Carrot

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Code: f31
Latin name: Daucus carota
Source material: Fresh frozen juice
Family: Apiaceae
Common names: Carrot

Allergen Exposure

Geographical distribution
Carrot is a biennial, indigenous to Europe. This member of the Parsley family has lacy green foliage and long, slender, fleshy, orange storage roots, which are eaten raw or cooked. Wild Carrots have small, woody taproots, but cultivated varieties have been improved by selection and breeding. The best Carrots are young and slender.

Environment
Carrot is used in a wide range of foods, including soups and stews. It is rich in sugar and has been renowned for over 2000 years for health-giving properties, and recently for high vitamin A content.

Allergens
Various allergens have been detected, including 23, 31 and 42 kDa protein bands, and 2 weaker bands between 66 and 87 kDa (1). A number of these cross-react with pollen allergens due to the presence of panallergens (2).

The following allergens have been characterised:

  • Dau c 1, a 16 kDa (or 18 kDa (3)) protein, a Bet v 1-homologue, a major allergen (4-13).
     
  • Dau c 3, a lipid transfer protein, which is heat-stable (11,14-16).
     
  • Dau c 4, a 12 kDa protein, a profilin (4,11,16-21).
     
  • Dau c Cyclophilin, a 20 kDa protein (22).

A 35 kDa protein related to Bet v 5, an isoflavone reductase-related protein, has been detected (23-24). Its clinical relevance was not determined.

A Bet v 6-related food allergen of approximately 30-35 kDa, which is a phenylcoumaran benzylic ether reductase (PCBER) – a plant defence protein – has been detected (4,16,25).

The presence of cross-reactive carbohydrate determinants (CCDs) has been reported (4,11,16).

Among 26 subjects with allergy to Carrot, Dau c 1 was recognised by IgE from 85%; 45% were sensitised to cross-reactive carbohydrate determinants, and 20% to Carrot profilin. In 1 subject, a Bet v 6-related Carrot allergen was recognised. In 4 patients, IgE binding to Dau c 1 was not inhibited or was only weakly inhibited by rBet v 1 or Birch pollen extract. The authors suggest that the lack of inhibition of IgE binding to Dau c 1 by Birch pollen allergens in a subgroup of patients might indicate an secondary immune response to new epitopes on the food allergen that are not cross-reactive with Bet v 1 (5).

In a study of sera from 40 Carrot-allergic patients, 98% were positive to at least 1 recombinant Carrot allergen: 98% reacted to rDau c 1.0104, 65% to rDau c 1.0201, 38% to rDau c 4 and 20% had IgE against CCD (11).

Carrot lipid transfer protein (Dau c 3), thought to be relevant in Carrot allergy, is not present at detectable levels in the edible parts of Carrot. The absence of this protein may explain why Carrot allergy is very rare in Mediterranean, countries, where LTP sensitisation is common (26).

Dau c Cyclophilin has been shown to react with about 14% of Carrot-allergic patients’ sera. No cross-reactivity between this allergen and Bet v 7, a Birch pollen cylcophilin, was observed (22).

Carrot allergens are reported to be more stable to heat and processing influences than are Apple allergens (27).

Potential cross-reactivity
An extensive cross-reactivity among the different individual species of the Apiaceae family could be expected. Members include Carrot, Celery, Fennel, Anise, Caraway, Dill, Lovage and Parsley (10,28-29). Hypersensitivity to Carrot is also frequently associated with sensitisation to Birch and Mugwort pollen (10).

In European countries, vegetables belonging to the Apiaceae family are frequent causes of pollen-related food allergy (30-32). As up to 25% of food-allergic subjects in this region are allergic to Carrot (33), it is important to evaluate Carrot-allergic patients for allergic rhinitis and/or asthma. The most frequent instances of cross-reactivity with Carrot have been reported as being to Birch pollen, Celery, a number of other vegetables, and spices (34-36).

Cross-reactivity between members of the Apiaceae family and Birch pollen is due to panallergens, in this case proteins that share common epitopes with allergens from Birch tree, i.e., Bet v 1-like proteins and profilin (4,19). Carrot contains more than 1 allergen that is cross-reactive with Birch tree pollen allergens. Approximately 70% of Europeans who are allergic to Birch pollen may experience symptoms after consumption of cross-reactive foods. The most important cross-reactive allergen is Dau c 1, cross-reactive with Bet v 1, the major Birch pollen allergen, which occurs in pollens of several tree species, and in fruits and vegetables: Apple, stone fruits, Celery, Carrot, nuts, and Soybean (37).

Cross-reactivity between Mango, Mugwort pollen, Birch pollen, Celery, and Carrot has been reported and is based on allergens related to Bet v 1 and Art v 1, the major allergens of Birch and Mugwort pollen, respectively (38).

However, sensitisation to Bet v 1 does not mean certain cross-reactivity, as indicated by a study assessing IgE binding to different food allergens in 50 Bet v 1-positive patients. It was found that 99% reacted with Mal d 1 from Apple, 93% with Cor a 1 from Hazelnut, 59% with Api g 1 from Celery and 38% with Dau c 1 from Carrot. Conversely, patients with Birch pollen-related food allergy were predominantly sensitised to Bet v 1 homologues and less frequently recognised other allergens contained in both sources, such as profilins (39).

