Saltwort (prickly)/Russian thistle

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Code: w11
Latin name: Salsola kali
Source material: Pollen
Family: Amaranthaceae (Chenopodiaceae)
Common names: Russian Thistle, Prickly Saltwort, Prickly Glasswort, Tumbleweed

Closely related species: Prickly Russian Thistle - Salsola kali ruthenica

Allergen Exposure

Saltwort or Russian thistle originated in Europe and Asia, but has become naturalised and common throughout most arid and semiarid regions of the world, including the central and western regions of Canada and the United States. It is commonly found on the coasts of Europe, North Africa, Asia, North America and Australia.

Saltwort is a rounded, erect annual, intricately branched, growing from 0.3 to 1m in height and from 0.3 to 1.7m in diameter. The stems are ridged and usually red- or purple-striped. The young plants are fleshy and tender, with narrow, dark-green, and fleshy 15mm to 5cm-long pointed leaves. These leaves drop off. The mature leaves are short, broader, stiff, awl-shaped, and tipped with stiff spines.

The plants flower in late summer and autumn. The inconspicuous whitish, green or pinkish flowers are clustered at the base of the leaves along the upper branches. The flowers are hermaphrodite (have both male and female organs) and are pollinated by wind. The winged, 2mm grey to brownish-yellow seeds are cone-shaped, coiled utricles with the coiled embryo visible, and are held in the leaf axils until after plant death. After the seeds mature in late autumn, the plant stem separates from the root, becoming a ‘tumbleweed’. The plant is then blown by wind. Seeds fall to the ground as the plant tumbles, and further dispersal is accomplished when wind scatters the winged seeds. These plants are prolific seeders.

Saltwort or Russian thistle is most common along beaches and sandy shores, in cultivated fields, waste places, and disturbed grassland and deserts. The largest populations occur in semiarid regions.

Pollen grains of the Chenopodiaceae-Amaranthaceae families are very similar, although the plants are very different in appearance. In Europe the highest pollen counts are detected at the end of August and beginning of September. However, significant pollen counts have been demonstrated during May to October, and patients sensitive to Chenopodiaceae may be symptomatic during this period. (1)

Members of the Amaranthaceae and Chenopodiaceae families, e.g. Russian thistle (Salsola kali/pestifer) and Lamb’s quarter (Chenopodium album), survive in aggressive climatic conditions such as dry summers and mild winters. The genus Salsola is one of the most well- known genera of the Chenopodiaceae family, and its species – especially S. kali (formerly S. pestifer) and S. incanescens – are common throughout arid and semiarid regions. (2) These species are also cultivated in desert countries such as Saudi Arabia, Kuwait, and the United Arab Emirates, as a part of ground-greening programs or to avoid erosion of drained zones. They are also spreading throughout areas of the United States and the temperate regions of southern Europe. (3)

In Spain, S. kali is very common in Toledo, Aragon, Andalucia, Murcia and Levante. (4, 5, 6, 7, 8, 9) In these areas, the pollen load may represent up to 5% of the total pollen, being responsible for many allergic sensitisations.

Chenopod has been reported to cause allergy in desert countries, where it is well adapted. (10, 11, 12, 13) The genus Salsola is one of the well- known genera of the Chenopodiaceae family and its species, especially S. kali (formerly S. pestifer) and S. incanescens, are common throughout arid and semiarid regions of Iran.

A significant feature of Chenopod sensitivity is its concomitant appearance with other pollinoses, which probably explains the lack of attention that this allergy has received. (3, 14, 15)

Allergen Exposure

The allergen profile of Salsola has been determined, but not fully characterised. Three allergens were initially isolated, with masses of 39 kDa, 42 kDa, and 14 kDa. (15) The two larger of these are glycoproteins, and were found to be immunologically identical. (16) Other predominant bands were subsequently identified at 15, 17, 18, 29, 58, 69, 74 and 97 kDa. Protein bands with molecular weight of between 36 and 90 kDa were more frequently recognised, especially those with molecular weight of 43, 57, 69 and 81 kDa. (17)

