Pineapple

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Code: f210
Latin name: Ananas comosus
Source material: Whole fresh fruit
Family: Bromeliaceae
Common names: Pineapple, Ananas, Piña

See also: Bromelain nAna c 2 k202

Food

A food, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Pineapple is the tropical fruit of a perennial herb, the only bromeliad in widespread agricultural cultivation. Hundreds of varieties of pineapple exist, but only a few are commercially important. Pineapple farming spread from the areas that are now southern Brazil and Paraguay to many tropical locales. At present, Hawaii is the world leader in pineapple production.

The name reflects the fruit’s similarity to very large pine cones; it is ovoid, with a tough, brownish, tessellated rind. Hard, long, spiky leaves form a tuft at the top. The pineapple is a multiple fruit, with many spirally-arranged flowers along the axis, each producing a fleshy fruit that presses against the fruits of adjacent flowers and congeals with them to form a single fleshy fruit. The fruit is yellow, very juicy, sweet to acidic, and with a distinctly rich taste.

Because of difficulties in storage, transport, and control of ripening, and because it is awkward to cut, fresh Pineapple is expensive and not common in comparison to other fresh tropical fruits. But it is often tinned and is available as a juice or in juice combinations. Tinned pineapple is often used in desserts, salads, meat dishes and 'fruit cocktail'. Pineapple enzymes are useful in marinades and meat tenderisers, and have various industrial uses. Pineapple is a topical  anti-inflammatory and proteolytic remedy.

Allergen Description 

The following allergen(s) have been characterised:

Ana c 1, a profilin. (1, 2)

Ana c 2, Bromelain, a protease. (1, 3, 4, 5)

A chitinase protein has been shown to be present in pineapple stems, fruit and leaves. It is produced following ethylene induction. (6, 7) Its allergenic potential was not evaluated.

The presence of a lipid transfer protein has been reported, but the allergen has not been characterised. (8)

Ana c 1 (a profilin) and banana profilin have been shown to have a 71-84% sequence identity to other known pollen and ingested profilins. Recombinant profilin was shown to bind to specific IgE in 8 of 19 pineapple-allergic subjects. High cross-reactivity to the birch pollen profilin Bet v 2 and the latex profilin Hev b 8 was demonstrated. (2)

Ana c 2, Bromelain, is a protease. The pineapple plant has been shown to contain at least 4 distinct cysteine proteinases. The major proteinase present in extracts of the plant stem is stem Bromelain, while fruit Bromelain was the major proteinase in the fruit. Two additional cysteine proteinases have been detected only in the stem: ananain and comosain. Stem Bromelain, fruit Bromelain, and ananain were shown to be immunologically distinct. (4)

As Bromelain-cross-reactive carbohydrate determinants have been shown to cross-react with several glycoallergens, Bromelain can be used to detect IgE to the carbohydrate side-chain of glycoproteins.

Potential Cross-Reactivity

Cross-reactivity with latex was demonstrated in a study with latex-allergic patients, where 19% exhibited IgE antibodies to pineapple, as demonstrated by the Phadia ImmunoCAP® System. (11) Cross-reactivity has also been found with perennial rye grass pollen, and with papain. (5, 16, 17)

As a result of the profilin present in pineapple, cross-reactivity with banana, bell pepper, celery and pineapple may occur, as seen in latex-fruit syndrome. (2) In patients with tomato allergy who are sensitised to other foods and birch pollen, IgE directed against tomato profilin (rLyc e 1) showed strong cross-reactivity with profilin from birch (Bet v 2), celery (Api g 4), sweet cherry (Pru av 4), pineapple (Ana c 1), banana (Mus xp 1), and carrot (Dau c 4). (9)

Banana and pineapple profilin have a high amino acid sequence identity to known allergenic pollen and food profilins (71-84%). IgE binding to the recombinant profilin was demonstrated in 7 of 16 sera from subjects with suspected banana allergy (44%), and in 8 of 19 sera from subjects with suspected pineapple allergy (42%). High cross-reactivity to the birch pollen profilin Bet v 2 and the latex profilin Hev b 8 was demonstrated. The authors concluded that, since such a high IgE-binding prevalence was observed in both banana and pineapple allergy, profilin is an important mediator of IgE cross-reactivity between pollen and exotic fruits. (2)