Some individuals may have allergy to Carrot without it being associated with Birch pollen allergy (36). This observation is supported by a study of 4 patients who demonstrated strong immediate systemic reactions after contact with or ingestion of raw Carrot, all of whom had significant levels of IgE antibodies to Carrot Dau c 1; but no IgE antibodies to Birch pollen were detected in any of them. Although the Carrot IgE-binding protein’s N-terminal sequence was homologous to that of Bet v 1 and to allergens previously described in Celery and other foods, the 4 patients studied were not sensitised to Birch pollen, and 3 of them tolerated fruit ingestion. The study concluded that sensitisation to Dau c 1 induces IgE antibodies that do not cross-react with Birch pollen allergens (3). This finding is supported by a study reporting that, although cross-reactivity of the major allergens of Cherry (Pru a 1),

Apple (Mal d 1), Pear (Pyr c 1), Celery (Api g 1) and Carrot (Dau c 1) was due to structural similarities reflected by high amino acid sequence identities with Bet v 1, IgE inhibition experiments with Mal d 1, Pru a 1 and Api g 1 demonstrated the presence of both common and different epitopes among the tested food allergens (40).

Minor Birch pollen allergens may also contribute to cross-reactivity: approximately 10-15% of Birch pollen-allergic individuals have IgE antibodies to a 35 kDa minor Birch pollen allergen, and cross-reactivity with proteins of comparable size from Carrot (along with Litchi, Mango, Banana, Orange, Apple, and Pear). This 35 kDa protein is immunologically independent of the major Birch pollen allergen Bet v 1 (41).

Profilin, a ubiquitous cross-reacting plant allergen related to Birch pollen Bet v 2, is also present in Carrot and may result in cross-reactivity (17-18). In an earlier study, ELISA inhibition assays demonstrated allergenic similarity among Celery, Cucumber, Carrot, and Watermelon. A 15 kDa protein band common to all 4 foods was demonstrated, and attributed to a protein now thought to be a profilin (42).

Cross-reactive patterns may vary among Birch pollen-allergic individuals and may be complex. Of 196 Birch pollen-hypersensitive patients with oral allergy syndrome (OAS), 195 had Apple and/or Hazelnut allergy, and 103 had Apiaceae sensitivity; only 1 patient had Apiaceae (Carrot, Celery, and Fennel) allergy alone. This study suggests that most Apiaceae determinants cross-react with Apple or Hazelnut determinants, whereas only some Apple or Hazelnut determinants cross-react with Apiaceae allergy determinants (43).

Carrot contains a lipid transfer protein, which may cross-react with LTP from several other plant-derived foods including Peach peel, Broccoli, Apple, Walnut, Hazelnut, Peanut, Corn, Rice and beer (14-15).

Carrot also contains a PCBER (phenyl-coumaran benzylic ether reductase), a plant defense protein related to the Birch pollen minor allergen Bet v 6. Cross-reactivity with other plant substances containing this allergen is possible, and these include Birch pollen, Pear, Apple, Peach, Orange, Litchi, Strawberry, Persimmon, and Zucchini (25,37).

Although the cyclophilin allergen detected in about 14% of Carrot-allergic patients’ sera was found to be homologous with other plant cyclophilins, no cross-reactivity between this Carrot allergen and Bet v 7, a Birch pollen cylcophilin, was observed (22).

Some individuals may also experience cross-reactivity to Mugwort. Carrot allergy associated with a sensitisation to Celery, spices, Mugwort, and Birch pollen is often referred to as the “Celery-Mugwort-spice-syndrome” or “Celery-Carrot-Birch-Mugwort-spice syndrome” (44-48). For instance, in a study of 26 patients with histories of allergy to Carrot, 22 reported pollinosis symptoms during the Birch flowering season, and 7 reported pollinosis symptoms during the Mugwort flowering season (4).

A number of studies have reported other relationships between Carrot and other foods or pollens but have not determined the molecular reasons for these. A relationship between Birch pollen allergy and sensitisation to Carrot, Hazelnut, Apple, Potato and Kiwi has been reported (49); also reported are cross-reactions among Celery, Carrot, Parsley, and Ragweed (50); allergy to Apple, Carrot and Potato in children with Birch pollen allergy (30); cross-reactions among Kiwi, Apple, and Hazelnut; and moderate reactions to Carrot and Potato (51).

RAST inhibition experiments demonstrated that Carrot does share allergens with Lettuce, although Carrot allergens are more potent than those of Lettuce (52).

Group 4 grass pollen allergens are 60 kDa glycoproteins recognised by 70% of patients sensitive to these pollens. In Timothy grass, Mugwort, and Birch pollens, these allergens are located in the cell wall, and in Timothy grass and Birch pollens additionally in the cytoplasm. In Peanut, Apple, and Celery and Carrot root, these occurred only in the cytoplasmic areas. Group 4-related allergens thus occur in pollens of unrelated plants and plant foods and may contribute to cross-reactivity in patients allergic to various pollens and plant foods (53).