An earlier study, utilising human IgE- and IgG-specific antibodies in in vitro studies, recognized twenty distinct protein bands of Russian thistle pollen extract. Molecular weights ranged from 12.2 kDa to 85 kDa. Allergic subjects had varying individual patterns of protein band recognition. (18)

The following allergens have been characterised:

Sal k 1, a 43 kDa protein, a pectin methylesterase. (17, 19, 20, 21, 22, 23)

Sal k 2, a protein kinase homologue. (19, 24)

Sal k 3, a methionine synthase. (19, 25)

Sal k 4, a 14 kDa protein, a profilin. (3, 19, 26, 27)

Sal k 5, an Ole e 1-related protein. (19, 28)

Of the 39 individuals with a positive allergen-specific IgE determination to S. kali, 26 (66.6%) had detectable IgE antibodies to Sal k 1. (20)

Sal k 1 was recognised by IgE from all 11 patients allergic to Saltwort. Two other allergens of 23 and 14 kDa were isolated and found to be present in 27% (n= 3) and 9% (n= 1), respectively, of the 11 subjects. (21)

Potential Cross-Reactivity

Extensive cross-reactivity among the different individual species of the genus may be expected, as well as among members of the families Chenopodiaceae (15, 29, 30) and Amaranthaceae (30, 31) to a certain degree. In particular, high cross-reactivity is well-known to occur between Chenopodium album (Goosefoot) and S. kali. The correlation of sensitisation to C. album in patients sensitised to S. kali has been reported to vary between 70-96% and 70-75% by skin-prick test or RAST respectively. (1, 6, 32)

S. incanescens pollen has been shown to have a close allergenic relationship with S. kali; and it has been shown that in S. incanescens-rich areas, S. kali pollen extracts could be used as a diagnostic reagent for patients allergic to S. incanescens pollen. (2)

However, Sal k 1, a pectin methylesterase, does not have a counterpart in the closely-related family member C. album. (21) A minor allergen from Birch pollen also belongs to the pectin methylesterase protein family. (33) In addition, an allergenic pectin methylesterase was identified in Kiwi fruit. (34) Ole e 11, a pectin methylesterase from Olive tree pollen, has a low amino acid sequence identity with foods such as carrot (23%), orange (25%) and tomato (24%), and higher identity with pectin methylesterase allergens in pollen from Arabidopsis thaliana (57%) and S. kali (54%). (35)

A significant degree of cross-reactivity has been demonstrated between saffron and Lolium, Salsola, and Olea. (36)

A significant but low antigenic cross-reactivity between Annual Mercury (M. annua) and Salsola kali, Olive tree (Olea europaea), Fraxinus elatior, Ricinus communis, Parietaria judaica and Artemisia vulgaris has been demonstrated by several in vitro techniques. (37)

Clinical Experience

IgE-mediated reactions

Saltwort pollen commonly induces asthma, allergic rhinitis and allergic conjunctivitis in sensitised individuals. (31, 36,38, 39, 40, 41, 42, 43)

In Sicily, 13.7% of 343 allergic patients were shown to be sensitised to Salsola pollen. Only one patient was monosensitised. (31) In 263 United Arab Emirate nationals with a respiratory disease suspected of being of allergic origin, 45.2% were positive to pollen from the Chenopodiaceae subfamily, specifically Salsola kali. (12)

In a Spanish multicentre study, sensitisation to Chenopodiaceae was found in 555 of 1536 patients; only a few patients were monosensitised (between 0% and 5%, depending on region). The prevalence of asthma was 41% in the total group, compared to just 20% in the 555 patients sensitized to Chenopodiaceae. Although pollen from this family accounted for just 1.6% of all pollen collected, the mean prevalence of positive skin tests in hay fever patients was high (31%), occupying third place (with regard to pollen sensitisation) after grass and olive pollens. (44)

