Potato

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Code: f35
Latin name: Solanum tuberosum
Source material: Fresh raw potato
Family: Solanaceae
Common names: Potato, Irish Potato, Spud

Allergen Exposure

Geographical distribution
First cultivated by the Incas, the Potato even at this period existed in thousands of edible varieties. It was brought to Europe in the 16th century by the Spaniards. It comes fourth after Wheat, Rice and Maize as a staple crop, as Potato tubers are high-yielding, store well and can be available all year round.

Environment
The Potato is not known in a truly wild situation. Potatoes are a very versatile food, having a mild flavour and readily accepting the flavour of other foods. Occasionally eaten raw, they are usually boiled, baked, fried, or added to soups, stews, etc. Cooked Potato can also be dried and made into a powder and then used as a thickener, or can be added to cereal flours for bread, biscuits, and so one. The Potato is a very rich source of starch but does not contain high quantities of other nutrients. When exposed to light, the skin turns green and develops the toxin solanine, an alkaloid (as do all other green parts of the plant).

While mainly used as a staple food, raw and cooked Potatoes also have medicinal virtues.

Unexpected exposure
The Potato is a source of starch for sizing cotton and making industrial alcohol. It also has many other uses in industry. Ripe Potato juice is an excellent cleaner of silks, cottons and woolens. The water in which Potatoes have been boiled can be used to clean silver and to restore a shine to furniture.

Emollient and cleansing face masks are made from Potatoes; these are used to treat hard, greasy and wrinkled skins.

Allergens
Potato contains a number of allergens, ranging from 16 to 65 kDa in size, of which a few have been characterised (1-2). In a Korean study of GM Potato and wild-type Potato, IgE-immunoblot analysis demonstrated the presence of 14 IgE-binding components within the wild-type Potato and 9 within the GM Potato. A common 45-kDa binding component that yielded similar IgE-binding patterns was noted in more than 80% of the reactions in sera from patients sensitised to either wild-type or GM Potato (3).

Evaluation of extracts of 6 different Potato strains showed differences in the pattern of the IgE-binding proteins, but no distinctions could be observed in the allergenic potency as evidenced in inhibition experiments. IgE binding to 14, 18, 20 23 and 43 kDa molecules occurred to all strains. Three cultivars (Karlena, Quarta, Mentor) contained additional IgE-binding protein at approximately 45 and 25 kDa. Only a slight decrease of allergenic activity from raising the temperature occurred. A new protein band of approximately 50 kDa resulting from heated Potato was detected and showed IgE binding activity (4).

The following allergens have been characterised:

  • Sol t 1, 43 kDa storage protein, patatin (5-11).
     
  • Sol t 2, a cathepsin D inhibitor (5,12).
     
  • Sol t 3, a cysteine protease inhibitor (5,12-13).
     
  • Sol t 4, an aspartic protease inhibitor (5,12).
     
  • Sola t 8, a profilin (4,14-15).
     
  • Sola t Glucanase (16-17).

Potato flour and starch are reported not to be allergenic (18). Simulated digestion is reported to abolish IgE reactivity in them (3), although another report found Sol t 1 (patatin) to be partially stable to digestion in vitro (8).

Patatin (Sol t 1), a major Potato allergen, is present as 4 isoforms representing 62%, 26%, 5%, and 7% of the total amount of patatin. All isoforms of the patatin family contain proteins with 2 molecular masses of approximately 40.3 and 41.6 kDa (11).

Sol t 1 has been reported to be both a heat-stable and a heat-labile allergen; there are conflicting studies (4,10). Potato certainly contains at least 1 heat-stable protein; this may be Sol t 1, as evidenced by reported immediate and delayed reactions, i.e., exacerbation of atopic dermatitis after oral challenge to cooked Potato (10). A recent study concluded that the heat-lability of patatin-IgE interaction is explained by aggregation of patatin with other Potato proteins rather than by denaturation of patatin itself. Aggregation of patatin resulted in a nonreversible unfolding and a concomitant important decrease in affinity for IgE (9). A report suggested that a new protein band of approximately 50 kDa forms in heated Potato and is capable of IgE binding (4).

Sol t 1 (patatin) in Potatoes is reported to be a significant IgE-binding protein for children with positive SPT to raw Potato. Twenty of 27 (74%) children with positive skin prick test responses to Potato showed specific binding of IgE antibodies to purified patatin. A positive wheal-and-flare reaction was seen in 8 of 14 children prick-tested with purified patatin (12). Similarly, a study reported that 75% of Potato-sensitised people reacted with patatin (8).

