Celery

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Code: f85
Latin name: Apium graveolens
Source material: Freeze-dried stem and root
Family: Apiaceae
Common names: Celery, Stick celery, Celeriac, Celery root, Root celery, Celery tuber, Knob celery

Allergen Exposure

Geographical distribution
Celery is a herbaceous edible biennial plant in the family Apiaceae. It is native to the coasts of western and northern Europe, and of the Middle East. It was used by the ancient Greeks and Romans as a flavouring. The ancient Chinese used it as a medicine.

The wild form of Celery is known as smallage. The stalks are furrowed and more stringy, the leaves are wedge-shaped, and the taste is rank and bitter. Around the 17th and 18th centuries, modern Celery was developed by breeding the bitterness out of smallage. The most common commercial variety now sold is the Pascal variety, although gardeners can grow a range of cultivars under two classes, white and red. The white cultivars are generally the most crisp and tender and the best flavoured.

Celery grows to 1 m tall, with pinnate to bipinnate leaves, and rhombic leaflets 3-6 cm long and 2-4 cm broad. The edible Celery stalk is not a plant stem but a petiole, which is part of a leaf. The flowers are creamy-white, 2-3 mm in diameter, produced in dense compound umbels. The seeds are broad ovoid to globose, 1.5-2 mm long and wide.

Environment
The pale-green, succulent Celery stalks are consumed not only raw as fresh salad but also, both blanched and green, as a cooked vegetable and as a constituent of sauces and soups.

Celery is claimed to be effective against a number of ailments; for example, it is a treatment for hypertension in traditional oriental medicine. It is said to help maintain healthy blood pressure and also to help kidneys function efficiently. This is evidently due to 3 n-butyl phthalide, which also acts as a sedative. Celery has been employed as a herbal infusion to induce abortions (1).

Celery seed is dried and used as a spice. It is combined with salt for a seasoning called Celery salt. It is notably used to enhance the flavour of Bloody Mary cocktails. The seeds are also the basis for a homeopathic extract that is a diuretic and a remedy for gout, among other uses. The furano-coumarin bergaptene, found in the seeds, is a potent photosensitiser and may cause photo-dermatitis, particularly in gardeners and field workers. Similarly, an essential oil made from the seed should not be applied externally by those about to go into bright sunshine.

Dried and powdered Celery root is a common ingredient of spice mixtures. The root also has medical uses, e.g., as a diuretic and as a digestive remedy.

Chinese celery (also known as Oriental celery) has thinner stalks and a stronger flavour. It is rarely consumed raw but is often added to soups and stir-fries.

Celeriac (Apium graveolens rapaceum) is a closely related plant that forms a greatly enlarged, solid, globular body just below the soil surface. It is not used raw but is especially well suited for soups and stews.

Unexpected exposure
See under Environment.

Allergens
Early allergen studies indicated the presence of IgE antibodies binding to Celery proteins with molecular weights of around 14, 15, 16, and 17 kDa (2-3). Celery was also shown to contain at least 3 distinct cross-reacting allergens: a homologue of Bet v 1, a homologue of Birch profilin (Bet v 2), and a group of proteins with a molecular-weight range of 46 to 60 kDa (4). These allergens cross-reacted not only with Birch and Mugwort pollen, but also with a number of other fruits and vegetables (5). The allergens were not classed as either heat-labile or heat-stable (6). Early studies did not necessarily differentiate between Root celery (Celeriac) or Stick celery, possibly presuming the allergens to be similar.

The following allergens have been characterised:
  • Api g 1, the major allergen, a 16 kDa protein and a Bet v 1 homologue (7-18).
     
  • Api g 1.0101 and Api g 1.0201, the isoforms of Api g 1 (19-20).
     
  • Api g 3, a chlorophyll Ab-binding protein (7,21).
     
  • Api g 4, a 14.3 kDa protein, a profilin and a minor allergen (7,11-12,16,22-29,34).
     
  • Api g 5, a 60 kDa protein, isolated from the tuber, with homology to FAD-containing oxidases (7,16,30-31).