Group 4 grass pollen allergens are 60 kDa glycoproteins recognised by 70% of patients sensitive to these pollens. In Timothy grass, Mugwort, and Birch pollens, these allergens were located in the cell wall, and in Timothy grass and Birch pollens additionally in the cytoplasm. In Peanut, Apple, and Celery and Carrot root, these occurred only in the cytoplasmic areas. Group 4-related allergens thus occur in pollens of unrelated plants and in plant food and may therefore contribute to cross-reactivity in patients allergic to various pollens and plant food (42).

Clinical Experience

IgE-mediated reactions
Carrot commonly induces symptoms of food allergy, oral allergy syndrome, and asthma in sensitised individuals (1,35,42-43,54-61). Allergy to Carrot is often associated with allergy to Birch pollen (30-32). Carrot allergy may occur in the elderly (62).

Carrot allergy has been reported to affect up to 25% of food-allergic subjects (33). In a Swiss study, Carrot was found to be the third-most-common food allergen, affecting 13% of food-allergic patients, and was more common than allergy to Hen’s egg or fish (63). In a similar study in Switzerland, in 173 patients with food allergy (predominantly adults), the most frequent food allergens were found to be Celery in 40.5%, Carrots (20%), Green beans (6%), eggs (21%), Milk and dairy products (20%), and fish (12%) (54). Similarly, in a German study, the most prevalent allergy was to Celery, in 44.5%, followed by Carrot (14.4%) (57). Other studies have demonstrated the high prevalence of Carrot allergy (64-65). In an Indian study of 24 children aged 3 to 15 years with documented deterioration in control of their perennial asthma, IgE antibodies to Carrot were documented in 21 (88%) (66).

The most frequently reported symptoms are oral allergy syndrome (35), but other symptoms include angioedema, urticaria, dyspnoea, vertigo, tightness of the throat or chest, dysphagia, hoarseness, conjunctivitis and rhinitis (4).

Allergy to Carrot may follow complex patterns. This is illustrated by a study that assessed the role of the Carrot allergen Dau c 1

in 3 patients with Carrot-induced asthma: Patient 1 had asthma when handling raw Carrot but was not sensitised to any pollens; Patient 2 experienced rhinoconjunctivitis due to grass, Olive pollen allergy, and asthma when handling raw Carrot; Patient 3 experienced rhinoconjunctivitis and asthma due to allergy to House dust mite, several pollens, and Cat, and asthma due to raw Carrot ingestion and inhalation. Patients 1 and 2 were shown to be sensitised to Dau c 1 from Carrot extract as well as to the recombinant rDau c 1. Bet v 1 from a Birch pollen extract was not recognised by either. Patient 3 were not sensitised to any of these allergens. Inhibition studies with Carrot showed 30% inhibition between Carrot and rDau c 1 in patient 1, nearly 100% inhibition between Carrot and rDau c 1 in patient 2, and no inhibition in patient 3. The study concluded that airborne Carrot allergens are able to sensitise without previous sensitisation to pollen. Dau c 1 was the main allergen in patient 2. In patient 1, there was a 30 kDa protein band that appeared to be the predominant allergen. Patients 1 and 2 were sensitised directly from Carrot allergens. In patient 3, Carrot allergy was not caused by Dau c 1 but seemed to be related to allergy to pollens other than Birch pollen (9).

A number of case reports further demonstrate how adverse reactions may vary among individual patients.

In a report on 2 patients with allergy to Carrot, 1 presented with sneezing, rhinorrhoea, contact urticaria on her hands and face, and coughing and wheezing after handling raw Carrots. She experienced no symptoms after eating cooked Carrots, but oropharyngeal itching, hoarseness, cough and wheezy dyspnoea occurred after eating raw Carrots. The second experienced oropharyngeal itching, a swollen throat, hoarseness and asthma after eating raw Carrots, and had similar but milder symptoms after eating cooked Carrots. She experienced itching of her hands, palpebral angioedema, ocular and nasal itching, and rhinorrhoea when handling raw Carrots. Bronchial provocation with Carrot extract elicited a FEV1 fall of 30% within 10 minutes (1).

A 34-year-old female cook experienced allergic rhinoconjunctivitis and contact urticaria with severe itching on both hands when she handled raw Carrot. The patient had had anaphylactic episodes after accidental ingestion of raw Carrots, but tolerated cooked Carrots. In this instance, monosensitisation to an 18 kDa protein in Carrot was reported (67).

Other studies have reported allergy to Carrot in adults. Two adult patients with respiratory and/or ocular symptoms from handling or eating Carrot and/or Lettuce were shown to have, on challenge, prolonged nasal obstruction and ocular symptoms (68).

A study of a 50-year-old non-pollen-allergic woman who presented with vomiting, diarrhoea, dyspnoea, and generalised urticaria to Carrot juice suggests that the allergen involved was a thermolabile, low-molecular-weight allergen, probably not related to any of the Carrot allergens identified so far (16).

A 38-year-old woman developed rhino-conjunctivitis, dyspnoea and general malaise after inhaling steam of cooking Green bean, Potato and Carrot. She reported contact dermatitis when preparing these vegetables. A bronchial provocation test with Carrot resulted in a FEV1 decrease, and in an intense cough and general malaise that lasted for more than 24 hours (12).

