with it, and was able to eat it
without ill effect. She tolerated spinach and
beet vapor and their contact or ingestion.
She was a nonsmoker and was nonatopic.
The patient was studied in our allergy
department. We performed skin prick tests
with a battery of common aeroallergens,
and with Swiss chard extract (20 mg/ml),
spinach extract (20 mg/ml), and beet extract
(20 mg/ml) and prick by prick tests with raw
and boiled Swiss chard. We obtained a
positive result for Swiss chard (raw, boiled,
and extract), spinach extract, beet extract,
and chenopod pollen extract.
Accepted for publication 11 January 2000
Allergy 2000: 55:511
about 2.5 h after
This rare case
Copyright # Munksgaard 2000
ISSN 0105-4538
having consumed red
currants. One month
later, she developed
exhibited IgG ± but
not IgE ± antibodies.
References
generalized urticaria after eating black
currant jam.
È
1. KUHL P, KALVERAM CM, GALL H.
Anaphylaxie auf rote Johannisbeere.
Allergo J 1997;7:17±19.
Skin prick tests were negative for a variety
of foods including spices, but prick-to-prick
tests with red currants and black currants
were strongly positive. Total IgE was 103
kU/l (normal: ,120 kU/l). Low
2. MARINKOVICH V. Speci®c IgG antibodies as
markers of adverse reactions to foods.
Monogr Allergy 1996;32:221±225.
3. BRUIJNZEEL-KOOMEN C, ORTOLANI C, AAS
K, et al. Position paper. Adverse reactions
to food. Allergy 1995;50:623±635.
concentrations of speci®c IgE antibodies
(RAST class 1 or 2) were detectable for
several spices, but not red currants or black
currants. There were, however, readily
detectable levels of IgG speci®c for red
currants.
È
4. WUTHRICH B. Speci®c IgG antibodies as
markers of adverse reactions to food.
Monogr Allergy 1996;32:226±227.
Although reports on IgG antibodies to
dietary antigens are frequent (2),
The bronchial provocation test with
511

methacholine revealed mild bronchial
hyperreactivity (PC20 1.43 mg/ml). The
bronchial provocation test with raw Swiss
chard extract (20 mg/ml) was performed as
previously described (1) and elicited a fall in
FEV1 of 30% from baseline and wheezy
dyspnea 5 min after challenge (1:10 v/v). No
late reaction was observed in PEF
syndrome. J Allergy Clin Immunol
patient. The positive skin prick test with
Swiss chard and the immediate positive
reaction after speci®c bronchial challenge
suggest that the patient had developed type I
hypersensitivity to the antigens in Swiss
chard. The inconclusive result of the
histamine-release test and the lack of
commercial Swiss chard-speci®c IgE failed
to con®rm this mechanism.
1989;83:683±690.
Â
5. PARRA FM, LAZARO M, CUEVAS M, et al.
Bronchial asthma caused by two
unrelated vegetables. Ann Allergy
1993;70:324±327.
Hypersensitivity to Viburnum
rhytidophyllum
measurements.
Total serum IgE and speci®c IgE to
spinach, beet, chenopod, salsola, and
pro®lin (rBet v 1, rBet v 2) (Pharmacia CAP
System IgE FEIA, Pharmacia Diagnostics,
Uppsala, Sweden) were determined. Total
serum IgE was 74 KU/l, and speci®c IgE
determinations were all negative. We could
not determine speci®c IgE to Swiss chard
because the material is not commercially
available.
There are only two earlier references in
the literature dealing with Swiss chard-
related asthma (1, 5), but, to the best of our
knowledge, there has been no previous
attempt at allergen characterization in Swiss
chard. Moreover, in view of the inconclusive
result of our immunoblot, we want to
emphasize the dif®culty of identifying
allergens, especially in food hypersensitivity.
Therefore, we think that more studies are
needed.
P. Dambra*, E. Nettis, M. P. Loria, G. Riva,
A. Ferrannini, A. Tursi
Key words: angioedema; urticaria; Viburnum
rhytidophyllum.
. URTICARIA and angioedema may appear
after ingestion of
We tried to carry out a histamine-release
test with the antigens mentioned above by
the automated ¯uorometric method of
Siraganian and Hook, but it was not
conclusive because the patient's serum did
not release histamine with anti-IgE.
SDS±PAGE and IgE immunoblotting
with Swiss chard, salsola, and chenopod
pollen extracts were carried out (2). A band
of a peptide of 42 kDa in Swiss chard
extract was observed to bind with patient
serum in an experiment; this binding band
did not appear in chenopod or salsola
extracts, nor in control sera, indicating
speci®c IgE binding. We could not
foods and drugs, or
A case of possibly
after contact with or
allergic urticaria and
*C/ Witerico 5, port 6, 38D
28025 Madrid
inhalation of
angioedema.
allergens (1). We
Spain
report a patient who was polysensitized to
inhalant allergens and hypersensitive to the
ornamental plant Viburnum rhytidophyllum.
P.A., an 18-year-old man, suffered
urticaria, angioedema, and dyspnea
whenever he was near a plant (V.
rhytidophyllum) growing in his garden. This
plant is a member of the Caprifoliaceae
family and is not widespread. It has rough,
bullous leaves that are whitish and dusty on
the back.
Accepted for publication 18 January 2000
Allergy 2000: 55:511±512
Copyright # Munksgaard 2000
ISSN 0105-4538
References
1. DE LA HOZ B, FERNANDEZ-RIVAS M, QUIRCE
S, et al. Swiss chard hypersensitivity:
clinical and immunologic study. Ann
Allergy 1991;67:487±492.
reproduce this result in further experiments,
probably because the responsible epitope
identi®ed in our ®rst assay was a
The patient had no clinical manifestations
of respiratory allergy and had normal
C1INH levels and functions.
2. LAEMMLI UK. Cleavage of structural
proteins during the assembly of the head of
bacteriophage T4. Nature
conformational one, easily destroyed by the
SDS±PAGE technique, making it dif®cult to
reproduce this ®nding. Other authors (3, 4)
have pointed out the great lability and
instability of vegetable and fruit antigens,
resulting in great sensitivity to
He underwent a full allergologic
examination as follows:
1970;227:680±685.
1) Skin prick tests (SPT) with the common
inhalant allergens and foods were
done with a commercial SPT (Lofarma,
Milan, Italy). The positive results
are presented in Table 1.
È
Â
3. BJORKSTEN F, HALMEPURO L, HANNUKSELA
M, LAHTI A. Extraction and properties
of apple allergens. Allergy
1980;35:671±677.
physicochemical modi®cations.
4. ORTOLANI C, ISPANO M, PASTORELLO EA,
ANSALONI R, MAGRI GC. Comparison of
results of skin prick tests (with fresh foods
and commercial food extracts) and
RAST in 100 patients with oral allergy
We report a case of asthma, in which the
reaction after speci®c bronchial provocation
test con®rmed the causative role of Swiss
chard in the symptoms reported by the
2) A patch test (2) was done with the
plant's leaves. The patch preparations
were applied with Finn chambers
on Scampor (Bracco, Milan, Italy)
512