A lipid transfer protein has been determined (32-33).

Api g 1 was shown to be a heat-labile protein, but was stable upon exposure to high voltage, high pressure, gamma rays, drying and powdering, and therefore has allergenicity potential as a spice (34).

A number of isoforms have been isolated, including Api g 1.0201. This allergen displays 72% sequence similarity to a previously identified Api g 1.0101 isoform. In general, Api g 1.0201 displays a weaker IgE-binding capacity than does Api g 1.0101, as concluded from immunoblotting experiments (19).

Recombinant rApi g 1 has been cloned by a number of researchers (35-38).

Celery profilin, Api g 4, has been cloned and expressed in Escherichia coli (39). Profilin has also been isolated from the Celery tuber (40).

Api g 5 may be a protein with cross-reactive carbohydrate determinants (CCD); and importantly, there is convincing evidence that IgE directed to CCD is capable of eliciting allergic reactions in vivo (30-31). This allergen may be similar or identical to a 60 kDa allergen isolated in an earlier study (41).

The presence of CCDs (cross-reactive carbohydrate determinants) has been reported in other studies (12). Celery-allergic individuals have been shown to be monosensitised to CCDs, with exclusively CCD-specific IgE (22). A report stated that IgE antibodies for CCDs are common in Celery-allergic patients and can represent the major proportion of IgE against this food. Alpha 1,3-fucose was shown to be an essential part of the IgE epitope, and immunoblotting inhibition indicated the presence of this carbohydrate determinant on multiple glycoproteins in Celery extract (42). Similarly, other studies have concluded that ubiquitous CCDs are important in allergy to Celery (and Zucchini) (7); and that, depending on the structure of the CCD-containing glycoproteins, CCDs can indeed be important epitopes for IgE; they may be clinically relevant allergens in certain patients and irrelevant in others (22).

In studies examining the prevalence of IgE against Api g 1, the percentage of positive reactions varied from 59% of 22 patients who had positive DBPCFC to Celery (22), to 80% of 30 patients with pollen allergy who reported immediate allergic reactions after ingestion of raw Celery (43), to 74% of a group of 23 patients who had type 1 Celery allergy (4). The sensitisation rate to profilin was similar: 23%, 23% and 30% respectively. This is in contrast with other research reporting that 42% of Celery-allergic individuals were sensitised to Celery profilin (23), and with a study reporting that 20% of all patients with pollen allergy were sensitised to the profilin in Celery (28). IgE to CCDs has been found to be present in sera of 27% of Celery-allergic individuals (43).

A major allergen of Celery, possibly a lipid transfer protein, has been shown to be heat-stable. Heating Celery tuber for 30 minutes at 100 °C did not deplete the immunoreactivity of the major allergens (44). Other studies have concurred: Celery remained allergenic even after extended thermal treatment (76.07 min/100 °C), indicating that Celery spice is allergenic for patients with an allergy to raw Celery (45). The in vitro immunochemical stability of 3 known allergenic structures of Celery was investigated for stability when processed by microwaving, drying, gamma irradiation, ultra-high pressure treatment and high-voltage impulse treatment; it was reported that the heat stability of the known Celery allergens decreased in the following order: carbohydrate epitopes > profilin > Api g 1 (46). In a study of in vivo stability, EAST inhibition showed that heat resistance of Celery allergens decreases in the following order: CCDs > Api g 4 > Api g 1. Five of 6 patients with a positive DBPCFC to cooked Celery were sensitised to profilin and/or CCDs. The study concluded that in a subset of patients with a positive DBPCFC to cooked Celery, the CCD allergens remain allergenic even after extended thermal treatment (76.07 min/100 °C) and that Celery spice is allergenic for patients with an allergy to raw Celery. All patients undergoing DBPCFC with Celery spice (dried and powdered Celery) reported reactions comparable to symptoms observed with raw Celery challenges (45).

Potential cross-reactivity
An extensive cross-reactivity among the different individual species of the family could be expected and in fact does occur frequently (47).