Although Carrot is frequently involved in food allergy and oral allergy syndrome, usually in association with other foods, it alone is rarely responsible for severe systemic reactions (69). Nevertheless, anaphylaxis has been described (70-71). As with other foods, anaphylaxis may occur to minute quantities of allergen, as described in an individual who developed anaphylactic shock due to the inadvertent ingestion of Carrot as a hidden allergen contained in ice cream (69).

Allergic manifestations in the skin have been reported. Contact urticaria to fresh Carrot has been described. A 16-year-old boy and a 45-year-old woman were reported on, the former with dermatitis and urticaria affecting the perioral area, hands and nape of the neck, and the latter with symptoms involving the face and hands. Individuals transfer the allergen to these areas through scratching or merely touching (72).

Allergic contact dermatitis from Carrot has been described. Exposure is usually occupational rather than domestic. Carrot is among the commonest causes of contact dermatitis of the hands (73-79).

A 38-year-old man experienced a single episode of facial allergic contact dermatitis, which developed after peeling and grating raw Carrots in the kitchen at home (74). In a study of 57 children under 1 year of age, 43 children aged 12 to 35 months, and 42 children aged 3 to 15 years with atopic dermatitis, they were skin-tested with foods suspected to have caused their dermatitis and other possible allergic symptoms. Hen’s egg was the most common food allergen in children under 1 year of age. After that age, Apple, Carrot, Pea, and Soybean elicited positive reactions as often as egg (73).

In a report, ingestion of 60 ml of freshly squeezed Carrot juice 2 hours after intake of 100 mg of aspirin induced striking angioedema and shortness of breath in an individual after 3 further hours, whereas a challenge with either on separate occasions did not result in any reaction (80).

Carrot has also been reported to result in eosinophilic cystitis (81).

Carrot may result in occupational allergy and is a cause of allergic dermatitis in the food industry (82). A 40-year-old female cook described sneezing, rhinorrhoea, contact urticaria and wheezing within few minutes of handling or cutting raw Carrot. Skin tests were positive to Carrot, Celery, Aniseed and Fennel. A rubbing test with fresh Carrot was positive. The level of IgE antibodies to Carrot was 4.44 kUA/l. A bronchial provocation test was positive, but instead of introducing the Carrot extract in the usual methodology, the patient was asked to peel and handle Carrot. She was shown to be sensitised to Dau c 1 and a 30 kDa Carrot protein thought possibly to correspond to a phenylcoumaran benzylic ether reductase (PCBER) (10).

In a study of the value of IgE antibody testing as compared to SPT for Carrot allergy, 20 of 26 patients were positive to Carrot in a DBPCFC study. IgE antibodies for Carrot (> 0.7 kUA/l) were demonstrated in 90%. The presence of skin reactivity tested through commercial extracts was shown in 26%, and through prick-to-prick tests with raw Carrot, in 100% (4).

Other reactions
Phytophotodermatitis is a phototoxic dermatitis resulting from contact with psoralen-containing plants such as Celery, Limes, Parsley, Figs, and Carrots (83-84).

Consuming large quantities of Carrots may result in inadvertent increased vitamin A intake, which may cause papilloedema, as described in a patient with documented idiopathic intracranial hypertension; she had consumed large quantities of raw Carrots as part of a fad diet (85). Another adverse effect of ingesting large quantities of Carrots, usually in the form of Carrot juice, is carotenaemia, also known as xanthoderma, in which the individual’s skin develops an orange colour (86). This has also been reported from the excessive consumption of Carrot products from nursing bottles in children ages 1 to 5 (87).

Carrot soup can be the cause of met-hemoglobinemia in infants (88-91). This appears to be due to the soup being rich in nitrate and nitrite (92). Fresh and canned Carrots have been reported to contain between 40 and 850 mg NO3/kg Carrot. Processed infant foods made of Carrots was found to contain between 55 and 215 mg NO3/kg (93).

Carrot has been reported to have monoamine oxidase inhibiting activity (94).

Carrot, though a common vegetable, has been involved in unusual clinical phenomena, including Carrot addiction (95). Air embolism occurred in a 40-year-old woman subsequent to vaginal insertion of a Carrot for an autoerotic purpose. The Carrot acted like a piston, displacing a sufficient amount of air to create an air embolism (96). This condition needs to be differentiated from anaphylaxis resulting from allergy to Carrot.

