Kiwi Allergy Data

Allergen Data Collection - Update: Kiwi Fruit (Actinidia chinensis)
Internet Symposium on Food Allergens 2(Suppl.2): 1-11 (2000) [http://www.food-allergens.de]

1 Prevalence of Kiwi Fruit Allergy


Country / Subjects	Sensitivity to	References
*France, Pierre Benite* a) 580 patients with adverse reactions to food b) 60 cases of anaphylaxis (study period 1984-92)	a) kiwi fruit 11% b) kiwi fruit 3.3%	Andre et al. 1994
*France, Toulouse* 142 food allergic children	kiwi fruit 2.8% (Labial food challenge)	Rance & Dutau 1997
*Germany* 136 latex allergic patients	kiwi fruit 16% (RAST inhibition)	Brehler et al. 1997
*Germany* 30 patients with birch pollen associated fruit allergy	kiwi fruit 77% (EAST)	Möller et al. 1997b
*Italy, Florence* 54 episodes of food-dependent anaphylaxis in 44 children (age of 1 month to 16 years) (from 1994-1996)	kiwi fruit 5.6%	Novembre et al. 1998
*Italy, Florence* 15 spina bifida patients with latex allergy	kiwi fruit 27% (SPT), 0% (RAST)	Bernardini et al. 1999
*Italy, Genoa* 132 pollen and food sensitive patients	kiwi fruit 4.4% (incidents of hypersensitivity)	Troise et al. 1992
*Japan* 171 birchpollen allergic patients	kiwi fruit 3.5% (RAST)	Yamamoto et al. 1995
*Spain, Gran Canaria* 142 food allergic adults	kiwi fruit 9.9% (Clinical symptoms)	Castillo et al. 1996
*Spain, Madrid* 29 plant-derived food allergic patients	kiwi fruit 41% (SPT)	Diez-Gomez et al. 1999
*Switzerland, Zurich* 402 food allergic adults	kiwi fruit and apple 1.5%	Wüthrich 1993
*Switzerland, Zurich* 383 food allergic patients (study period 1990-94)	kiwi fruit 5.5%	Etesamifar & Wüthrich 1998
*Turkey, Ankara* 61 hospital employees, 40 atopic children	kiwi fruit 22 subjects (specific Serum-IgE)	Saraclar Y et al. 1998
*USA* 33 latex allergic patients with associated food allergy	kiwi fruit 17% (Skin Prick Test)	Beezhold et al. 1996
*USA, Long Beach, CA* 137 patients with latex allergy	kiwi 12.2% (convincing history after ingestion)	Kim & Hussain 1999

2 Symptoms of Kiwi Fruit Allergy

Symptoms & Case Reports References

systemic reactions
anaphylaxis (2, 3, 6, 7, 11, 13), severe generalized symptoms (1)
cutaneous symptoms
angioedema (13), contact urticaria (5), localized pruritic reaction (4), rhinitis (9), urticaria (4, 9, 13)
gastrointestinal symptoms
dysphagia (4), itching of mouth and throat (9), oral allergy syndrome* (10, 11, 13), oral and pharyngeal hypersensitivities (8), acute pancreatitis (12), swelling of lips (9), vomiting (4)
* symptoms, which could be involved in oral allergy syndrome: local symptoms as intra-oral and lip-irritation, angioedema and systemic symptoms as rhino-conjunctivitis, urticaria-angioedema, asthma, and anaphylaxis
(1) Fine 1981
(2) Falliers 1983
(3) Freye 1989
(4) Garcia et al. 1989
(5) Veraldi & Schianchi-Veraldi 1990
(6) Novembre et al. 1995
(7) Shimizu & Morikawa 1995
(8) Yamamoto et al. 1995
(9) Möller et al. 1997b
(10) Arai et al. 1998
(11) Fahlbusch et al. 1998
(12) Gastaminza et al. 1998
(13) Diez-Gomez et al. 1999

Symptoms & Case Reports	References
systemic reactions anaphylaxis (2, 3, 6, 7, 11, 13), severe generalized symptoms (1) cutaneous symptoms angioedema (13), contact urticaria (5), localized pruritic reaction (4), rhinitis (9), urticaria (4, 9, 13) gastrointestinal symptoms dysphagia (4), itching of mouth and throat (9), oral allergy syndrome* (10, 11, 13), oral and pharyngeal hypersensitivities (8), acute pancreatitis (12), swelling of lips (9), vomiting (4) * symptoms, which could be involved in oral allergy syndrome: local symptoms as intra-oral and lip-irritation, angioedema and systemic symptoms as rhino-conjunctivitis, urticaria-angioedema, asthma, and anaphylaxis	(1) Fine 1981 (2) Falliers 1983 (3) Freye 1989 (4) Garcia et al. 1989 (5) Veraldi & Schianchi-Veraldi 1990 (6) Novembre et al. 1995 (7) Shimizu & Morikawa 1995 (8) Yamamoto et al. 1995 (9) Möller et al. 1997b (10) Arai et al. 1998 (11) Fahlbusch et al. 1998 (12) Gastaminza et al. 1998 (13) Diez-Gomez et al. 1999