In an early study of Celery allergy, in 20 patients, among whom the ingestion of Celery resulted in generalised urticaria and angioedema in 18, respiratory symptoms in 7, and anaphylaxis in 4, the main cross-reactivity was to pollen allergens in 16/20. Food allergy to other vegetables, mainly other family members and Apples, coexisted in 12 cases. Fourteen were allergic to Mugwort pollen and 9 to Birch pollen. The study suggested the presence of common antigenic epitopes (48). Similar results were reported in other studies (49-51).

Subsequently, Celery allergy was shown in a number of studies to be strongly associated with Birch and Mugwort pollen allergy, a phenomenon often referred to as “Birch-Mugwort-Celery syndrome” (6,52) or “Celery-Carrot-Birch-Mugwort-spice syndrome” when Carrot and Spices are included (6,53-56). Cross-reactivity with other members of the Apiaceae family was reported to be more prevalent, the members including Anise, Fennel, Coriander, Cumin, Caraway, Carrot, Dill, Lovage and Parsley (57-61). The syndrome is reported to occur more frequently in females (81.4%) than in males and may be severe, resulting in anaphylactic reactions (62).

Up to 70% of patients with tree pollen allergy display allergic symptoms when eating certain fruits and vegetables. Allergy to Celery brought about through sensitisation to Birch tree pollen occurs only in areas where Birch trees are common. In areas where no Birch trees grow, primary sensitisation takes place through other pollen allergens (e.g., Mugwort pollen). Birch pollen allergy and Celery allergy are closely related in Central Europe, whereas in Southern Europe the Mugwort-Celery type is predominant (37).

Therefore, even if there are no overt symptoms of pollen allergy in a Celery-allergic patient, IgE antibodies may be found, usually to the pollen most common to that region; for example, in Sweden it is Birch, whereas in the area of Lyons in France, Ragweed, Mugwort and Compositae tend to be the culprits. An early study stated that the allergic sensitisation is strictly one-way, Celery → pollen: a patient allergic to Celery is likely to be sensitised to pollen, but not the other way around. But the reverse can occur: the presence of IgE antibodies to Celery is often found when the allergy is caused by Ragweed or Mugwort (63).

Allergy to other pollen may result in a variable degree of cross-reactivity with Celery allergy. Utilising SPT and RAST inhibition experiments, an important cross-reactivity was found between the pollen of Platanus acerifolia (London Plane tree) and Hazelnut and Banana fruit, and an intermediate cross-reactivity with Celery and Peanut (64). Hop Japanese pollen may have links with Celery, Hop, and Sunflower pollens on skin-prick testing (65).

Recent studies have demonstrated that cross-reactivity among Birch pollen, Mugwort pollen and Celery was due to at least 4 distinct cross-reacting allergens, of which a Bet v 1 homologue (Api g 1) and a profilin (Api g 4) have been clearly elucidated.

Api g 1, the major Celery allergen, is a homologue of the major Birch pollen allergen Bet v 1 (15). Bet v 1 cross-reacts with homologous proteins in Celery, Apples, stone fruits, Carrot, nuts, Soybean, Hazelnuts and pollens of several tree species (4,66). Approximately 70% of patients who are allergic to Birch pollen may experience symptoms after consumption of foods from these groups (67). Two minor allergenic structures – profilin and cross-reactive carbohydrate determinants (CCDs) – were shown to have sensitised approximately 10-20% of all pollen-allergic patients and to be present in Celery and in grass pollen and weed pollen (4,67) (See below).

The patterns may appear complex. For example, among sera of 61 patients with IgE antibodies to Mugwort pollen, 36 were positive for Celery and 23 had IgE antibodies to Birch pollen (2). Similarly, 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. The study suggested that most Apiaceae determinants cross-react with Apple or Hazelnut determinants, whereas only some Apple or Hazelnut determinants cross-react with Apiaceae-allergenic determinants (68). Similarly, cross-reactivity has been reported between Celery and Zucchini, and it is stated that a specific association with Birch pollen allergy exists in allergy to Celery (mediated by Api g 1), but not in Zucchini allergy (7).