An earlier Spanish study conducted in Madrid evaluated the sensitisation profile of individual allergens in 891 pollen-sensitised patients, in a region with high exposure to Olive pollen. From a panel of 13 purified allergens, which included the most relevant allergens in the area, as well as minor Olive allergens and pan-allergens, Olive tree pollen allergy (Ole e 1 sensitisation) was found to be the leading pollen allergy in the area. Profilin sensitisation was the second most prevalent cause of pollen allergy (associated mainly with grass allergy). Saltwort pollen allergy was the third most common cause of pollen allergy in the area (28.8%) as inferred from Sal k 1, the main allergen of Salsola kali pollen, which was found to be the third most common allergen. Sensitization occurred mainly in central and eastern regions. In some areas, Salsola was the most frequent cause of pollinosis. ( 45) In a more recent study Spanish study of 179 pollen-sensitised patients who underwent SPT with pollen extract and allergen-specific IgE determination against different allergens, 51(28.5%) were skin prick test positive to S. kali and 22 (12.3%) sensitised to Sal k 1. (46)

In another Spanish study, conducted in Zaragoza, sensitisation to Chenopodiaceae was the second most prevalent cause of sensitisation, affecting 42% of the patients with clinical sensitivity to pollen. (1, 47) Symptoms in monosensitised patients were shown to lag high pollen counts by almost two weeks. (1, 48)

In the Alicante Province of Spain, a review of 3066 paediatric patients with asthma or rhinitis attending three hospitals in this coastal region in the south-east of Spain found that the main aeroallergens in this region, in descending order of importance, were: Olive tree, mites, Saltwort, Alternaria, Cat, Dog and grasses. (49)

In an European study, IgE reactivity to the major mugwort allergen Art v 1 in relation to allergens from other weed pollen and cross-reactive components in mugwort-sensitised subjects was studied. The major finding was that the prevalence of IgE reactivity to Art v 1 was significantly higher in samples from North Europe than in those from North America. IgE to Art v 3 in mugwort-allergic patients was more common in North Europe than in South Europe and North America, while IgE to Sal k 1 was similar between the areas. (50)

In the third National Health and Nutrition Examination Surveys (NHANES III) conducted in the United States from 1988 through 1994, 10 allergen and 2 control skin-prick tests were administered to all subjects aged 6 to 19 years, and a random half-sample of subjects aged 20 to 59 years. Of these, 54.3% of the population had positive test responses to one or more allergens. The prevalence of sensitisation to dust mite was 27.5% (the highest recorded); lower percentages were 26.9% for Perennial rye, 26.2% for Short ragweed, 26.1% for German cockroach, 18.1% for Bermuda grass, 17.0% for Cat, 15.2% for Saltwort, 13.2% for white oak, 12.9% for Alternaria alternata, and 8.6% for Peanut. (51)

In Tucson, Arizona, USA – a city that has a high prevalence of allergic rhinitis and asthma – Russian Thistle contributes largely to the overall aeroallergen load. (52) Salsola pollen has also been found to be an aeroallergen in St. Louis, Missouri, and in other parts of the Midwest of the USA. (53, 54)

Salsola has also been shown to be a prominent allergen in Iran. (39, 55) In a study conducted in Mashhad City, the second largest city in Iran, with a semiarid climate, skin-prick tests performed for 27 common regional aeroallergens in 311 patients with allergic rhinitis found that the overall rate of sensitisation to any allergen was 81%. S. kali was the most prevalent allergen, with 72.5% of subjects sensitised. Of the atopic patients, 97% were sensitised to S. kali and/or White Ash tree (Fraxinus Americana). (56) S. incanescens is reported to be more abundant than S. kali in Mashhad; however, S. incanescens pollen has recently been shown to have a close allergenic relationship with S. kali, and in S. incanescens-rich areas, S. kali pollen extracts could be used as a diagnostic reagent for patients allergic to S. incanescens pollen. (2)