3 Diagnostic Features

Parameters / Subjects Outcome References

IgE and Clinical Symptoms
22 kiwi allergic patients Patients with severe clinical symptoms to kiwi fruit had moderately elevated IgE levels to kiwi fruits, whereas those with mild localized symptoms had no detectable IgE to kiwi fruits Gall et al. 1994

IgE and Clinical Symptoms
3 case reports of kiwi hypersensitivity reactions without elevated specific serum IgE- levels (1) localized pruritic reaction, dysphagia, vomiting and urticaria (RAST 0.35 AEU/mL)
(2) anaphylaxis after kiwi ingestion (RAST 0.87 kU/L)
(3) gastrointestinal symptoms (RAST <0.35 kU/L) (1) Garcia et al. 1989
(2) Fahlbusch et al. 1998
(3) Möller et al. 1998

Symptoms during Prick Test
6 kiwi allergic patients 2 of 6 patients had systemic allergic symptoms during prick by prick testing with kiwi pulp Huertas et al. 1999

Parameters / Subjects	Outcome	References
*IgE and Clinical Symptoms* 22 kiwi allergic patients	Patients with severe clinical symptoms to kiwi fruit had moderately elevated IgE levels to kiwi fruits, whereas those with mild localized symptoms had no detectable IgE to kiwi fruits	Gall et al. 1994
*IgE and Clinical Symptoms* 3 case reports of kiwi hypersensitivity reactions without elevated specific serum IgE- levels	(1) localized pruritic reaction, dysphagia, vomiting and urticaria (RAST 0.35 AEU/mL) (2) anaphylaxis after kiwi ingestion (RAST 0.87 kU/L) (3) gastrointestinal symptoms (RAST <0.35 kU/L)	(1) Garcia et al. 1989 (2) Fahlbusch et al. 1998 (3) Möller et al. 1998
*Symptoms during Prick Test* 6 kiwi allergic patients	2 of 6 patients had systemic allergic symptoms during prick by prick testing with kiwi pulp	Huertas et al. 1999

4 Composition of Kiwi Fruit

5 Allergens of Kiwi Fruit

Proteins / Glycoproteins Allergen Nomenclature References

Actinidin (30 kDa) Act c 1 Pastorello et al. 1998

43-kDa Allergen Act c 2 * Möller et al. 1997a

41-kDa Allergen (Putative chitinase) Diaz-Perales et al. 1999

Allergens: 13, 22, 30, 67 kDa Möller et al. 1997b

Allergens: 10-12 kDa, 20-25 kDa Voitenko et al. 1997

Allergens: 12, 17, 24, 28 kDa Pastorello et al. 1996, 1998

Allergens: 23, 30, 43, 80, 92 kDa Fahlbusch et al. 1998

12 Allergens: 15-94 kDa Rudeschko et al. 1998

* proposed name not yet listed in WHO/IUIS Allergen Nomenclature

5.1 Sensitization to Kiwi Fruit Allergens

Country / Subjects Sensitivity to References

Germany, Hamburg
22 kiwi allergic patients 67-kDa Allergen 55%
43-kDa Allergen 68%
30-kDa Allergen 19%
22-kDa Allergen 31%
13-kDa Allergen 9%
(SDS-PAGE / immunoblot) Möller et al. 1997b

Germany, Jena
9 kiwi allergic patients 92-kDa Allergen 22%
80-kDa Allergen 44%
43-kDa Allergen 44%
30-kDa Allergen 89%
23-kDa Allergen 56%
(SDS-PAGE / immunoblot) Fahlbusch et al. 1998

Italy, Milan
30 kiwi allergic patients 30-kDa Allergen (Act c 1) 100%
22-, 24-, 28-, 32-, 38-, and 41-kDa Allergens in 30 to 50%
12-, 14-, 17-, 20-, and 64-kDa Allergens in <30%
(SDS-PAGE / immunoblot) Pastorello et al. 1996