Given that Mugwort and Birch pollen allergy are frequently associated with IgE-mediated hypersensitivity to Celery and spices, a study of sera from 22 patients with Mugwort-Birch-Celery-spice syndrome proved interesting. In an immonoblotting test for IgE binding to the spices Pepper and Paprika, it was found that in the Mugwort-Birch-Celery-spice syndrome, IgE cross-reactivity to Pepper and Paprika was not caused by homologues of Bet v 1 and profilin (69).

Bet v 1 plays a significant role in the cross-reactivity described. Celery Api g 1 has a 40% identity (60% similarity) to this major allergen of Birch pollen (35), and Birch pollen-allergic individuals frequently develop type I hypersensitivity reactions to Celery (70-71). Api g 1 has in fact been identified as the Celery homologue of Bet v 1 (19). A number of studies have demonstrated that cross-reactions among Birch pollen, Celery, Carrot, and various fruits and other vegetables are based on allergens related to Bet v 1 and Art v 1, the latter of which is the major allergen of Mugwort pollen (5,38,71-72).

Nevertheless, epitope differences between Bet v 1-related food allergens exist, indicating different degrees of cross-reactivity among these allergens (73). Similar results with other allergens have been reported: concurrent sensitisation to Mugwort or Birch pollen and Camomile may occur, and binding was inhibited to varying degrees by extracts from Celery and Anise, and pollen from Mugwort, Birch and Timothy grass. Profilins (Bet v 2) were not detected in the Camomile extracts (74).

A protein related to Bet v 1 was isolated from cells of the Madagascar periwinkle, and shown to also be present in Celery, but it had no allergenic characteristics (75).

Individuals may be allergic to Celery without allergy or sensitisation to Birch tree pollen; 8% of Swiss patients allergic to Celery were not sensitised to rBet v 1 or rBet v 2 (76). Similarly, in a study of sera from 4 patients showing strong immediate systemic reactions after contact or ingestion of raw Carrot, all the patients had significant levels of IgE antibodies to Carrot allergen, Dau c 1, a Bet v 1 homologue, but no IgE antibodies to Birch pollen was detected in any. The sera contained a single band of around 18 kDa with raw Carrot and with Celery (with a weaker reaction), but no reactive band was found with Birch pollen. 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 indicated that a sensitisation to Dau c 1 induces IgE antibodies that do not cross-react with Birch pollen allergens (77).
Research has focused on the T cell response and epitope involvement influencing cross-reactivity between Birch pollen and Celery. In a study evaluating the T cell response to the major allergen Api g 1 in Celery, and the cellular cross-reactivity with its homologous major allergen in Birch pollen, Bet v 1, the latter allergen was identified as the most important T cell epitope for cross-reactivity with Api g 1. The study concluded that the activation of Bet v 1-specific Th2 cells by Api g 1, in particular outside the pollen season, may have consequences for Birch pollen-allergic individuals (78). A study investigating the IgE-binding capacity of 2 cross-reactive allergens, Apg1.0101 from Celery and Pru av 1 from Cherry, showed that the IgE-binding epitopes are highly patient-specific (79-80).

The panallergen profilin, an allergen homologous to Bet v 2, is particularly important in patients allergic to Celery who have a Birch-Mugwort-Celery sensitisation (4,43,81). Celery profilin has a high degree of identity with other plant profilin (71-82%) (39). Profilin is recognised by IgE from about 20% of Birch pollen- and plant food-allergic patients. In a study of the immunological properties of a number of profilins, including profilin from Celery (Api g 4) and Birch pollen (Bet v 2), 43 of 49 patients (88%) were pre-selected for an IgE-reactivity with Bet v 2; among these, IgE antibodies to the equivalent Celery protein were demonstrated in 80% of the sera. However, IgE binding profiles also indicated the presence of epitope differences among related profilins. Nevertheless, profilin from a number of plants (Pyr c 4, Pru av 4, Api g 4 and Bet v 2) presented almost identical allergenic properties in cellular mediator release tests (24). Profilin has also been detected in both Hazel pollen and Hazelnut extracts (25). A study suggested that Celery profilin is more important in patients with an additional sensitisation to Mugwort pollen (12). Other studies have demonstrated the importance of profilin in cross-reactivity between Celery, Mugwort, Birch and other plants, including numerous other species such as Cynodon dactylon, Sorghum halopense, Poa pratensis, Ambrosia elatior, and Apple and Carrot (11,26). Lolium perenne grass pollen was shown to contain profilin. In a grass pollen-sensitive population, patients with IgE to vegetables have been reported to have a high incidence of antibodies against profilin (82). However, cross-reactivity as a result of profilin may be variable.