A study, conducted in patients with asthma and rhinitis residing in Riyadh in Saudia Arabia, evaluated skin prick test results of 139 Saudi nationals with a mean age of 27 +/-12 years. Seventy-five percent of patients reacted to one or more allergen extracts. Of the outdoor allergens, sensitisation to Prosopis juliflora was demonstrated in 72.1%, to Bermuda grass in 53.8%, to Chenopodium album in 47.1%, to Rye grass in 36.5% and to Saltwort in 36.5%. (57)

Similarly, in a study in the nearby arid country of Kuwait, most allergic patients were reported to become sensitised to pollens; the strongest and most frequent reaction being to the closely-related Saltwort plant, Salsola imbricate. This plant is found growing extensively in most areas of the country, flowering mainly in autumn, when the most common pollen is of the Chenopod-Amaranth type and when most patients with seasonal allergic rhinitis become symptomatic. Patients with asthma or allergic rhinitis (451 patients aged 5 to 60 years) were tested (by means of skin-prick tests) for a battery of allergens; and of these, 403 (89.4%) had a positive test result to at least one allergen, with most being sensitised to Salsola pollen (76.7%), followed by Chenopodium album (57.6%), and 38.2% to Bermuda grass. D. pteronyssinus was positive in only 37.5%, and American and German cockroaches in 33.2% and 22.3% respectively. (58)

Many pollen-allergic patients develop allergy to plant foods, attributed to cross-reactivity between food and pollen allergens. A study analysed the differences among pollen-allergic patients with and without plant food allergy in 806 recruited from 8 different hospitals. Each clinical research group included 100 patients (50 plant food-allergic patients and 50 pollen-allergic patients). A panel of 28 purified allergens from pollens and/or plant foods was used to quantify specific IgE. Six hundred and sixty eight patients (83%) of the 806 evaluated had pollen allergy: 396 patients with pollen allergy alone and 272 patients with associated food and pollen allergies. A comparison of both groups showed a statistically significant increase in the food and pollen allergy subgroup in frequency of: (a) asthma (47 vs. 59%; (b) positive skin test results to several pollens: Plantago, Platanus, Artemisia, Betula, Parietaria and Salsola; (c) sensitization to purified allergens: Pru p 3, profilin, Pla a 1 - Pla a 2, Sal k 1, PR-10 proteins and Len c 1. (43)

Other reactions

Russian thistle may cause dermatitis in persons who come into direct contact with it. The dermatitis appears to be due only to mechanical irritation from plant floral bracts, which pierce the skin and stimulate an urticarial reaction. (59)