5.2 Properties of Actinidin
5.3 Properties of 43-kDa-Allergen

6 Isolation & Preparation

Extract / Purified Allergens Methods References

Protein Extract fresh fruit homogenized in acetone (-40°C), precipitates washed, filtered, lyophylized and water extracted Möller et al. 1997a

Protein Extract comparison of extraction buffers: phosphate- buffered saline and
borate- buffered saline Voitenko et al. 1997

Protein Extract fresh fruit homogenized in phosphate buffer saline, centrifuged and dialyzed Fahlbusch et al. 1998

Protein Extract fresh fruit homogenized in phosphate buffer, centrifuged and dialyzed Pastorello et al. 1998

Actinidin covalent chromatography (thiol-disulfide interchange) Thomas et al. 1995

43-kDa-Allergen (Act c 2) IEC, SDS-PAGE / electroelution Möller et al. 1997a

30-kDa-Allergen (Act c 1) IEC purification Fahlbusch et al. 1998

30-kDa-Allergen (Act c 1) and 17, 24, 28-kDa Allergens IEC purification Pastorello et al. 1998

Extract / Purified Allergens	Methods	References
Protein Extract	fresh fruit homogenized in acetone (-40°C), precipitates washed, filtered, lyophylized and water extracted	Möller et al. 1997a
Protein Extract	comparison of extraction buffers: phosphate- buffered saline and borate- buffered saline	Voitenko et al. 1997
Protein Extract	fresh fruit homogenized in phosphate buffer saline, centrifuged and dialyzed	Fahlbusch et al. 1998
Protein Extract	fresh fruit homogenized in phosphate buffer, centrifuged and dialyzed	Pastorello et al. 1998
Actinidin	covalent chromatography (thiol-disulfide interchange)	Thomas et al. 1995
43-kDa-Allergen (Act c 2)	IEC, SDS-PAGE / electroelution	Möller et al. 1997a
30-kDa-Allergen (Act c 1)	IEC purification	Fahlbusch et al. 1998
30-kDa-Allergen (Act c 1) and 17, 24, 28-kDa Allergens	IEC purification	Pastorello et al. 1998

7 Cross-Reactivities

Cross-Reacting Allergens Subjects / Methods References

Kiwi Fruit
hazelnuts, rye grain 2 kiwi allergic patients (RAST inhibition) Seifert et al. 1988

Kiwi Fruit
hazelnuts, poppy seeds, sesame seeds, rye grain 8 patients with food / pollen allergy
(immunoblot inhibition) Vocks et al. 1993

Kiwi Fruit
birch, grass and, mugwort pollen, apple, potato 2 kiwi allergic patients (1)
3 kiwi allergic patients (2)
(RAST inhibition) (1) Gall et al. 1990
(2) Gall et al. 1994

Kiwi Fruit
60 kDa mugwort allergen (Art v 1) patients with food / pollen allergy
(RAST inhibition) Heiss et al. 1996

Kiwi Fruit
latex 3 and 4 kiwi and latex allergic patients
(RAST inhibition) Brehler et al. 1997

Kiwi Fruit
*potentially cross- reactive latex allergen: Hev b 5 Hev b 5, an acidic 16-kDa allergen in latex from Hevea brasiliensis with pI=3.5 shows a high degree of homology in the amino acid sequence (47% sequence identity) to an acidic protein from kiwi fruit* Akasawa et al. 1996

Kiwi Allergens
a) timothy pollen, b) birch pollen Pooled serum and 6 sera from kiwi allergic patients:
a) Inhibition of IgE- binding to 22, 38, and 41 kDa kiwi allergens by timothy pollen extract;
b) Inhibition of IgE- binding to 14, 22, 24, 38, and 41 kDa kiwi allergens by birch pollen extract (immunoblot inhibition) Pastorello et al. 1996

Kiwi Allergens (43, 67 kDa)
birch pollen (68-kDa-Allergen), apple (67-kDa-Allergen), carrot, celery 7 kiwi allergic patients (immunoblot inhibition) Möller et al. 1997b

Kiwi Allergens (10-12 kDa)
birch pollen 15 birch pollen allergic patients (immunoblot inhibition) Voitenko et al. 1997

Kiwi Fruit (23-92 kDa)
birch pollen, birch pollen carbohydrates 2 kiwi allergic patients: 23-, 43-, 80-, and 92-kDa kiwi allergens were inhibited by birch pollen extract (immunoblot inhibition)
Inhibition of IgE- binding to kiwi extract by birch pollen carbohydrates (proteinase-K digested birch pollen, ELISA inhibition) Fahlbusch et al. 1998