Other studies have also reported on the presence of an approximately 60 kDa allergen in fruit and vegetables, resulting in cross-reactivity with the major Mugwort pollen allergen Art v 1. Pre-adsorption of Mugwort-allergic patients’ sera with the 60 kDa Mugwort allergen led to a reduction of IgE binding to components of similar molecular weight present in Birch pollen, Timothy grass, Apple, Peanuts, and Celery extracts. The allergen was distinct from Bet v 1 and profilin and was reported to possibly represent a novel cross-reactive allergen in oral allergy syndrome (41,83). A 60 kDa Group 4 grass pollen allergen, recognised by 70% of patients sensitive to grass pollen, may be similar to or the same as that reported in previous studies. In Timothy grass, Mugwort and Birch pollens, these allergens were located in the cell wall, and in Timothy grass and Birch pollen in the cytoplasm as well. In Peanut, Apple, Celery, and Carrot, the allergen was detected only in cytoplasmic areas (84).

An association of Celery-Mugwort allergy with allergy to Mango fruit was also reported (61).

Celery contains a lipid transfer protein, which may result in cross-reactivity among a number of vegetables and fruits, including members of the Rosaceae family (such as Peach), cereals from the Poaceae family, Pistachio, Broccoli, Carrot, Tomato, Melon, and Kiwi. Many of these cross-reactivities may be accompanied by clinical food allergy, frequently including systemic reactions (32-33). It has been stated that in view of the high prevalence and severity of the allergic reactions induced, Hazelnut, Walnut, and Peanut should be regarded as potentially hazardous for patients allergic to lipid transfer proteins (85-86). In a study aimed at examining the relationship between Peach LTP-specific IgE levels and cross-reactivity to several non-Rosaceae plant-derived foods, results suggested that all allergenic determinants in LTP from vegetable foods other than Peach cross-react with Peach LTP determinants, whereas only some Peach LTP epitopes cross-react with allergenic determinants on botanically unrelated plant-derived foods (32).

A number of reports indicate cross-reactivity between Celery and Ragweed (63,71,87).

Frequently, the occurrence of cross-reactive IgE antibodies is not correlated with the development of clinical food allergy. In particular, the clinical relevance of sensitisation to cross-reactive carbohydrate determinants (CCD) was reported to not be important (67). However, recently inhibition experiments with a purified carbohydrate moiety clearly showed that the IgE epitope mannose-xylose-fucose-glycan or a closely related structure is present in Celery and is important in patients with clinical allergy to Celery (22).

A study investigated the relationship between pollen sensitivity and sensitivity to food in Latex-allergic patients. Forty-four Latex-allergic patients, 24 of whom were also allergic to tree and/or grass pollen, and 25 pollen-allergic patients who were not allergic to Latex, were studied. Latex-allergic patients were most likely to have a positive skin test and a history of a reaction to Avocado or Banana, whereas patients with pollinosis only were most likely to have positive SPT and a history of a reaction to Apple, Peach or Celery (88). Notably, healthcare providers who have coexisting risk factors, such as atopy and food allergies (Chestnuts, Bananas, Avocados, Passion fruit, Celery, Potatoes, and Peaches) have been reported to be at an even greater risk for severe allergic reactions following repeated Latex exposure (89).

Recently, homology was reported between the Celery allergen Api g 5 and the pollen allergen rPhl p 4 from Timothy grass, a berberine bridge enzyme-like protein (90). Whether this was clinically relevant was not determined.

