Latin name: Plantago lanceolata
Source material: Pollen
Common names: English Plantain, Ribwort Plantain, Ribwort
Plants in the genus Plantago, commonly known as Plantains, generally have a rosette of basal leaves and flowers on a dense, terminal spike. These green weedy plants are native to Europe and Asia, but now grow practically anywhere in the world. English Plantain is common in most temperate regions, and is considered a troublesome pollen weed in such diverse areas as New Zealand, Mauritania, Italy, Canada, Ecuador, Belgium, Germany, France and the USA.
English Plantain is an erect perennial growing 0.3m to 0.5m in height. The leaves are found at the base of the stalk, and are dark green, 5 to 40cm long, 8 to 25mm wide, and 3-ribbed, with a smooth, wavy texture. The margins are slightly toothed. The leaves are oblong or lance-shaped, tapering at the base into a slender stalk. The leaf axils are often filled with long brownish cottony hairs.
The plant flowers from April to August. The spike is 2 to 7.5cm long at the tip of the flower stalks, and each crowded flower has 4 parchment-like petals 3mm long; 4 stamens on hair-like stalks ending in large, cream-coloured anthers; and bracts present under flowers. The flowers are hermaphrodite (have both male and female organs) and are pollinated by wind and insects. The plant is also self-fertilising. English Plantain produces more pollen than the other Plantains. Rugel Plantain has the potential to cause hay fever, but the pollen is produced in such small quantities that it is considered of less importance as an allergen. The seeds ripen from June to September. The 3mm-long seedpods are globe-shaped, dry and papery, and contain 2 seeds. They open by the upper half falling off as a lid. The seeds are boat-shaped, the surface usually shiny, and greenish brown to dark brown.
Plantain is found on grasslands, roadsides, and cultivated ground. The English Plantain is a troublesome weed; it often invades lawns and gardens.
The leaves and stems are used in salads or for herbal therapies.
Initially at least 16 different antigens were detected in Plantain pollen, and at least 6 of these antigens may be allergenic. (1) Subsequent studies isolated 3 specific allergens of 17, 19, and 40 kDa. (2)
The following allergens have been characterised:
Pla l 1, a 17-20 kDa protein with an unknown biological function, a major allergen. (3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
Pla l Cytochrome C, a cytochrome c protein. (13)
Pla l CBP, a calcium binding protein. (14)
Pla I 1, occurs as 16 to 20 kDa isoforms. Pla I 1 shares a partial sequence identity with Ole e 1. The prevalence of specific IgE to purified Pla l 1 in Plantain-allergic patients was demonstrated to be 86%, and this represents about 80% of the total allergen-specific IgE-binding capacity of the Plantain extract. (4) However, although Pla l 1 is an Ole e 1-related protein (olive tree pollen) this similarity appears to have little clinical relevance. (15)
In a Spanish study of 179 pollen-sensitized patients who underwent skin prick testing with pollen extract and allergen-specific IgE determination against different allergens, 94 (53%) were sensitised to P. lanceolata and 8 (5%) to Pla l 1. (10)
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 Plantaginaceae. (16) However, contrary to the taxonomical inferences, the results of two studies showed that there was little cross-allergenicity between English Plantain pollen and Psyllium (P. ovata), closely related members of the same genus. (17, 18) These studies are contrary to an earlier study which suggested that English Plantain may cross-react to Psyllium. (19) Thus indicating the presence of both common and species specific allergens.