 
Compiled by Dr Harris Steinman, harris@zingsolutions.com

References

  1. Quirce S, Blanco R, Diez-Gomez ML, Cuevas M, Eiras P, Losada E. Carrot-induced asthma: immunodetection of allergens.
    J Allergy Clin Immunol 1997;99(5):718-9
  2. Ebner C, Hirschwehr R, Bauer L, Breiteneder H, Valenta R, Hoffmann K, Krebitz M, Kraft D, Scheiner O. Identification of allergens in apple, pear, celery, carrot and potato: cross-reactivity with pollen allergens. Monogr Allergy 1996;32:73-7
  3. Moneo I, Gomez M, Sanchez-Monge R, Alday E, de las Heras M, Esteban I, Bootello A, Salcedo G.
    Lack of crossreaction with Bet v 1 in patients sensitized to Dau c 1, a carrot allergen.
    Ann Allergy Asthma Immunol 1999;83(1):71-5
  4. International Union of Immunological Societies Allergen Nomenclature: IUIS official list http://www.allergen.org/List.htm 2008
  5. Ballmer-Weber BK, Wuthrich B, Wangorsch A, Fotisch K, Altmann F, Vieths S. Carrot allergy: double-blinded, placebo-controlled food challenge and identification of allergens.
    J Allergy Clin Immunol 2001;108(2):301-7
  6. Hoffmann-Sommergruber K, O’Riordain G, Ahorn H, Ebner C, Laimer Da Camara Machado M,
    Puhringer H, Scheiner O, Breiteneder H. Molecular characterization of Dau c 1, the Bet v 1 homologous protein from carrot and its cross-reactivity with Bet v 1 and Api g 1.
    Clin Exp Allergy 1999;29(6):840-7
  7. Reese G, Ballmer-Weber BK, Wangorsch A, Randow S, Vieths S. Allergenicity and antigenicity of wild-type and mutant, monomeric, and dimeric carrot major allergen Dau c 1: Destruction of conformation, not oligomerization, is the roadmap to save allergen vaccines.
    J Allergy Clin Immunol 2007;119(4):944-51
  8. Bollen MA, Garcia A, Cordewener JH, Wichers HJ, Helsper JP, Savelkoul HF, van Boekel MA. Purification and characterization of natural Bet v 1 from birch pollen and related allergens from carrot and celery.
    Mol Nutr Food Res 2007;51(12):1527-36
  9. Moreno-Ancillo A, Gil-Adrados AC, Cosmes PM, Dominguez-Noche C, Pineda F. Role of Dau c 1 in three different patterns of carrot-induced asthma. Allergol Immunopathol (Madr) 2006;
    34(3):116-20
  10. Moreno-Ancillo A, Gil-Adrados AC, Dominguez-Noche C, Cosmes PM, Pineda F. Occupational asthma due to carrot in a cook. Allergol Immunopathol (Madr) 2005;33(5):288-90
  11. Ballmer-Weber BK, Wangorsch A, Bohle B, Kaul S, Kundig T, Fotisch K, van RR, Vieths S. Component-resolved in vitro diagnosis in carrot allergy: Does the use of recombinant carrot allergens improve the reliability of the diagnostic procedure? Clin Exp Allergy 2005;35(7):7-978
  12. Agustin-Ubide MP, Martinez-Cocera C, Alonso-Llamazares A, Robledo T, Lombardero M, Dominguez J, Carballo MA. Diagnostic approach to anaphylaxis by carrot, related vegetables and horsetail (Equisetum arvense) in a homemaker. Allergy 2004;59(7):786-7
  13. Kazemi-Shirazi L, Pauli G, Purohit A, Spitzauer S,
    Froschl R, Hoffmann-Sommergruber K, Breiteneder H, Scheiner O, Kraft D, Valenta R. Quantitative IgE inhibition experiments with purified recombinant allergens indicate pollen-derived allergens as the sensitizing agents responsible for many forms of plant food allergy.
    J Allergy Clin Immunol 2000;105(1 Pt 1):116-25
  14. Asero R, Mistrello G, Roncarolo D, Amato S, van Ree R. A case of allergy to beer showing cross-reactivity between lipid transfer proteins.
    Ann Allergy Asthma Immunol 2001;87(1):65-7
  15. Asero R, Mistrello G, Roncarolo D, de Vries SC, Gautier MF, Ciurana CL, Verbeek E, Mohammadi T, Knul-Brettlova V, Akkerdaas JH, Bulder I, Aalberse RC, van Ree R. Lipid transfer protein: a pan-allergen in plant-derived foods that is highly resistant to pepsin digestion.
    Int Arch Allergy Immunol 2000;122(1):20-32
  16. Fernandez-Rivas M, Gonzalez-Mancebo E, van Leeuwen WA, Leon F, van Ree R. Anaphylaxis to raw carrot not linked to pollen allergy.
    Allergy 2004;59(11):1239-40
  17. Vallier P, Dechamp C, Vial O, Deviller P. Purification and characterization of an allergen from celery immunochemically related to an allergen present in several other plant species. Identification as a profilin.
    Clin Allergy 1992;22:774-82
  18. Valenta R, Duchene M, Ebner C, Valent P, Sillaber C, Deviller P, Ferreira F, Tejkl M, Edelmann H, Kraft D, et al. Profilins constitute a novel family of functional plant pan-allergens. J Exp Med 1992;175:377-85