Sol t 2, Sol t 3 and Sol t 4 have molecular masses ranging from 16 to 20 kDa and have been identified as cathepsin D-, cysteine-, and aspartic protease-inhibitors belonging to the family of Soybean trypsin inhibitors (Kunitz type). In ELISA tests, 51% of the sera of 39 atopic children showed IgE antibodies to Sol t 2, 43% to Sol t 3.0101, 58% to Sol t 3.0102, and 67% to Sol t 4 (12).

Three protein inhibitors of proteolytic enzymes with molecular weights of 21, 22, and 23 kDa were isolated from Potato and showed a high degree of homology to the other Kunitz-type proteinase inhibitors from plants (19-20). The clinical significance of this protein was not determined.

Potential cross-reactivity
An extensive cross-reactivity among the different individual species of the genus could be expected, as well as to a certain degree among members of the family Solanaceae (21). Antigenically cross-reactive material found in Tobacco leaf has been demonstrated in Eggplant, Green Pepper, Potato, and Tomato, which are all members of the family Solanaceae (22).

Cross-reactivity has been shown among Birch, Apple, Pear, Celery, Carrot, Hazelnut and Potato (14,23-24), which may well be due to a profilin allergen. An association has also been reported between grass pollinosis and sensitisation to Tomato, Potato, Green pea, Peanut, Watermelon, Melon, Apple, Orange and Kiwi (25).

Patatin (Sol t 1) has been reported to be a major cross-reactive Potato allergen. A study reported that 75% of Potato-sensitised people reacted with patatin in immunoblots, and that 25% of the positive reactions to Hev b 7 could be blocked by preincubation of the patients’ sera with purified Potato patatin. Examination of children with atopic dermatitis showed that most sera contained patatin-specific IgE, whereas no Hev b 7-IgE antibodies were detected (8). Hev b 7 has a sequence identities of 39% to 42% to patatins (26).

Latex and Potato cross-reactivity has been reported by numerous studies. In one study, Tomato, Potato, and Latex were shown to have a common protein of 44-46 kDa. This protein could be implicated in the high degree of cross-reactivity among Tomato, Latex, and Potato observed in immunoblotting and CAP inhibition. The protein was reported to probably correspond to patatin (27). Other studies have reported that Latex proteins showed strong cross-reactivity with protein from several fruits and vegetables, such as Avocado, Potato, Banana, Tomato, Chestnut, and Kiwi (28-29). The implication is that individuals allergic to Potato may be at higher risk of reacting these other fruits and vegetables. In Latex allergy patients, positive food SPT occurred most frequently with Avocado (53%), Potato (40%), Banana (38%), Tomato (28%), Chestnut (28%), and Kiwi (17%) (30).

Cross-reactivity between Potato and Latex may depend on the age of the individual. In a study, 17 (49%) of 35 Natural rubber latex (NRL)-allergic adults had IgE antibodies to Hev b 7, in contrast to only 1 of 35 NRL-allergic children. Fifteen (43%) of the NRL-allergic adults and 29 (83%) of the NRL-allergic children had IgE antibodies to Sol t 1. Ten (29%) of the adult sera showed IgE binding to both Sol t 1 and Hev b 7, and crosswise inhibition tests with pooled sera revealed marked cross-reactivity. These results suggest that Hev b 7 is an important NRL allergen for adults, but not for children. The authors suggest that the clinical importance of the observed cross-reactivity between Hev b 7 and Sol t 1 requires further studies (7).

In a Finnish study of 177 children aged less than 4 years and suspected of food allergy who were prick tested with Soybean and fresh Potato, 10/177 (5%) had positive tests to Soybean, and 14 (7%) to Potato. Most Potato SPT-positive children (70%) showed IgE antibodies to a Kunitz-type Soybean trypsin inhibitor (KSTI) and 75% had IgE antibodies to Soybean. Significantly, 9 (75%) children suspected of Soy allergy had IgE antibodies to Sola t 2-4, and a marked crosswise inhibition was demonstrated between Sola t 2-4 and KSTI allergens. The study concluded that children with suspected food allergy are frequently sensitised to Soybean and Potato, and that positive skin and serum IgE tests to Soybean may be due to cross-reactive IgE antibodies against structurally altered Potato allergens, and vice versa; and that this should be considered when evaluating children suspected of Soy or Potato allergy (31).

Sol t 8, a profilin, can be expected to cause a variable degree of cross-reactivity with other foods or pollens containing this panallergen (15,32). However, the clinical implications with specific reference to Potato have not been elucidated yet.

A recent study suggested that 1,3-beta-glucanase was a potential panallergen family involved in pollen-Latex-fruit syndrome. Ole e 10, a major allergen from Olive tree pollen, shows homology with Ole e 9, a 1,3-beta-glucanase (53% identity). Ole e 10 shares IgE B cell epitopes with proteins from a number of pollens, Latex, and vegetable foods such as Tomato, Kiwi, Potato, and Peach (17).