Kiwi Allergens (43, 67 kDa)
avocado, banana, latex 5 kiwi allergic patients (immunoblot inhibition) Möller et al. 1998

Kiwi Fruit (15-94 kDa)
birch, timothy, rye, and
mugwort pollen 22 kiwi allergic patients (immunoblot inhibition) Rudeschko et al. 1998

Kiwi Allergen (41 kDa)
avocado allergen (Prs a 1, chitinase class I), latex extract Pooled serum from latex- fruit allergic patients: Inhibition of IgE- binding to 41-kDa kiwi allergen by Prs a 1 from avocado and by latex extract (immunoblot inhibition) Diaz-Perales et al. 1999

* not proven by inhibition-tests

Unique Allergens Subjects / Methods References

Kiwi Fruit / Birch Pollen
30-kDa allergen not cross- reactive to birch pollen extract 1 kiwi allergic patient with and 1 without birch pollen allergy, respectively (immunoblot inhibition) Fahlbusch et al. 1998

Kiwi Fruit
latex Children with atopic dermatitis: cross inhibition between kiwi and latex <25% in 12 latex sensitized patients (latex and avocado 100%);
no significant difference in sensitization to kiwi in 12 latex sensitized children and 20 children without specific latex IgE (RAST, RAST inhibition) Tucke et al. 1999

Cross-Reacting Allergens	Subjects / Methods	References
*Kiwi Fruit* hazelnuts, rye grain	2 kiwi allergic patients (RAST inhibition)	Seifert et al. 1988
*Kiwi Fruit* hazelnuts, poppy seeds, sesame seeds, rye grain	8 patients with food / pollen allergy (immunoblot inhibition)	Vocks et al. 1993
*Kiwi Fruit* birch, grass and, mugwort pollen, apple, potato	2 kiwi allergic patients (1) 3 kiwi allergic patients (2) (RAST inhibition)	(1) Gall et al. 1990 (2) Gall et al. 1994
*Kiwi Fruit* 60 kDa mugwort allergen (Art v 1)	patients with food / pollen allergy (RAST inhibition)	Heiss et al. 1996
*Kiwi Fruit* latex	3 and 4 kiwi and latex allergic patients (RAST inhibition)	Brehler et al. 1997
*Kiwi Fruit* *potentially cross- reactive latex allergen: Hev b 5	Hev b 5, an acidic 16-kDa allergen in latex from Hevea brasiliensis with pI=3.5 shows a high degree of homology in the amino acid sequence (47% sequence identity) to an acidic protein from kiwi fruit*	Akasawa et al. 1996
*Kiwi Allergens* a) timothy pollen, b) birch pollen	Pooled serum and 6 sera from kiwi allergic patients: a) Inhibition of IgE- binding to 22, 38, and 41 kDa kiwi allergens by timothy pollen extract; b) Inhibition of IgE- binding to 14, 22, 24, 38, and 41 kDa kiwi allergens by birch pollen extract (immunoblot inhibition)	Pastorello et al. 1996
*Kiwi Allergens* (43, 67 kDa) birch pollen (68-kDa-Allergen), apple (67-kDa-Allergen), carrot, celery	7 kiwi allergic patients (immunoblot inhibition)	Möller et al. 1997b
*Kiwi Allergens* (10-12 kDa) birch pollen	15 birch pollen allergic patients (immunoblot inhibition)	Voitenko et al. 1997
*Kiwi Fruit* (23-92 kDa) birch pollen, birch pollen carbohydrates	2 kiwi allergic patients: 23-, 43-, 80-, and 92-kDa kiwi allergens were inhibited by birch pollen extract (immunoblot inhibition) Inhibition of IgE- binding to kiwi extract by birch pollen carbohydrates (proteinase-K digested birch pollen, ELISA inhibition)	Fahlbusch et al. 1998
*Kiwi Allergens* (43, 67 kDa) avocado, banana, latex	5 kiwi allergic patients (immunoblot inhibition)	Möller et al. 1998
*Kiwi Fruit* (15-94 kDa) birch, timothy, rye, and mugwort pollen	22 kiwi allergic patients (immunoblot inhibition)	Rudeschko et al. 1998
*Kiwi Allergen* (41 kDa) avocado allergen (Prs a 1, chitinase class I), latex extract	Pooled serum from latex- fruit allergic patients: Inhibition of IgE- binding to 41-kDa kiwi allergen by Prs a 1 from avocado and by latex extract (immunoblot inhibition)	Diaz-Perales et al. 1999