In a study of 200 consecutive patients with pollen allergy who underwent skin-prick tests with purified natural date palm profilin (Pho d 2), 60 patients (30%) showed skin reactivity to Pho d 2. All were sensitised to grass pollen, and most reacted to birch, mugwort, ragweed and plantain pollen as well. The large majority of profilin-allergic patients reported oral allergy syndrome as the only food-induced symptom, and were able to tolerate the offending foods if they were cooked or otherwise processed. Twenty-eight of 34 reported reactivity to 2 or more plant-derived foods. Rosaceae, tree nuts, melon and watermelon, tomato, pineapple, citrus fruits and banana were the more frequently offending foods. The authors suggest that profilin should therefore be considered a clinically relevant food allergen. Allergy to melon, watermelon, tomato, banana, pineapple and orange may be considered to be a marker of profilin hypersensitivity. (10)

Cross-reactivity between latex, pineapple and other foods may occur due to cross-reactive allergens. This association has been termed ‘latex-fruit syndrome’. (11, 12, 13)

Cross-reactivity has been reported to occur between apricot, avocado, banana, cherry, chestnut, grape, kiwi, papaya, passion fruit, peach and pineapple. (14)

Kiwi fruit, papaya, avocado, pineapple, fig and banana may be associated with sensitisation to Ficus benjamina allergens. (15)

Clinical Experience

IgE-mediated reactions

Ingestion of pineapple has been reported to cause asthma, rhinitis and gastrointestinal symptoms. (2, 5, 16, 17, 18) Angioedema and shock have also been observed. (11, 16) One study reports that pineapple is one of the most common self-reported triggers of atopic dermatitis. (19)

A cross-sectional, descriptive, questionnaire-based survey was conducted in Toulouse (France) schools to determine the prevalence of food allergies among schoolchildren. It was reported that, out of 2 716 questionnaires returned, 192 reported a food allergy. Of these, 7 reported adverse reactions to pineapple. (20)

A study was conducted at 17 clinics in 15 European cities to evaluate the differences between some Northern countries regarding what foods, according to the patients, elicit hypersensitivity symptoms. According to questionnaires administered to food-allergic individuals concerning 86 different foods, the foods that most often elicited symptoms in Russia, Estonia, and Lithuania were citrus fruits, chocolate, honey, apple, hazelnut, strawberry, fish, tomato, hen’s egg, and cow’s milk; a situation that differed from that of Sweden and Denmark, where birch pollen-related foods such as nuts, apple, pear, kiwi, stone fruits, and carrot were the most common reported causes. The most common symptoms reported were oral allergy syndrome and urticaria. Birch pollen-related foods dominated as reported culprits in Scandinavia, whereas some mugwort-related foods were of more importance in Russia and the Baltic States. Out of 1 139 individuals, pineapple was the 26th most commonly reported food, resulting in adverse effects in 18%. (21)

Of 32 patients who became symptomatic shortly after they had eaten pineapple, most complained of intense itching and urticarial rashes, followed by abdominal pain, vomiting and diarrhoea; 68% became symptomatic within half an hour of eating pineapple; 20 presented with shock. (16)

Other reactions

See Bromelain k202.

The protease Bromelain from pineapple is used frequently in industry as an enzyme, and may result in occupational allergy. A study reviews the literature concerning occupational airway sensitisation due to Bromelain. (22)

Bromelain is a natural mixture of proteolytic enzymes derived from the pineapple stem and has been shown to have anti-inflammatory activity when administered orally. Although most proteins given orally without an adjuvant (which would usually be food) are tolerated, researchers previously reported that long-term oral exposure to Bromelain stimulated the development of serum anti-Bromelain antibody titers. (23)