Clinical Experience

IgE-mediated reactions
Potato can induce symptoms of food allergy, sneezing, wheezing, asthma, rhino-conjunctivitis, atopic dermatitis contact urticaria, contact dermatitis and anaphylaxis in sensitised individuals (3,33-42).

In a Korean study of the allergenicity of wild-type and GM Potato, out of 1886 patients with various allergic diseases, skin prick tests for wild-type or GM Potato extracts were positive in 108 (5.7%). IgE antibodies were detected in 38 (58%) of 65 skin test-positive subjects evaluated (3).

In a Finnish study of 177 children aged less than 4 years and suspected of food allergy who were prick tested with Soybean and fresh Potato, 10/177 (5%) had positive SPT to Soybean, and 14 (7%) to Potato (31).

In an Indian study of 24 children aged 3 to 15 years with documented deterioration in control of their perennial asthma, IgE antibodies to Potato were documented in 83% (43). A French study reported that Hen’s egg, Cow’s milk, Wheat, fish, Potato, and Pork were the foods most frequently associated with childhood asthma (37).

In a Korean study whose aim was to evaluate the IgE sensitisation rate to and cross-reactivity among homemade agricultural products, 5,340 allergy patients complaining of various allergic diseases were evaluated. Sensitisation to Potato was documented in 5.7% (44).

In a European questionnaire-based study conducted at 17 clinics in 15 European cities, Potato was the 25th most prevalent cause of symptoms among 86 foods, affecting 18% of individuals (45).

An study of IgE-positive food-allergic patients in a hospital in Verona, Italy, during 2003 reported that IgE antibodies to Potato were found in 1 of 24 patients aged 0-2 years, 5 of 42 aged 3-12, 1 of 22 aged 3-5, 4 of 20 aged 6-12, and 20 of 191 over 12 years of age (46).

Studies and case reports demonstrate the range of symptoms that may occur in Potato allergy, and the variability of allergen sensitisation.

A study in Belgium evaluated 36 children, aged 4-36 months, with atopic symptoms and a positive SPT or IgE antibody test to Potato. Presenting symptoms in 17 children with proven Potato allergy were eczema (16/17), gastrointestinal complaints (8/17), urticaria and/or angioedema (5/17), wheezing/rhinitis (3/17), and anaphylaxis (2/17). Fifteen children were also Cow’s milk-allergic and sensitised to Egg. The study reported that a serum Potato-specific IgE cut-off of > 2 kUA/l provided 100% sensitivity and 62.5% specificity for diagnosis of Potato allergy, while a skin prick test score > 3 had 100% sensitivity, and a score > 4 had 100% specificity. Tolerance to cooked Potato was achieved in 80% of subjects at age 16-102 months. The authors concluded that most children with Potato allergy develop tolerance at a mean age of 4 years, and that allergy to cooked Potato was a risk factor for the development of pollen allergy (47).

Sera were assessed of 27 children, aged 4 months to 10 years, who were examined for food allergy and had atopic dermatitis, asthma, or allergic rhinitis and a positive skin prick test to raw Potato, and who were suspected of having allergy to Potato. The main clinical symptoms were asthma in 10, atopic dermatitis in 25, and allergic rhinitis in 9. IgE antibodies for Potato were present in all 17 tested (0.4 – 62.5 kUA/l). Twenty of the 27 (74%) children were sensitised to purified patatin (6).

In a study evaluating allergens in 6 Potato strains, sera from 12 German patients suffering from adverse reactions to raw Potato were evaluated. All the patients also suffered from pollen allergy and had IgE to Birch and Mugwort pollen. Eight were males. Symptoms reported but not specifically attributed to Potato were diarrhoea (n=1), eczema (n=5), itching in the mouth (n=5), itching in thethroat (n=3), rhinitis (n=5), swelling of the lips (n=1), and urticaria (n=3) (4).

An early study reported on a 24-year-old woman who experienced sneezing, rhinorrhoea, nasal obstruction, a tickling sensation and pain in the throat following inhalation of finely dispersed particles of raw Potato from the peeling and scraping of the Potato. Her atopic dermatitis was also aggravated. Cooked Potato was handled and eaten without any difficulty. Skin tests with raw Potato juice were positive. An intradermal test with cooked Potato was negative (34).

Two housewives have been reported in whom peeling raw Potatoes precipitated rhinoconjunctivitis and asthma attacks, and, in one of them, contact urticaria (48). Similarly, an atopic housewife is described with rhino-conjunctivitis, asthma, intense treatment-resistant dermatitis of the face, and contact urticaria from peeling raw Potatoes, all of which symptoms resolved on the removal of Potato (38). Other similar reports have been published (49).