Cross-reactivity between grass and Plantain pollen is mainly caused by a 30-kDa protein in Plantain pollen. A Group 5 grass pollen allergen is probably responsible for most grass/Plantain cross-reactivity. (2)
Pla I 1 and Ole e 1 from Olive tree pollen share 38.7% of their amino acid sequences. ( 5, 6, 8) The Ole e 1-like family of proteins comprises allergenic members (Fra e 1, Lig v 1, Syr v 1 from Oleaceae species; Pla l 1 from P. lanceolata; Che a 1 from Chenopodium album; Lol p 11 from Lolium perenne; and Phl p 11 from Phleum pratense). (20)
A 2 EF-hand calcium-binding allergen from Timothy grass pollen, Phl p 7, has been shown to contain the majority of relevant IgE epitopes among calcium-binding allergens occurring in pollen species of different plants, including ribwort (English Plantain). (14)
Immunoblotting inhibition experiments, performed with extracts of Melon, P. lanceolata pollen and Dactylis glomerata pollen, showed that all allergens of Melon blotting were almost completely inhibited by grass and Plantago pollen extracts. The results support the presence of structurally similar allergens in Melon, Plantago and grass pollens, and that all allergenic epitopes of Melon are present in these pollens. (21, 22)
Sera from subjects diagnosed as allergic to White Cypress Pine, Italian Cypress, Ryegrass or Birch pollen were shown to have IgE antibodies that reacted with pollens from these four species and from Cocksfoot, Couch Grass, Lamb's Quarters, Wall Pellitory, Olive, Plantain and Ragweed. The authors concluded that the presence of pollen-reactive IgE antibodies might not necessarily be a true reflection of sensitising pollen species. (23)
Preliminary evidence for cross-reactivity between English Plantain and Paterson's Curse (Echium plantagineum) was demonstrated by RAST inhibition studies. (13)
A French study reported that Plantain is frequently associated with sensitisation to Latex, but no common allergen was detected. (24)
IgE mediated reactions
English Plantain pollen is an important cause of asthma, allergic rhinitis and allergic conjunctivitis, particularly in the temperate regions of North America, Australia and Europe. (11, 12, 25, 26, 27, 28, 29)
Plantain pollen has been shown to be present in relatively large amounts in Montpellier, in southern France, and was the second most important cause of allergy, after grass pollen allergy, in pollen-allergic patients. (30)
Plantago pollen has been found in aerobiological studies of the air of Badajoz (31) and Estepona in the "Costa del Sol" (32) in southwest Spain. Allergen-specific IgE to this pollen was demonstrated in Madrid in allergic individuals with Cupressaceae pollinosis. (33) In Salamanca, in a study to evaluate allergy to plant-derived fresh foods among pollen-allergic patients from a Birch- and Ragweed-free area, in 95 pollen-allergic patients, the largest number were sensitised to grass (Lolium and Phleum; 97.9%), followed by tree (Olea; 82.1%) and Plantago (64.2%). (34) The flowering of grasses, along with Plantago, occurs earlier and lasts longer in the south than the north of Spain. (35) Asthma-related hospital emergencies in Madrid was associated with a lag of 1 day for Urticaceae, a lag of 2 days for Plantago, and a day lag of 3 days for Poaceae. (36)
Plantago pollen is also a prominent aeroallergen in Italy, depending on geographical location, as documented in a study involving 80 data-gathering stations and 40 clinical centres nationwide. (37)
Several countries in Europe have documented the importance of Plantago pollen as an allergen. Plantago pollen has been shown to be a prominent allergen in aerobiological surveys in Cordoba, Salamanca and Seville, in Spain, (38, 39, 40) In the north of France, this plant’s pollen was the third most prevalent cause of pollinosis in children, (41) and it was one of the most important pollens in Zurich, Switzerland. (26, 42, 43)