Clinical Experience

IgE-mediated reactions
The first case of allergic reaction to Celery root was reported in 1926 (91). Since then, many studies from across the world, and in particular from European countries, have documented the high prevalence of allergy to Celery, especially in association with cross-allergy to pollen (3-4,7,42,48,54,56,62-63,86,92-102). IgE antibodies to Celery may be present in an individual’s sera but without clinical sensitisation (4).

In Switzerland, about 40% of patients with food allergy are sensitised to Celery, some of them having severe anaphylactic reactions (98-99). Other studies have reported a higher prevalence of allergy to Celery; one reported 42% (103); among the 69% of a group of 32 patients who had a history of Celery allergy, DBPCFC resulted in systemic reactions in 50% (11/22) (7). In a study from 1978 to 1982, 173 cases of food allergy were diagnosed in patients (predominantly adults) attending the University of Zurich. The most frequent food allergens were found to be Celery in 40.5%, Carrots (20%), Green beans (6%), Hen’s egg (21%), Cow’s milk and other dairy products (20%) and fish (12%) (104).

In France, 30% of 580 patients with food allergy were sensitised to Celery, as determined by IgE antibody analysis. Sixty presented with severe, near-fatal reactions; the most common food implicated was Celery: 30% of severe anaphylactic reactions to food were thought to be due to Celery, according to patient histories (100).
In Germany, of 167 patients with a pollen-related food allergy, 70% were sensitised to Celery, as shown by IgE antibody analysis or SPT, and 14% reported allergy to Celery (34).

In a Swiss and German study, 22 of 32 patients claiming to be allergic to Celery were positive on DBPCFC with Celery. Celery IgE antibodies (> 0.7 kUA/l) was detected in 73% of patients with a positive DBPCFC result; skin reactivity (> 3 mm) was detected in 48% to 86%, with the use of various commercial extracts; and 96% were positive in prick-to-prick tests with raw Celery. The positive predictive value of the SPT and IgE antibody tests was between 87% and 96%, whereas the specificity and negative predictive values were poor. The study concluded that the skin reactivity and IgE antibodies test methods proved to be reliable for the diagnosis of a relevant allergy to Celery in regard to sensitivity and positive predictive value, but not in regard to specificity and negative predictive value (52).

In a German study, 20.8% of 1,537 subjects reported symptoms to food. One quarter of the subjects (25.1%) were sensitised to at least 1 food allergen, as shown by SPT, with Hazelnut (17.8%), Celery (14.6%), and Peanut (11.1%) being the most prevalent (94). A second German study, of 229 patients experiencing immediate-type allergy to 1 or more specific foodstuffs and diagnosed from 1983 to 1987, reported that Celery was responsible in 44.5% of cases, followed by Carrots (14.4%) and spices (16.6%). In 24 cases, Celery-spice sensitisation was responsible for severe anaphylactic reactions (62).

In a multi-centre Polish study, the greatest number of positive skin prick tests with food allergens were to nuts, Celery, Rye flour, Carrot, Strawberry, Pork and Beans (102). Twenty to 40 percent of Polish children sensitised to Birch pollen were shown to have skin reactivity to Celery, Carrot, Potato, Tomato, Apple, Peach and Grape (95).

In an American study of 132 children aged 3-19 years, 58% reported food-allergic reactions in the past 2 years. The offending food was identified in 34 of 41 reactions, Cow’s milk being the causative food in 11 (32%); Peanut in 10 (29%); Egg in 6 (18%); tree nuts in 2 (6%); and Soy, Wheat, Celery, Mango, and Garlic in 1 (3%) each (105).

Celery can cause oral symptoms (aphthae, stomatitis, swelling of the lips or tongue, pharyngitis, hoarseness and laryngeal oedema) and can often also induce acute generalised symptoms, such as severe laryngeal oedema, bronchial asthma, urticaria or allergic shock (106). Oral allergy syndrome has been documented (35,107), and the symptoms have been reported to be more marked in severity compared to reactions to other vegetables (108).