Potato allergy has also been described as resulting in oral allergy syndrome (OAS) (40,50-51).

Contact urticaria due to raw Potato has been reported in children (52-53) and in adults (36,54) a 19-year-old man exhibited symptoms of immediate urticaria and angioedema related to contact with raw Potato (54). Pruritus, contact urticaria and generalised urticaria caused by the application of raw Potato to the face was described in a 25-year-old female. Surprisingly, skin tests were negative to raw Potato extract, but a provocation test, the application of raw Potato on the forearm, produced an immediate onset of pruritus and contact urticaria. High levels of IgE antibodies to raw Potato were demonstrated (41).

A 39-year-old woman with fingertip dermatitis complained that rubber gloves irritated her hands, but that handling uncooked Potato and Tomato aggravated her dermatitis; and that uncooked but not cooked Tomato, resulted in oral tingling and facial erythema. Cooked Potato did not affect her. IgE antibodies were detected for Latex, Tomato and Potato. The authors concluded that her allergy to Latex arose secondarily via primary sensitisation to Potato or Tomato (55).

The first report that cooked Potato could cause atopic dermatitis in infants under a year of age came in 1987 (whereas older children appeared to be asymptomatic) (56), and the symptom was subsequently reported in other age groups by other authors (10,57-58).

A study was conducted of 57 children under 1 year of age, 43 children aged 12 to 35 months, and 42 children aged 3 to 15 years, all with atopic dermatitis and all skin-tested with foods suspected to have caused this condition. Of the 24 patients aged 0-11 months who were skin prick-tested for Potato, 3 were positive, 2 of these cases being consistent with patient history. Of the 11 children aged 12-35 months who were skin prick-tested with fresh Potato, 1 was positive, and this was consistent with the patient’s history. Four of 29 children aged 3-15 years tested positive, of which 3 cases were consistant with patient history. Allergen avoidance diets were beneficial; most symptoms disappeared within 2 weeks in 16 children, all of whom were under 5 years of age. Milk, cereals, cooked Potato, Banana, and Soy were the allergens responsible for hypersensitivity in these particular 16 cases (56).

Of 8 atopic children selected on the basis of suspicion of allergy to cooked Potato, all were found to have Potato-specific IgE antibodies; 2 of 8 had experienced immediate allergic reactions, and 6 of 8 had eczema that improved with a Potato-elimination diet. Seven patients were challenged with cooked Potato. The mean SCORAD index decreased from 43.3 before to 11.5 after elimination of Potato from the diet. Potato ImmunoCAP® values ranged from 3.71 to greater than 100 kUA/l. Potato challenge results were positive in 7 of 7 patients (58). In another study, of 12 infants who had atopic dermatitis (AD) and were suspected of having adverse reactions to Potatoes, rubbing the skin with raw Potato resulted in skin reactions in 7 (58%), and oral challenge was positive in 8 (67%). One infant presented with an immediate reaction, and 7 with a delayed reaction, i.e., exacerbation of AD, after oral challenge to cooked Potato. Nine (75%) infants were shown to have IgE antibodies to Sol t 1, and SPT to natural Sol t 1 were positive in 6 (50%) Potato-allergic infants (10). In a recent Australian study evaluating skin prick tests to 31 different food allergens in a selected population of predominantly breast-fed young infants who had moderate to severe generalised atopic dermatitis, of the 59 infants (mean age 26.5 weeks) tested, 54 (91.5%) had positive responses to 1 or more foods. Potato was positive in 12 (20%) and strongly positive in 1 (59).

Anaphylaxis may also occur as a result of contact with Potato (39,49). A report described a 4-year-old with raw Potato-induced anaphylaxis, in the absence of oral allergy syndrome. Rapidly developing urticaria, angioedema, respiratory distress, vomiting and diarrhoea occurred after biting into a raw Potato that was being used for painting in preschool (49).

Anaphylaxis in an 11-year-old girl, exclusively breastfed for her first 4 months, has been reported. She developed anaphylactic symptoms after ingestion of Potato at 5 months of age when she was fed Potato for the first time. Subsequently, she developed urticaria, angioedema, and respiratory and systemic symptoms on dermal contact with Potatoes, ingestion of Potatoes, and exposure to cooking Potatoes or Potato pollen (39).

Food-dependent exercise-induced anaphylaxis with Potato may occur (60-61).

Other reactions
Occupational contact dermatitis to raw Potato has been reported (62).

Skinned Potatoes or pre-cut French fries may be dipped in a sulphite or metabisulphite solution to prevent browning. The sulphite may trigger asthma in susceptible individuals (63-64).

Potato processing workers may be affected by organic dust, endotoxin or moulds (65-68). Hypersensitivity pneumonitis has been described (69).

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.