In a Polish study involving 22 patients between 13 and 53 years of age with seasonal allergic rhinitis, specific IgE determination demonstrated the importance of English Plantain as an aeroallergen. (44) In a second study from this country, in 2561 patients suffering from upper airway allergy symptoms, hypersensitivity to weed pollen allergens was found in 1069 patients with pollinosis. In patients sensitised to weeds, the most prevalent allergens were Wormwood (86.2%), Mugwort (82.9%), White Goosefoot (44.3%), and Narrowleaf Plantain (28.8%). (45)
Plantago pollen has also been found in aerobiological surveys in Athens, (46) in Balikesir (47) and Bitlis (48) in Turkey, and in the Canary Islands. (49) A study measuring specific IgE in patients with allergic rhinitis in south Hungary showed Plantago pollen to be an important allergen in sensitisation. (50)
In a study of Kibbutz Netzer Sereni, a rural community in Israel, air sampling demonstrated that English Plantain was one of the most prevalent allergenic pollens. (51)
English Plantain has also been shown to be a very prevalent allergen in England. In Surrey, 34% of sera from subjects with respiratory allergy had specific IgE to Plantain. (52)
In New South Wales, Australia, in 3 populations of schoolchildren aged 8 to 11 years and living in different climatic areas, 95 to 97% of all atopic children were sensitised to one of seven allergens, including English Plantain, House Dust, Dermatophagoides farinae, D. pteronyssinus, Cat dander, Plantain, Rye grass, and Alternaria tenuis. (53)
Few studies on English Plantain have emanated from the USA. In St. Louis, Missouri, English Plantain was found to be present but not a prominent problem. (54) Similarly, a study of the United States Gulf Coast stated that Plantago pollen was very infrequently sampled (less than 0.1% in the air) even though several species were common in the area. (55) Similarly, Plantago was detected in Alaska, but in low levels. (56, 57)
In children with wheezing bronchitis on the small Pacific island of Niue, skin testing and serologic results indicated that hypersensitivity to House Dust mite (Dermatophagoides pteronyssinus) and Plantain (P. lanceolata) antigens were associated with the wheezing bronchitis. (58)
An early study of atmospheric counts of aeroallergens in Tehran, Iran, documented the presence of English Plantain in the atmosphere. (59)
Immediate and delayed cutaneous hypersensitivity are believed to be implicated in the physiopathology of atopic dermatitis. A study to evaluate Type I and Type IV allergy to aeroallergens in children with atopic dermatitis reported that of 59 children presenting with this condition and tested with common environmental aeroallergens, 9.8% were sensitised to Plantain pollen. (60)
The measurement of allergen-specific IgE antibodies is one method of determining sensitisation to English Plantain. Various diagnostic tests may be required to confirm clinical sensitivity. (61)
Compiled by Dr Harris Steinman, email@example.com
- Baldo BA, Chensee QJ, Howden ME, Sharp PJ. Allergens from plantain (plantago lanceolata). Studies with pollen and plant extracts. Int Arch Allergy Appl Immunol 1982;68(4):295-304.
- Asero R, Mistrello G, Roncarolo D, Casarini M. Detection of allergens in plantain (Plantago lanceolata) pollen. Allergy 2000;55(11):1059-62.
- International Union of Immunological Societies Allergen Nomenclature: IUIS official list http://www.allergen.org/List.htm 2008
- Calabozo B, Barber D, Polo F. Purification and characterization of the main allergen of Plantago lanceolata pollen, Pla l 1. Clin Exp Allergy 2001;31(2):322-30.
- Castro AJ, Alché JD, Calabozo B, Rodríguez-García MI, Polo F. Pla 1 1 and Ole e 1 pollen allergens share common epitopes and similar ultrastructural localization. J Investig Allergol Clin Immunol 2007;17 Suppl 1.
- Calabozo B, Díaz-Perales A, Salcedo G, Barber D, Polo F. Cloning and expression of biologically active Plantago lanceolata pollen allergen Pla l 1 in the yeast Pichia pastoris. Biochem J 2003;372:889-896.
- Calabozo B, Barber D, Polo F. Studies on the carbohydrate moiety of Pla l 1 allergen. identification of a major N-glycan and significance for the immunoglobulin E-binding activity. Clin Exp Allergy 2002;32(11):1628-34.