  19. Ebner C, Hirschwehr R, Bauer L, Breiteneder H, Valenta R, Ebner H, Kraft D,Scheiner O. Identification of allergens in fruits and vegetables: IgE cross-reactivities with the important birch pollen allergens Bet v 1 and Bet v 2 (birch profilin).
    J Allergy Clin Immunol 1995;95(5 Pt 1):962-9
  20. Yamamoto M, Torikai S, Oeda K. A major root protein of carrots with high homology to intracellular pathogenesis-related (PR) proteins and pollen allergens.
    Plant Cell Physiol 1997;38(9):1080-6
  21. van Ree R, Voitenko V, van Leeuwen WA, Aalberse RC. Profilin is a cross-reactive allergen in pollen and vegetable foods.
    Int Arch Allergy Immunol 1992;98(2):97-104
  22. Fujita C, Moriyama T, Ogawa T. Identification of cyclophilin as an IgE-binding protein from carrots.
    Int Arch Allergy Immunol 2001;125(1):44-50
  23. Karamloo F, Schmitz N, Scheurer S, Foetisch K, Hoffmann A, Haustein D, Vieths S. Molecular cloning and characterization of a birch pollen minor allergen, Bet v 5, belonging to a family of isoflavone reductase-related proteins.
    J Allergy Clin Immunol 1999;104:991-9
  24. Vieths S, Frank E, Scheurer S, Meyer HE, Hrazdina G, Haustein D. Characterization of a new IgE-binding 35-kDa protein from birch pollen with cross-reacting homologues in various plant foods.
    Scand J Immunol 1998;47(3):263-72
  25. Karamloo F, Wangorsch A, Kasahara H, Davin LB, Haustein D, Lewis NG, Vieths S.
    Phenylcoumaran benzylic ether and isoflavonoid reductases are a new class of cross-reactive allergens in birch pollen, fruits and vegetables.
    Eur J Biochem 2001;268(20):5310-20
  26. Lidholm J, Ballmer-Weber BK, Mari A, Vieths S.
    Component-resolved diagnostics in food allergy. Curr Opin Allergy Clin Immunol 2006;6(3):234-40
  27. Paschke A, Wigotzki M, Steinhart H. Alterations of allergenicity of fruits and vegetables during technological processing. [Abstract] 8th International Symposium on Problems of Food Allergy, Venice. 2001, March 11-13
  28. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09
  29. Stäger J, Wüthrich B, Johansson SGO. Spice allergy in celery-sensitive patients.
    Allergy 1991;46:475-8
  30. Dreborg S, Foucard T. Allergy to apple, carrot and potato in children with birch pollen allergy. Allergy 1983;38(3):167-72
  31. Wüthrich B, Stager J, Johansson SGO. Celery allergy associated with birch and mugwort pollinosis. Allergy 1990;45:566-71
  32. Hoffmann-Sommergruber K, Demoly P,
    Crameri R, Breiteneder H, Ebner C, Laimer Da Camara Machado M, Blaser K, Ismail C, Scheiner O, Bousquet J, Menz G. IgE reactivity to Api g 1, a major celery allergen, in a Central European population is based on primary sensitization by Bet v 1. J Allergy Clin Immunol 1999;104(2 Pt 1):478-84
  33. Etesamifar M, Wüthrich B. IgE-vermittelte Nahrungsmittelallergie bei 383 Patienten unter Berücksichtigung des oralen Allergie-Syndroms. Allergologie 1998;21:451-7
  34. Halmepuro, L, Lowenstein H. Immunological investigation of possible structural similarities between pollen antigens and antigens in apple, carrot and celery tuber.
    Allergy 1985;40:264-72
  35. Ortolani C, Ispano M, Pastorello E, Bigi A, Ansaloni R. The oral allergy syndrome.
    Ann Allergy 1988;61(6 Pt 2):47-52
  36. Helbling A, Lopez M, Schwartz HJ, Lehrer SB. Reactivity of carrot-specific IgE antibodies with celery, apiaceous spices, and birch pollen.
    Ann Allergy 1993;70(6):495-9
  37. Vieths S, Scheurer S, Ballmer-Weber B. Current understanding of cross-reactivity of food allergens and pollen.
    Ann N Y Acad Sci 2002;964:47-68
  38. Paschke A, Kinder H, Zunker K, Wigotzki M, Steinhart H, Wessbecher R, Vieluf I. Characterization of cross-reacting allergens in mango fruit. Allergy 2001;56(3):237-42
  39. Bohle B. The impact of pollen-related food allergens on pollen allergy.
    Allergy 2007;62(1):3-10
  40. Scheurer S, Son DY, Boehm M, Karamloo F, Franke S, Hoffmann A, Haustein D, Vieths S. Cross-reactivity and epitope analysis of Pru a 1, the major cherry allergen.
    Mol Immunol 1999;36(3):155-67
  41. Wellhausen A, Schoning B, Petersen A, Vieths S. IgE binding to a new cross-reactive structure: a 35 kDa protein in birch pollen, exotic fruit and other plant foods. Zeitschrift fur Ernahrungswissenschaft 1996;35(4):348-55