Compiled by Dr Harris Steinman,


  1. Colas C, Lezaun A. Russian thistle pollinosis: form allergen characterization to specific immunotherapy treatment. Front Biosci 2009;14:4652-7.
  2. Assarehzadegan MA, Sankian M, Jabbari F, Noorbakhsh R, Varasteh A. Allergy to Salsola kali in a Salsola incanescens-rich area: role of extensive cross allergenicity. Allergol Int 2009;58(2):261-6.
  3. Rodriguez R, Villalba M, Batanero E, Palomares O, Salamanca G. Emerging pollen allergens. Biomed Pharmacother 2007;61(1):1-7.
  4. 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.
  5. Carinanos P, Galan C, Alcazar P, Dominguez E. Allergenic pollen in the subdesert areas of the Iberian peninsula. J Investig Allergol Clin Immunol 2000;10(4):242-7.
  6. Moral A, Senent C, Cabaiiez N, Garcia Y, Gomez-Serranillas M. Polenes alergenicos y polinosis en Toledo. Rev Esp Alergol Inmunol Clin 1998;2:126-34.
  7. González Minero FJ, Morales J, Candau P, Tomás MC, Pérez Tello AM. Aerobiological study of Chenopodiaceae and Amaranthaceae in the Mediterranean area of southwestern Spain. J Investig Allergol Clin Immunol 1998;8(6):370-5.
  8. Munuera Giner M, Garcia Selles J. Allergenic pollens in south-east Spain. Allergy 2002;57(1):59-60.
  9. Subiza Garrido-Lestache J. Allergenic pollens in Spain. [Spanish] Allergol Immunopathol (Madr) 2004;32(3):121-4.
  10. Ezeamuzie CI, al-Mousawi M, Dashti H, al-Bashir A, al-Hage M, al-Ali S. Prevalence of allergic sensitization to inhalant allergens among blood donors in Kuwait--a desert country. Allergy 1997;52(12):1194-200.
  11. Suliaman FA, Holmes WF, Kwick S, Khouri F, Ratard R. Pattern of immediate type hypersensitivity reactions in the Eastern Province, Saudi Arabia. Ann Allergy Asthma Immunol 1997;78(4):415-8.
  12. Lestringant GG, Bener A, Frossard PM, Abdulkhalik S, Bouix G. A clinical study of airborne allergens in the United Arab Emirates. Allerg Immunol (Paris) 1999;31(8):263-7.
  13. Dowaisan A, Al-Ali S, Khan M, Hijazi Z, Thomson MS, Ezeamuzie CI. Sensitization to aeroallergens among patients with allergic rhinitis in a desert environment. Ann Allergy Asthma Immunol 2000;84(4):433-8.
  14. Lombardero M, Duffort O, Carreira J. Allergenic significance of chenopod pollen. In: D’Amato G, Spieksma FT, Bonini S, editors. Allergenic pollen and pollinosis in Europe. Oxford: Blackwell Scientific Publications; 1991:128-31.
  15. Wurtzen PA, Nelson HS, Lowenstein H, Ipsen H. Characterization of Chenopodiales (Amaranthus retroflexus, Chenopodium album, Kochia scoparia, Salsola pestifer) pollen allergens. Allergy 1995;50(6):489-97.
  16. Shafiee A, Yunginger JW, Gleich GJ. Isolation and characterization of Russian thistle (Salsola pestifer) pollen allergens. J Allergy Clin Immunol 1981;67(6):472-81.
  17. Carnés J, Fernández-Caldas E, Casanovas M, Lahoz C, Colás C. Immunochemical characterization of Salsola kali pollen extracts. Allergy 2001;68(Suppl.):274.
  18. Gomez J, Mansfield LE, Frederick RW, Rael ED. Analysis of the individual allergens of Russian thistle pollen by an enzyme-linked immunoblotting technique. J Asthma 1989;26(4):243-50.
  19. International Union of Immunological Societies Allergen Nomenclature: IUIS official list Accessed: 28 November 2011.
  20. Carnes J, Fernandez-Caldas E, Marina A, Alonso C, Lahoz C, Colas C, Lezaun A. Immunochemical characterization of Russian thistle (Salsola kali) pollen extracts. Purification of the allergen Sal k 1. Allergy 2003;58(11):1152-6.
  21. Barderas R, García-Sellés J, Salamanca G, Colás C, Barber D, Rodríguez R, Villalba M. A pectin methylesterase as an allergenic marker for the sensitization to Russian thistle (Salsola kali) pollen. Clin Exp Allergy 2007;37(7):1111-9.