- Calabozo B, Duffort O, Carpizo JA, Barber D, Polo F. Monoclonal antibodies against the major allergen of Plantago lanceolata pollen, Pla l 1: affinity chromatography purification of the allergen Allergy 2001;56(5):429-35.
- Gadermaier G, Dedic A, Obermeyer G, Frank S, Himly M, Ferreira F. Biology of weed pollen allergens. Curr Allergy Asthma Rep 2004;4(5):391-400.
- Orovitg A, Guardia P, Barber D, de la Torre F, Rodríguez R, Villalba M, Salcedo G, Monteseirìn J, Conde J. Enhanced diagnosis of pollen allergy using specific immunoglobulin E determination to detect major allergens and panallergens. J Investig Allergol Clin Immunol 2011;21(4):253-9.
- Cuesta-Herranz J, Barber D, Blanco C, Cistero-Bahima A, Crespo JF, Fernandez-Rivas M, Fernandez-Sanchez J, Florido JF, Ibanez MD, Rodriguez R, Salcedo G, Garcia BE, Lombardero M, Quiralte . Differences among pollen-allergic patients with and without plant food allergy. Int Arch Allergy Immunol 2010 Apr 23;153(2):182-192
- Barber D, de la TF, Lombardero M, Antepara I, Colas C, Davila I, Tabar AI, Vidal C, Villalba M, Salcedo G, Rodriguez R. Component-resolved diagnosis of pollen allergy based on skin testing with profilin, polcalcin and lipid transfer protein pan-allergens. Clin Exp Allergy 2009 Nov;39(11):1764-1773
- Matthews PA, Baldo BA, Howden ME. Cytochrome c allergens isolated from the pollens of the dicotyledons English plantain (Plantago lanceolata) and Paterson's curse (Echium plantagineum). Mol Immunol 1988;25(1):63-8.
- Grote M, Westritschnig K, Valenta R. Immunogold Electron Microscopic Localization of the 2 EF-Hand Calcium-Binding Pollen Allergen Phl p 7 and its Homologues in Pollens of Grasses, Weeds and Trees. Int Arch Allergy Immunol 2008;146(2):113-121.
- Sastre J. Molecular diagnosis in allergy. Clin Exp Allergy 2010;40(10):1442-60.
- Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09
- Morgan MS, Arlian LG, Vyszenski-Moher DL, Deyo J, Kawabata T, Fernandez-Caldas E. English plantain and psyllium: lack of cross-allergenicity by crossed immunoelectrophoresis. Ann Allergy Asthma Immunol 1995;75(4):351-9.
- Gauss WF, Alarie JP, Karol MH. Workplace allergenicity of a psyllium-containing bulk laxative. Allergy 1985;40(1):73-6.
- Rosenberg S, Landay R, Klotz SD, Fireman P. Serum IgE antibodies to psyllium in individuals allergic to psyllium and English plantain. Ann Allergy 1982;48(5):294-8.
- Rodríguez R, Villalba M, Batanero E, Palomares O, Quiralte J, Salamanca G, Sirvent S, Castro L, Prado N. Olive pollen recombinant allergens: value in diagnosis and immunotherapy. J Investig Allergol Clin Immunol 2007;17 Suppl 1:4-10.
- Garcia Ortiz JC, Ventas P, Cosmes P, Lopez-Asunsolo A. An immunoblotting analysis of cross-reactivity between melon, and plantago and grass pollens. J Investig Allergol Clin Immunol 1996;6(6):378-82.
- Garcia Ortiz JC, Cosmes Martin P, Lopez-Asunolo A. Melon sensitivity shares allergens with Plantago and grass pollens. Allergy 1995;50(3):269-73.
- Pham NH, Baldo BA. Allergenic relationship between taxonomically diverse pollens. Clin Exp Allergy 1995;25(7):599-606.
- Drouet M, Gros N, Sabbah A. Latex and pollinosis. [French] Allerg Immunol (Paris) 1994;26(8):289-92, 295-6.