  42. Jordan-Wagner DL, Whisman BA, Goetz DW. Cross-allergenicity among celery, cucumber, carrot, and watermelon.
    Ann Allergy 1993;71(1):70-9
  43. Asero R. Relevance of pollen-specific IgE levels to the development of Apiaceae hypersensitivity in patients with birch pollen allergy.
    Allergy 1997;52(5):560-4
  44. Wuthrich B, Dietschi R. The celery-carrot-mugwort-condiment syndrome: skin test and RAST results. [German] Schweiz Med Wochenschr 1985;115(11):258-64
  45. Bauer L, Ebner C, Hirschwehr R, Wuthrich B, Pichler C, Fritsch R, Scheiner O, Kraft D. IgE cross-reactivity between birch pollen, mugwort pollen and celery is due to at least three distinct cross-reacting allergens: immunoblot investigation of the birch-mugwort-celery syndrome.
    Clin Exp Allergy 1996;26(10):1161-70
  46. Pauli G, Bessot JC, Dietemann-Molard A, Braun PA, Thierry R. Celery sensitivity: clinical and immunological correlations with pollen allergy. Clin Allergy 1985;15:273-9
  47. Helbling A. Food allergy. [German] Ther Umsch 1994;51(1):31-7
  48. Dietschi R, Wuthrich B, Johannsson SG. So-called ”celery-carrot-mugwort-spice syndrome.” RAST results with new spice discs. [German] Z Hautkr 1987;62(7):524-31
  49. Caballero T, Martin-Esteban M. Association between pollen hypersensitivity and edible vegetable allergy: a review. J Investig Allergol Clin Immunol 1998;8(1):6-16
  50. Bonnin JP, Grezard P, Colin L, Perrot H. A very significant case of allergy to celery cross-reacting with ragweed. [French] Allerg Immunol (Paris) 1995;27(3):91-3
  51. Gall H, Kalevam KJ, Forck G, Sterry W. Kiwi fruit allergy: a new birch pollen-associated food allergy. J Allergy Clin Immunol 1994;94:70-6
  52. Helbling A, Schwartz HJ, Lopez M, Lehrer SB. Lettuce and carrot allergy: are they related? Allergy Proc 1994;15(1):33-8
  53. Grote M, Stumvoll S, Reichelt R, Lidholm J, Rudolf V. Identification of an allergen related to Phl p 4, a major timothy grass pollen allergen, in pollens, vegetables, and fruits by immunogold electron microscopy.
    Biol Chem 2002;383(9):1441-5
  54. Hannuksela M, Lahti A. Immediate reactions to fruits and vegetables.
    Contact Dermatitis. 1977;3(2):79-84
  55. Lahti A, Hannuksela M. Hypersensitivity to apple and carrot can be reliably detected with fresh material. Allergy 1978;33(3):143-6
  56. Hofer T, Wuthrich B. Food allergy. II. Prevalence of organ manifestations of allergy-inducing food. A study on the basis of 173 cases, 1978-1982. [German] Schweiz Med Wochenschr 1985;115(41):1437-42
  57. Muhlemann RJ, Wuthrich B. Food allergies 1983-1987. [German] Schweiz Med Wochenschr 1991;121(46):1696-700
  58. Jankiewicz A, Aulepp H, Baltes W, Bogl KW, Dehne LI, Zuberbier T, Vieths S. Allergic sensitization to native and heated celery root in pollen-sensitive patients investigated by skin test and IgE binding.
    Int Arch Al Immunol 1996;111(3):268-78
  59. Erdmann SM, Sachs B, Schmidt A, Merk HF, Scheiner O, Moll-Slodowy S, Sauer I, Kwiecien R, Maderegger B, Hoffmann-Sommergruber K. In vitro analysis of Birch-pollen-associated food allergy by use of recombinant allergens in the basophil activation test.
    Int Arch Allergy Immunol 2005;136(3):230-8
  60. Roehr CC, Edenharter G, Reimann S, Ehlers I, Worm M, Zuberbier T, Niggemann B. Food allergy and non-allergic food hypersensitivity in children and adolescents.
    Clin Exp Allergy 2004;34(10):1534-41
  61. Zuidmeer L, Goldhahn K, Rona RJ, Gislason D, Madsen C, Summers C, Sodergren E, Dahlström 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
  62. Bakos N, Schöll I, Szalai K, Kundi M, Untersmayr E, Jensen-Jarolim E. Risk assessment in elderly for sensitization to food and respiratory allergens.
    Immunol Lett 2006;107(1):15-21
  63. Helbling A. Food allergy. Most often conceals an inhalational allergy. [German] Schweiz Rundsch Med Prax 1998;87(40):1309-15
  64. Bircher AJ, Van Melle G, Haller E, Curty B,
    Frei PC. IgE to food allergens are highly prevalent in patients allergic to pollens, with and without symptoms of food allergy.
    Clin Exp Allergy 1994;24(4):367-74
  65. Hofman T, Buczylko K, Brewczynski P. Typical food allergens for pollinosis in selected regions of Poland. Multiagent studies. [Polish] Pol Merkuriusz Lek 1998;4(20):69-71
  66. Agarkhedkar SR, Bapat HB, Bapat BN. Avoidance of food allergens in childhood asthma. Indian Pediatr 2005;42(4):362-6