  22. Assarehzadegan MA, Sankian M, Jabbari F, Tehrani M, Varasteh A. Expression of the recombinant major allergen of salsola kali pollen (sal k 1) and comparison with its low-immunoglobulin e-binding mutant. Allergol Int 2010;59(2):213-22.
  23. Arilla MC, Ibarrola I, Brena S, Martinez A, Colas C, Asturias JA. The Russian Thistle (Salsola kali) pollen major allergen, Sal k 1, can be quantified in allergenic extracts and airborne pollen. Int Arch Allergy Immunol 2010;152(4):319-26.
  24. Civantos E., Del Pozo V., Lopez E., Cortegano I., Gallardo S., Colas C., Cardaba B., Palomino P., Lahoz C. Molecular cloning and expression of a novel allergen from Salsola kali pollen: Sal k 2. EMBL/GenBank/DDBJ databases. 2002;September.
  25. Assarehzadegan MA, sankian M, Jabbari F, Tehrani M, Falak R, Varasteh A. Identification of methionine synthase (Sal k 3), as a novel allergen of Salsola kali pollen. Mol Biol Rep 2011;38(1):65-73.
  26. Barderas R, Villalba M, Rodriguez R. Recombinant expression, purification and cross-reactivity of chenopod profilin: rChe a 2 as a good marker for profilin sensitization. Biol Chem 2004;385(8):731-7.
  27. Assarehzadegan MA, Amini A, Sankian M, Tehrani M, Jabbari F, Varasteh A. Sal k 4, a new allergen of Salsola kali, is profilin: a predictive value of conserved conformational regions in cross-reactivity with other plant-derived profilins. Biosci Biotechnol Biochem 2010;74(7):1441-6.
  28. Castro L., Villalba M., Abian S., Prado N., Sirvent S., Palomares O., Batanero E., Barber D., Rodriguez R. Isolation, characterization, and cloning of Sal k 4, an Ole e 1-like protein from Salsola kali. EMBL/GenBank/DDBJ databases. 2009.
  29. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala, Sweden. 1982: ISBN 91-970475-09.
  30. Lombardero M, Duffort O, Selles JG, Hernandez J, Carreira J. Cross-reactivity among Chenopodiaceae and Amaranthaceae. Ann Allergy 1985;54(5):430-6.
  31. Crimi N, Palermo B, Palermo F, Pistorio MP, Rizza S, Mistretta A, De Leonardis W, Longhitano N. On the pollen morphology and frequency of allergic sensitization in Sicily of the genus Salsola L. (Chenopodiaceae). Allergol Immunopathol (Madr) 1988;16(4):259-62.
  32. Feo Brito F, Galindo PA, Garcia R et al. Polenes alergenicos en Ciudad Real: Aerobiologia e incidencia clinica. Rev Esp Alergol Inmunol Clin 1998;2:79-85.
  33. Mahler V, Fischer S, Heiss S, Duchene M, Kraft D, Valenta R. cDna cloning and characterization of a cross-reactive birch pollen allergen: identification as a pectin esterase. Int Arch Allergy Immunol 2001;124(1-3):64-6.
  34. Ciardiello MA, Tamburrini M, Tuppo L, Carratore V, Giovane A, Mattei B, Camardella L. Pectin methylesterase from kiwi and kaki fruits: purification, characterization, and role of pH in the enzyme regulation and interaction with the kiwi proteinaceous inhibitor. J Agric Food Chem 2004;52(25):7700-3.
  35. Salamanca G, Rodríguez R, Quiralte J, Moreno C, Pascual CY, Barber D, Villalba M. Pectin methylesterases of pollen tissue, a major allergen in olive tree. FEBS J 2010;277(13):2729-39.
  36. Feo F, Martinez J, Martinez A, Galindo PA, Cruz A, Garcia R, Guerra F, Palacios R. Occupational allergy in saffron workers. Allergy 1997;52(6):633-41.
  37. Vallverdu A, Garcia-Ortega P, Martinez J, Martinez A, Esteban MI, de Molina M, Fernandez-Tavora L, Fernandez J, Bartolome B, Palacios R. Mercurialis annua: characterization of main allergens and cross-reactivity with other species. Int Arch Allergy Immunol 1997;112(4):356-64.
  38. Weber RW. Russian Thistle. Ann Allergy Asthma Immunol 2001;87(2):A-4.
  39. Shafiee A, Jamali F, Bayat B. Clinical significance of total serum IgE determination in screening of Iranian Russian thistle pollen hypersensitive individuals. Clin Allergy 1980;10(1):111-4.