- Garcia-Gonzalez JJ, Vega-Chicote JM, Rico P, del Prado JM, Carmona MJ, Miranda A, Perez-Estrada M, Martin S, Cervera JA, Acebes JM. Prevalence of atopy in students from Malaga, Spain. Ann Allergy Asthma Immunol 1998;80(3):237-44.
- Wuthrich B, Annen H. Pollionosis: I. Findings on the clinical aspects and the pollen spectrum in 1565 pollen-sensitive patients. [German] Schweiz Med Wochenschr 1979;109(33):1212-8.
- Spieksma FT, Charpin H, Nolard N, Stix E. City spore concentrations in the European Economic Community (EEC). IV. Summer weed pollen (Rumex, Plantago, Chenopodiaceae, Artemisia), 1976 and 1977. Clin Allergy 1980;10(3):319-29.
- Ruiz-Garcia M, Garcia Del PM, Fernandez-Nieto M, Barber D, Jimeno-Nogales L, Sastre J. Profilin: A relevant aeroallergen? J Allergy Clin Immunol 2011;128(2):416-18.
- Mohapatra SS, Lockey RF, Polo F. Weed pollen allergens. Clin Allergy Immunol 2008;21:127-39.
- Bousquet J, Cour P, Guerin B, Michel FB. Allergy in the Mediterranean area. I. Pollen counts and pollinosis of Montpellier. Clin Allergy 1984;14(3):249-58.
- Silva Palacios I, Tormo Molina R, Nunoz Rodriguez AF. Influence of wind direction on pollen concentration in the atmosphere. Int J Biometeorol 2000;44(3):128-33.
- Recio M, Del Mar TM, Toro F, Docampo S, Garcia-Gonzalez J, Cabezudo B. A three-year aeropalynological study in Estepona (southern Spain). Ann Agric Environ Med 2006;13(2):201-207.
- Caballero T, Romualdo L, Crespo JF, Pascual C, Munoz-Pereira M, Martin-Esteban M. Cupressaceae pollinosis in the Madrid area. Clin Exp Allergy 1996;26(2):197-201.
- Cuesta-Herranz J, Lazaro M, Figueredo E, Igea JM, Umpierrez A, De-Las-Heras M. Allergy to plant-derived fresh foods in a birch- and ragweed-free area. Clin Exp Allergy 2000;30(10):1411-6.
- Gonzalez Minero FJ, Herrero Villacorta B, Candau P. Latitudinal study of allergenic pollen in two Spanish cities. J Investig Allergol Clin Immunol 1993;3(6):304-10.
- Tobías A, Galán I, Banegas JR. Non-linear short-term effects of airborne pollen levels with allergenic capacity on asthma emergency room admissions in Madrid, Spain. Clin Exp Allergy 2004;34(6):871-8.
- Negrini AC, Arobba D. Allergenic pollens and pollinosis in Italy: recent advances. Allergy 1992;47(4 Pt 2):371-9.
- Alcazar P, Galan C, Carinanos P, Dominguez-Vilches E. Diurnal variation of airborne pollen at two different heights. J Investig Allergol Clin Immunol 1999;9(2):89-95.
- Hernandez Prieto M, Lorente Toledano F, Romo Cortina A, Davila Gonzalez I, Laffond Yges E, Calvo Bullon A. Pollen calendar of the city of Salamanca (Spain). Aeropalynological analysis for 1981-1982 and 1991-1992. Allergol Immunopathol (Madr) 1998;26(5):209-22.
- Gonzalez Minero FJ, Candau P, Tomas C, Morales J. Daily variation patterns of airborne allergenic pollen in southwestern Spain. J Investig Allergol Clin Immunol 1998;8(2):89-93.
- Does mugwort pollenosis occur in children in the northern region? [French] Allerg Immunol (Paris) 1986;18(8):28-31.