Compiled by Dr Harris Steinman, harris@allergyadvisor.com

References

  1. International Union of Immunological Societies Allergen Nomenclature: IUIS official list http://www.allergen.org/. Accessed November 2012.
  2. Reindl J, Rihs HP, Scheurer S, Wangorsch A, Haustein D, Vieths S. IgE reactivity to profilin in pollen-sensitized subjects with adverse reactions to banana and pineapple. Int Arch Allergy Immunol 2002;128(2):105-14.
  3. Pike RN, Bagarozzi D Jr, Travis J. Immunological cross-reactivity of the major allergen from perennial ryegrass (Lolium perenne), Lol p I, and the cysteine proteinase, bromelain. Int Arch Allergy Immunol 1997;112(4):412-4.
  4. Rowan AD, Buttle DJ, Barrett AJ. The cysteine proteinases of the pineapple plant. Biochem J 1990;266(3):869-75.
  5. Baur X, Fruhmann G. Allergic reactions, including asthma, to the pineapple protease bromelain following occupational exposure. Clin Allergy 1979;9(5):443-50.
  6. Taira T, Toma N, Ichi M, Takeuchi M, Ishihara M. Tissue distribution, synthesis stage, and ethylene induction of pineapple (Ananas comosus) chitinases. Biosci Biotechnol Biochem 2005;69(4):852-4.
  7. Taira T, Toma N, Ishihara M. Purification, characterization, and antifungal activity of chitinases from pineapple (Ananas comosus) leaf. Biosci Biotechnol Biochem 2005;69(1):189-96.
  8. Asero R, Mistrello G, Roncarolo D, Amato S. Detection of some safe plant-derived foods for LTP-allergic patients. Int Arch Allergy Immunol 2007;144(1):57-63.
  9. Westphal S, Kempf W, Foetisch K, Retzek M, Vieths S, Scheurer S. Tomato profilin Lyc e 1: IgE cross-reactivity and allergenic potency. Allergy 2004;59(5):526-32.
  10. Asero R, Monsalve R, Barber D. Profilin sensitization detected in the office by skin prick test: a study of prevalence and clinical relevance of profilin as a plant food allergen. Clin Exp Allergy 2008;38(6):1033-7.
  11. Brehler R, Theissen U, Mohr C, Luger T. "Latex-fruit syndrome": frequency of cross-reacting IgE antibodies. Allergy 1997;52(4):404-10.
  12. Bernardini R, Novembere E, Brizzi I, Bertini G, Mariani E, Vierucci A. Latex allergy in children: description of two cases. [Italian] Pediatr Med Chir 1995;17(2):169-71.
  13. Asero R, Mistrello G, Roncarolo D, Amato S, Falagiani P. Detection of novel latex allergens associated with clinically relevant allergy to plant-derived foods J Allergy Clin Immunol 2005;115(6):6-1314.
  14. Twarog FJ. Food-induced allergy in childhood. Allergy Asthma Proc 1998;19(4):219-22.
  15. Focke M, Hemmer W, Wohrl S, Gotz M, Jarisch R. Cross-reactivity between Ficus benjamina latex and fig fruit in patients with clinical fig allergy. Clin Exp Allergy 2003;33(7):971-7.
  16. Kabir I, Speelman P, Islam A. Systemic allergic reaction and diarrhoea after pineapple ingestion. Tropical Geographical Med 1993;45:77-9.
  17. Pike RN, Bagarozzi D Jr, Travis J. Immunological cross-reactivity of the major allergen from perennial ryegrass (Lolium perenne), Lol p I, and the cysteine proteinase, bromelain. Int Arch Allergy Immunol 1997;112(4):412-4.
  18. Zuidmeer L, Goldhahn K, Rona RJ, Gislason D, Madsen C, Summers C, Sodergren E, Dahlstrom J, Lindner T, Sigurdardottir ST, McBride D, Keil T. The prevalence of plant food allergies: a systematic review. J Allergy Clin Immunol 2008;121(5):1210-8.
  19. Steinman HA, Potter PC. The precipitation of symptoms by common foods in children with atopic dermatitis. Allergy Proc 1994;15(4):203-10.
  20. Rance F, Grandmottet X, Grandjean H. Prevalence and main characteristics of schoolchildren diagnosed with food allergies in France. Clin Exp Allergy 2005;35(2):167-72.
  21. Eriksson NE, Moller C, Werner S, Magnusson J, Bengtsson U, Zolubas M. Self-reported food hypersensitivity in Sweden, Denmark, Estonia, Lithuania, and Russia. J Investig Allergol Clin Immunol 2004;14(1):70-9.
  22. van Kampen V, Merget R, Brüning T. Occupational allergies to bromelain. [French] Pneumologie 2007;61(3):159-61.
  23. Hale LP, Fitzhugh DJ, Staats HF. Oral immunogenicity of the plant proteinase bromelain. Int Immunopharmacol 2006;6(13-14):2038-46.

 

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.