Unique Allergens	Subjects / Methods	References
*Kiwi Fruit / Birch Pollen* 30-kDa allergen not cross- reactive to birch pollen extract	1 kiwi allergic patient with and 1 without birch pollen allergy, respectively (immunoblot inhibition)	Fahlbusch et al. 1998
*Kiwi Fruit* latex	Children with atopic dermatitis: cross inhibition between kiwi and latex <25% in 12 latex sensitized patients (latex and avocado 100%); no significant difference in sensitization to kiwi in 12 latex sensitized children and 20 children without specific latex IgE (RAST, RAST inhibition)	Tucke et al. 1999

8 Posttranslational Modifications

Modification Methods References

Carbohydrate Structures
Specific binding to carbohydrate epitopes by 5 out of 7 sera from kiwi allergic patients Preincubation of kiwi extract with periodate in order to destroy carbohydrate structures: 15 to 80% reduction of IgE- binding (EAST) Fahlbusch et al. 1998

Carbohydrate Structures
Specific binding to carbohydrate epitopes by 4 out of 5 sera from kiwi allergic patients Preincubation of sera with proteinase-K digested kiwi extract to obtain cross- reactive carbohydrates: IgE (EAST inhibition) Fahlbusch et al. 1998

Carbohydrate Structures
{alpha}-fucose moieties in 35-, 43-, 50-, 60-, 80-, and 92-kDa proteins Immunodection by lectin binding from Aleuria aurantia (SDS-PAGE immunoblot) Fahlbusch et al. 1998

Asparagine-linked Glycans
in 41-kDa kiwi allergen Detection of complex asparagine- linked glycans by class I and II chitinase- specific mAb (rabbit); IgE- binding by pooled serum from latex- fruit allergic patients (SDS-PAGE immunoblot) Diaz-Perales et al. 1999

Modification	Methods	References
*Carbohydrate Structures* Specific binding to carbohydrate epitopes by 5 out of 7 sera from kiwi allergic patients	Preincubation of kiwi extract with periodate in order to destroy carbohydrate structures: 15 to 80% reduction of IgE- binding (EAST)	Fahlbusch et al. 1998
*Carbohydrate Structures* Specific binding to carbohydrate epitopes by 4 out of 5 sera from kiwi allergic patients	Preincubation of sera with proteinase-K digested kiwi extract to obtain cross- reactive carbohydrates: IgE (EAST inhibition)	Fahlbusch et al. 1998
*Carbohydrate Structures* {alpha}-fucose moieties in 35-, 43-, 50-, 60-, 80-, and 92-kDa proteins	Immunodection by lectin binding from Aleuria aurantia (SDS-PAGE immunoblot)	Fahlbusch et al. 1998
*Asparagine-linked Glycans* in 41-kDa kiwi allergen	Detection of complex asparagine- linked glycans by class I and II chitinase- specific mAb (rabbit); IgE- binding by pooled serum from latex- fruit allergic patients (SDS-PAGE immunoblot)	Diaz-Perales et al. 1999

9 Stability of Kiwi Allergens

Treatment Effects References

Kiwi Fruit
heat: 40, 60, 80, and 90°C (microwave)
3 kiwi-allergic patients Prick-test:
decrease of activity with increasing temperature,
90°C: complete loss of activity in 2 patients Gall et al. 1993

Treatment	Effects	References
*Kiwi Fruit* heat: 40, 60, 80, and 90°C (microwave) 3 kiwi-allergic patients	Prick-test: decrease of activity with increasing temperature, 90°C: complete loss of activity in 2 patients	Gall et al. 1993

10 References

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Yamamoto T, Kukuminato Y, Nui I, Takada R, Hirao M, Kamimura M, Saitou H, Asakura K, Kataura A (1995) Relationship between birch pollen allergy and oral and pharyngeal hypersensitivity to fruit Nippon Jibiinkoka Gakkai Kaiho 98(7):1086-91 (in Japanese)

Proteins / Glycoproteins	Allergen Nomenclature	References
Actinidin (30 kDa)	Act c 1	Pastorello et al. 1998
43-kDa Allergen	Act c 2 *	Möller et al. 1997a
41-kDa Allergen (Putative chitinase)		Diaz-Perales et al. 1999
Allergens: 13, 22, 30, 67 kDa		Möller et al. 1997b
Allergens: 10-12 kDa, 20-25 kDa		Voitenko et al. 1997
Allergens: 12, 17, 24, 28 kDa		Pastorello et al. 1996, 1998
Allergens: 23, 30, 43, 80, 92 kDa		Fahlbusch et al. 1998
12 Allergens: 15-94 kDa		Rudeschko et al. 1998