The prevalence of OAS was significantly higher in patients having IgE antibodies to Birch pollen or Mugwort pollen than those negative to either pollen. The main causative foods were fruits of the Rose family in patients with only Birch pollen-specific IgE antibody; foods outside the Rose family, such as Kiwi, Melon, Orange, Celery and Onion, were causative in those with only Mugwort pollen-specific IgE antibody. A close relationship was suggested between Mugwort pollen sensitisation and OAS (109).

The major Birch pollen allergen Bet v 1 cross-reacts with homologous food allergens, resulting in IgE-mediated oral allergy syndrome (OAS). To avoid this type of food allergy, allergologists and guidebooks advise patients to consume Birch pollen-related foods only after heating. A study evaluated whether cooked Bet v 1-related food allergens induce IgE- and T cell-mediated reactions in vitro and in vivo, and found that in vitro, cooked food allergens lost the capacity to bind IgE and to induce mediator release, but had the same potency in activating Bet v 1-specific T cells as native proteins had. In vivo, ingestion of cooked Birch pollen-related foods did not induce OAS but caused atopic eczema to worsen. Therefore, T-cell cross-reactivity between Bet v 1 and related food allergens occurs independently of IgE cross-reactivity in vitro and in vivo. In patients with atopic dermatitis, the resulting immune reaction can even manifest as late eczematous skin symptoms. In consequence, the view that cooked pollen-related foods can be consumed without allergologic consequences should be reconsidered (110).

Even oral allergy syndrome may occur with cooked Celery. In a DBPCFC with cooked Celery, 5 of 11 patients reacted with oral allergy symptoms. During DBPCFC with Celery powder, 4 patients developed symptoms of oral allergy syndrome. One patient also had rhinoconjunctivitis and angioedema, and another patient responded with a flush and angioedema (45). Similarly, in 12 patients with a history of allergic reactions to raw or raw and cooked Celery, DBPCFC with raw Celery (n=10), cooked Celery (110 °C/15 min; n=11), and Celery spice (n=5) was performed. Nine patients who underwent an open mucosal challenge with 4 samples of canned Celery retorted at Co-values (cooking effect) of 7.45-76.07 (corresponding to the time periods in minutes at a thermal influence of 100 °C). Six out of 11 patients showed a positive DBPCFC to cooked Celery, and 5 out of 5 patients to Celery spice. The allergenicity of Celery was preserved for 4 patients with a positive DBPCFC to cooked Celery, even if Celery was treated at a Co-value of 76.07 (45).

In a study of 20 patients, the ingestion of Celery was responsible for generalised urticaria and angioedema in 18 and respiratory symptoms in 7. Four cases of systemic anaphylaxis were reported. Sixteen had concomitant pollen allergy. Food allergy to other vegetable products, mainly other Umbelliferae and Apples, coexisted with Celery allergy in 12 cases. Cosensitisation with Mugwort pollen (14 cases) and Birch pollen (9 cases) was found. The study reported that Celery allergens responsible for clinical sensitisation originate chiefly in the tuber and are at least partly thermally labile, and a higher incidence of allergic reactions to the root than to the leaves was reported (48). In a similar study, the same author reported on 20 patients with Celery allergy and concomitant hypersensitivity to Mugwort and Birch pollen. He found that symptoms induced by eating Celery were attacks of urticaria and angioedema in 17 of the 20, respiratory complaints in 8, and systemic anaphylaxis with vascular collapse in 3 (55).

Laryngeal oedema and bronchospasm have been reported (3). A 54-year-old woman was described as experiencing increasing difficulty breathing, due to laryngeal oedema, with onset 3 hours after eating raw Celery (111).

Celery and Parsley were shown to be aetiological agents in 14 patients with severe attacks of angioedema and urticaria (112). These foods may have severe effects, including urticaria, oedema and anaphylaxis (86).