  40. Colas C, Monzon S, Venturini M, Lezaun A. Double-blind, placebo-controlled study with a modified therapeutic vaccine of Salsola kali (Russian thistle) administered through use of a cluster schedule. J Allergy Clin Immunol 2006;117(4):810-6.
  41. Garde J, Ferrer A, Jover V, Pagan JA, Andreu C, Abellan A, Félix R, Milán JM, Pajarón M, Huertas AJ, Lavín JR, de la Torre F. Tolerance of a Salsola kali extract standardized in biological units administered by subcutaneous route. Multicenter study. Allergol Immunopathol (Madr) 2005;33(2):100-4.
  42. Rodríguez D, Davila I, Sánchez E, Barber D, Lorente F, Sánchez J. Relationship between airborne pollen counts and the results obtained using 2 diagnostic methods: allergen-specific immunoglobulin E concentrations and skin prick tests. J Investig Allergol Clin Immunol 2011;21(3):222-8.
  43. 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;153(2):182-92.
  44. Pola J, Subiza J, Zapata C, Moral A, Feo F. Correlation between total annual atmospheric pollen counts for Chenopodiaceae--Amaranthaceae and the prevalence of positive skin prick tests to Chenopodium and/or Salsola pollen extracts: a multicenter study. J Investig Allergol Clin Immunol 2009;19(1):73-4.
  45. Barber D, De la Torre F, Feo F, Florido F, Guardia P, Moreno C, Quiralte J, Lombardero M, Villalba M, Salcedo G, Rodríguez R. Understanding patient sensitization profiles in complex pollen areas: a molecular epidemiological study. Allergy 2008;63(11):1550-8.
  46. 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.
  47. Belmonte J, Roure JM, Colas C, Duce Gracia F, Garcia Rodriguez RM, Laborda Borobia M, Portillo del Olmo J. Aerobiologia de Aragon. ISBN: 84-699-6872-6. Quasar Serveis d'lmatge, S.L. Barcelona. 2001;41-6.
  48. Colas C, Monzon S, Venturini M, Lezaun A, Laclaustra M, Lara S, Fernandez-Caldas E. Correlation between Chenopodiacea/Amaranthacea pollen counts and allergic symptoms in Salsola kali monosensitized patients. J Investig Allergol Clin Immunol 2005;15(4):254-8.
  49. Moral L, Roig M, Garde J, Alós A, Toral T, Fuentes MJ. Allergen sensitization in children with asthma and rhinitis: marked variations related to age and microgeographical factors. Allergol Immunopathol (Madr) 2008;36(3):128-33.
  50. Moverare R, Larsson H, Carlsson R, Holmquist I. Mugwort-Sensitized Individuals from North Europe, South Europe and North America Show Different IgE Reactivity Patterns. Int Arch Allergy Immunol 2010;154(2):164-72.
  51. Arbes SJ Jr, Gergen PJ, Elliott L, Zeldin DC. Prevalences of positive skin test responses to 10 common allergens in the US population: results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol 2005;116(2):377-83.
  52. Sneller MR, Hayes HD, Pinnas JL. Pollen changes during five decades of urbanization in Tucson, Arizona. Ann Allergy 1993;71(6):519-24.
  53. Stokes JR, Hartel R, Ford LB, Casale TB. Cannabis (hemp) positive skin tests and respiratory symptoms. Ann Allergy Asthma Immunol 2000;85(3):238-40.
  54. Lewis WH, Imber WE. Allergy epidemiology in the St. Louis, Missouri, area. IV. weeds. Ann Allergy 1975;35(3):180-7.
  55. Shafiee A. Atmospheric pollen counts in Tehran, Iran, 1974. Pahlavi Med J 1976;7(3):344-51.
  56. Fereidouni M, Farid Hossini R, Jabbari Azad F, Ali Assarezadegan M, Varasteh A. Skin prick test reactivity to common aeroallergens among allergic rhinitis patients in Iran. Allergol Immunopathol (Madr) 2009;37(2):73-9.
  57. Almogren A. Airway allergy and skin reactivity to aeroallergens in Riyadh. Saudi Med J 2009;30(3):392-6.
  58. Al-Dowaisan A, Fakim N, Khan MR, Arifhodzic N, Panicker R, Hanoon A, Khan I. Salsola pollen as a predominant cause of respiratory allergies in Kuwait. Ann Allergy Asthma Immunol 2004;92(2):262-7.
  59. Powell RF, Smith EB. Tumbleweed dermatitis. Arch Dermatol 1978;114(5):751-4.



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