- Helbling A, Leuschner RM, Wuthrich B. Pollinosis. IV. Which pollens should be tested in allergology practice? Results of determinations of allergy-causing pollens in the Zurich air 1981-1984, with reference to threshold concentrations. [German] Schweiz Med Wochenschr 1985;115(34):1150-9.
- Gehrig R. The influence of the hot and dry summer 2003 on the pollen season in Switzerland. Aerobiologia 2006;22(1):27-34.
- Silny W, Kuchta D, Siatecka D, Silny P. Antigen specific immunoglobulin E to grass and weed pollens in the plasma of patients with seasonal allergic rhinitis. [Polish] Otolaryngol Pol 1999;53(1):55-8.
- Gniazdowska B, Doroszewska G, Doroszewski W. Hypersensitivity to weed pollen allergens in the region of Bygdoszcz. [Polish] Pneumonol Alergol Pol 1993;61(7-8):367-72.
- Apostolou EK, Yannitsaros AG. Atmospheric pollen in the area of Athens. Acta Allergol 1977;32(2):109-17.
- Bicakci A, Akyalcin H. Analysis of airborne pollen fall in Balikesir, Turkey, 1996-1997. Ann Agric Environ Med 2000;7(1):5-10.
- Celenk S, Bicakci A. Aerobiological investigation in Bitlis, Turkey. Ann Agric Environ Med 2005;12(1):87-93.
- Garcia Cobaleda I, De la Torre Morin F, Garcia Robaina JC, Hardisson de la Torre A. The capturing of pollens in the atmosphere of La Laguna City, Tenerife, Canary Islands 1990-1995. Allergol Immunopathol (Madr) 1997;25(6):272-9.
- Kadocsa E, Juhasz M. Change in the allergen spectrum of hay fever patients in the Southern Great Plains of Hungary (1990-1998). [Hungarian] Orv Hetil 2000;141(29):1617-20.
- Rachmiel M, Waisel Y, Verliger H, Keynan N, Katz Y. Correlation between exposure to allergenic pollens and allergic manifestations. [Hebrew] Harefuah 1996;130(8):505-11, 584.
- Mehta V, Wheeler AW. IgE-mediated sensitization to English plantain pollen in seasonal respiratory allergy: identification and partial characterisation of its allergenic components. Int Arch Allergy Appl Immunol 1991;96(3):211-7.
- Peat JK, Woolcock AJ. Sensitivity to common allergens: relation to respiratory symptoms and bronchial hyper-responsiveness in children from three different climatic areas of Australia. Clin Exp Allergy 1991;21(5):573-81.
- Lewis WH, Imber WE. Allergy epidemiology in the St. Louis, Missouri, area. IV. weeds. Ann Allergy 1975;35(3):180-7.
- Lewis WH, Dixit AB, Wedner HJ. Aeropollen of weeds of the western United States Gulf Coast. Ann Allergy 1991;67(1):47-52.
- Anderson JH. Allergenic airborne pollen and spores in Anchorage, Alaska. Ann Allergy 1985;54(5):390-9.
- Anderson JH. A survey of allergenic airborne pollen and spores in the Fairbanks area, Alaska. Ann Allergy 1984;52(1):26-31.
- Kuberski T, Holdaway D, Turner KJ, Nemaia H. Wheezing bronchitis in children on a South Pacific Island. Am J Trop Med Hyg 1981;30(1):264-72.
- Shafiee A. Atmospheric pollen counts in Tehran, Iran, 1974. Pahlavi Med J 1976;7(3):344-51.
- Cabon N, Ducombs G, Mortureux P, Perromat M, Taieb A. Contact allergy to aeroallergens in children with atopic dermatitis: comparison with allergic contact dermatitis. Contact Dermatitis 1996;35(1):27-32.
- Granel C, Tapias G, Valencia M, Randazzo L, Olive A. Plantain allergy (Plantago lanceolata): assessment of diagnostic tests. Allergol Immunopathol (Madr) 1993;21(4):158-60.