A number of studies have reported anaphylaxis following the ingestion of Celery (113-116). A French study reported that the food products most frequently incriminated in anaphylactic reactions were not of a primary nutritional importance: Celery (30%), crustaceans (17%), fish (13%), Peanuts (12%), Mango (6%), and Mustard (3%); but they are often hidden allergens in commercial foods. In a group of 580 patients, sensitisation to food products was demonstrated, in decreasing order of frequency, as follows: Wheat (39%), Peanuts (37%), Crab (34%), Celery (30%), and Soy (30%). The authors reported that the frequency of sensitisation to various foods had changed and that sensitisation to a number of foods, including Celery, was definitely increasing (100).

In 102 patients with an initial diagnosis of idiopathic anaphylaxis, who were skin tested with a battery of 79 food-antigen, 32 (31%) had positive tests to 1 or more food antigens, and in 5, subsequently eating a food that had elicited a positive test provoked an anaphylactic reaction. Celery was one of the foods implicated (117).

Celery has been associated with food-dependant exercise-induced anaphylaxis (FDEIA) (118-119). Four patients with Celery FDEIA were described in a study: 2 developed symptoms when Celery ingestion preceded exercise, and 1 when exercise preceded Celery ingestion. A fourth, a woman 23 years of age, abruptly developed a diffuse erythematous rash, oedema, syncope, and sustained hypotension while exercising. Within 20 minutes, a sensation of throat tightness occurred, along with warmth, dizziness, blurred vision, and swelling of the extremities. She vomited once, then had a several-second syncopal episode. She experienced abdominal pain (120).

Celery has also been reported to be responsible for dermatitis (121), and particularly for occupational dermatitis in gardeners (122).

Other reactions
Celery has been reported to adversely affect individuals with irritable bowel syndrome (IBS) (123).

Phytophotodermatitis is a phototoxic dermatitis resulting from contact with psoralen-containing plants such as Celery, Lime, Parsley, Fig, and Carrot (124-125). A number of studies have reported that Celery may result in pytodermatitis (121-122). Skin reactions have been reported in grocery workers (126-127). An epidemic of dermatitis was reported, featuring a vesicular, peeling rash due to occupational exposure to blanched Celery. A phytophototoxic dermatitis due to exposure to blanched Celery was diagnosed (128). An outbreak of phytophotodermatitis among 11 workers during a Celery harvest in southern Israel was reported. It was found that the Celery harvested in the south of the country contained 84 micrograms/g fresh weight (fwt.) total psoralens, as compared to 35 micrograms/g fwt. in Celery harvested in the north of the country the same year. A late harvest in the south of the country was incriminated in the unusually high levels of psoralens in that Celery (129).

Berloque dermatitis is a variant of phytophotodermatitis and is caused by high concentrations of psoralen-containing fragrances, most commonly oil of bergamot. Berloque dermatitis is rarely seen today because of the removal of these fragrances from most cosmetic products in the United States. There is a report, however, of a group of patients still at risk for berloque dermatitis. These patients use the colognes “Florida Water” and “Kananga Water,” which are popular in Hispanic, African-American, and Caribbean populations. These fragrant waters are used for spiritual blessing, treating headaches, and personal hygiene (130).

Reactions may occur following Celery ingestion and exposure to sunlight, as described in a 65-year-old woman who developed a severe, generalised phototoxic reaction following a visit to a tanning parlour. Further interrogation showed that she had consumed a large quantity of Celery root 1 hour earlier (131-132). Similarly, ingestion of Celery soup can result in severe phototoxicity during PUVA therapy, even if the soup is cooled (133).

A new Celery cultivar (a result of plant breeding to produce a more pest-resistant variety) was responsible for significant incidences of phytophotodermatitis in grocery employees (134). Adverse reactions may not be due to Celery per se: 11 men developed a severe phototoxic dermatitis of the hands and forearms after harvesting Celery infected with Sclerotinia sclerotiorum (135).

Celery in a herbal product was reported to increase the risk of bleeding and to potentiate the effects of warfarin therapy (136).
A phototoxic side-effect following Celery ingestion during PUVA therapy has been reported (137).

Compiled by Dr Harris Steinman, harris@zingsolutions.com

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