  67. Gomez M, Curiel G, Mendez J, Rodriguez M, Moneo I. Hypersensitivity to carrot associated with specific IgE to grass and tree pollens. Allergy 1996;51(6):425-9
  68. Schwartz HJ, Arnold JL, Strohl KP. Nasal response to carrot and lettuce challenge in allergic patients.
    Ann Allergy Asthma Immunol 1995;74:152-4
  69. Schiappoli M, Senna G, Dama A, Bonadonna P, Crivellaro M, Passalacqua G. Anaphylaxis due to carrot as hidden food allergen. Allergol Immunopathol (Madr) 2002;30(4):243-4
  70. Muñoz D, Leanizbarrutia I, Lobera T, Fernández de Corres L. Anaphylaxis from contact with carrot. Contact Dermatitis 1985;13:345-6
  71. Lopez M, Schwartz H, Helbling A, Lehrer S.
    Anaphylaxis to carrot: crossreactivity of carrot specific IgE with spices from the Umbelliferae family. J Allergy Clin Immunol 1991;87:530(Suppl 1 Pt2)
  72. Meynadier J, Meynadier JM, Guilhou JJ. Contact urticaria in atopic patients. Apropos of 2 cases. [French] Ann Dermatol Venereol 1982;109(10):871-4
  73. Hannuksela M. Diagnosis of dermatologic food allergy. Ann Allergy 1987;59(5 Pt 2):153-6
  74. Murdoch SR, Dempster J. Allergic contact dermatitis from carrot.
    Contact Dermatitis 2000;42(4):236
  75. Ottolenghi A, De Chiara A, Arrigoni S, Terracciano L, De Amici M. Diagnosis of food allergy caused by fruit and vegetables in children with atopic dermatitis. [Italian] Pediatr Med Chir 1995;17(6):525-30
  76. Vickers H R. The carrot as a cause of dermatitis. Br J Dermatol 1941;53:52-7
  77. Klauder JV, Kimmich JM. Sensitization dermatitis to carrots.
    Arch Dermatol 1956;74:149-58
  78. Kanerva L, Estlander T, Jolanki R. Occupational allergic contact dermatitis from spices.
    Contact Dermatitis 1996;35(3):157-62
  79. Sinha S M, Pasricha J, Sharma R, Kandhari K. Vegetables responsible for contact dermatitis of the hands. Arch Dermatol 1977;113:776-9
  80. Schöpf P, Ruëff F, Ludolph-Hauser D, Przybilla B. Aspirin-dependent food allergy. AAAAI 56th Annual Meeting 2000;March 3–8
  81. Sánchez Palacios A, Quintero de Juana A, Martínez Sagarra J, Aparicio Duque R. Eosinophilic food-induced cystitis. Allergol Immunopathol (Madr) 1984;12(6):463-9
  82. Veien NK, Hattel T, Justesen O, Norholm A. Causes of eczema in the food industry.
    Derm Beruf Umwelt 1983;31(3):84-6
  83. Egan CL, Sterling G. Phytophotodermatitis: a visit to Margaritaville. Cutis 1993;51(1):41-2
  84. Poljacki M, Paravina M, Jovanovic M, Subotic M, Duran V. Contact allergic dermatitis caused by plants. [Serbo-Croatian] Med Pregl 1993;46(9-10):371-5
  85. Donahue SP. Recurrence of idiopathic intracranial hypertension after weight loss: the carrot craver.
    Am J Ophthalmol 2000;130(6):850-1
  86. Clegg KE, Schiffman FJ. Carrot juice xanthoderma: an orange patient with multiple myeloma. R I Med 1993;76(7):361-3
  87. Wetzel WE, Lehn W, Grieb A. Carotene jaundice in infants with ”sugar nursing bottle syndrome”. [German] Monatsschr Kinderheilkd 1989;137(10):659-61
  88. Sernia O, Rivetti S, Rossano C, Orecchia L.
    Carrot soup as the cause of met-hemoglobinemia in an infant. Case report. [Italian] Ann Osp Maria Vittoria Torino 1984;27(1-6):85-92
  89. Arranz L, Alustiza E, Ruiz Benito C, Angulo P, Perez-Yarza EG. Acquired methemoglobinaemia (author’s transl). [Spanish] An Esp Pediatr 1981;15(5):482-7
  90. Kovacs L, Kostalova L, Tibenska M, Soltes L, Michalickova J. Nutritional nitrate methemoglobinemia caused by carrot infusion. [Slovak] Cesk Pediatr 1981;36(10):585-7
  91. L’Hirondel J, Guihard J, Morel C, Freymuth F, Signoret N, Signoret C. A new cause of methemoglobinemia in infants: carrot soup. [French] Ann Pediatr (Paris) 1971;18(10):625-32
  92. Blanc JP, Teyssier G, Geyssant A, Lauras B. Methemoglobinemia in acute diarrhea in infants. [French] Pediatrie 1983;38(2):87-99
  93. Stolley H, Schlage C, Droese W. Nitrate content of carrots in baby formulas (author’s transl). [German] Monatsschr Kinderheilkd 1978;126(2):100-1
  94. Gupta L, Garg RP, Sharma RC, Arora RB. Monoamine oxidase inhibiting activity of Daucus carota.
    Indian J Exp Biol 1973;11(4):342-3
  95. Kaplan R. Carrot addiction. Aust N Z J Psychiatry 1996;30(5):698-700
  96. Marc B, Chadly A, Durigon M. Fatal air embolism during female autoerotic practice.
    Int J Legal Med 1990;104(1):59-61

 

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