Allergy information for: Grape (Vitis vinifera )

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    References (0)

      Clinical History

      • Number of Studies:11-20
      • Number of Patients:21-50
      • Symptoms:

        There are many reports of one or two cases of allergy to either grapes or wine, the single article of Pastorello et al. (2003) [707] reporting 14 severe cases.

        • Exercise-induced anaphylaxis after eating grapes (Dohi et al 1991 [318]).
        • Palmoplantar pruritus, urticaria, dyspnea, dysphagia, gastric pain, sweating, and tachycardia (Bircher et al. 1999) [869]
        • Oral allergy syndrome to grapes and wine (Giannoccaro et al 1998 [341]).
        • Two cases of oral allergy syndrome to grapes: one of them with an episode of anaphylaxis and the other with exercise-induced anaphylaxis after eating grapes (Guinnepain et al. 1998 [348]).
        • A woman with two episodes of urticaria, angioedema and diyspnea and one of anaphylaxis (Vaswani et al 1999 [551]).
        • Exercise-induced anaphylaxis with wine (Garcia-Robaina et al 2001 [340]).
        • Facial flushing, edema of lips, and dyspnea after drinking white or red wine but could eat fresh grapes without a problem. However, exercise-induced anaphylaxis after eating white grapes and then exercise. After exercise, urticaria, facial/pharyngeal edema, abdominal pain, and dyspnea appeared and rapidly worsened (Senna et al 2001 [706])
        • Oral allergy syndrome and lip angioedema in a 5-year-old child after eating grapes (Rodriguez et al 2001 [705])
        • Oral allergy syndrome in a 4 year old boy after the consumption of grapes (Petrus & Malandain 2002 [709])
        • Anaphylaxis after eating white grapes (Anton et al 1997 [961]; Caiaffa et al 2003 [708])
        • Pastorello et al. (2003) [707] reported 14 adult patients with severe symptoms, 11 to grape and 3 to wine. Two showed OAS and others angioedema, laryngeal edema, urticaria, gastrointestinal symptoms, hypotension, asthma and anaphylactic shock. One case of anaphylactic shock after exercise.

        • Rodriguez et al (2004) [960] reported 14 patients with OAS (6/14), anaphylaxis (4/14), angioedema (2/14), urticaria (1/14) and urticaria-angioedema (1/14)

      Skin Prick Test

      • Number of Studies:11-20
      • Food/Type of allergen:

        Commercial grape extract and fresh grapes (Anton et al. 1997) [961].

        Red grapes (Guinnepain et al. 1998) [348].

        Fresh red and white grapes and dried grapes (Giannoccaro et al. 1998) [341].

        Grape extract (Vaswani et al. 1999) [551]

        Raisins and grape juice and with different species of fresh grapes (Bircher et al. 1999) [869].

        Pulp and peel of fresh white grape (Moscatel variety) and pulp and peel of blue grape (Rodriguez et al. 2001) [705].

        White and red grape juice (Senna et al. 2001) [706].

        Fresh grape (Garcia-Robaina et al. 2001 [340], Pastorello et al. 2003) [707]

        Commercial grape extract, white fresh grapes and white grape juice (Caiaffa et al. 2003) [708].

        Commercial grape extract and pulp or peel from fresh grape (Rodriguez et al. 2004) [960].

      • Protocol: (controls, definition of positive etc)Prick test and prick-by-prick test (Anton et al. 1997 [961], Rodriguez et al. 2001) [705].

        Prick to prick test (Guinnepain et al. 1998 [348], Giannoccaro et al. 1998 [341], Garcia-Robaina et al. 2001) [340].

        The skin test was positive with a 10 mm wheal and 14 mm erythema above the saline control (Vaswani et al. 1999) [551].

        Prick-to-prick. The test was defined as positive with a wheal diameter of at least 3 mm (Bircher et al. 1999) [869].

        Prick-plus-prick technique. A positive skin reaction was defined as the presence of a wheal larger than that elicited with the histamine phosphate control as read after 20 minutes (Pastorello et al. 2003) [707]

        Prick test and prick-by-prick test. The tests were positive when a wheal diameter of at least 3 mm was observed (Caiaffa et al. 2003) [708].

      • Number of Patients:

        3 patients who suffered anaphylactic reaction after eating fresh grapes (Anton et al., 1997) [961].

        Two patients. One of them experienced anaphylactic shock and the second patient developed exercise-induced anaphylaxis (Guinnepain et al. 1998) [348].

        A 24-year-old man with no family history of allergy suffered from oral allergy syndrome (OAS) after eating fresh grapes and drinking either white or red wine (Giannoccaro et al. 1998) [341].

        A 28-year-old woman (Vaswani et al. 1999) [551].

        A 44-year-old man (Bircher et al. 1999) [869].

        A 5-year-old female (Rodriguez et al. 2001) [705].

        A 33-year-old woman showing exercise-induced anaphylaxis (Senna et al. 2001) [706].

        A 19-year-old man (Garcia-Robaina et al. 2001) [340].

        Fourteen patients, 10 women and 4 men (mean age, 30.5 years; age range 23-47 years), were selected on the basis of a documented history of severe allergic reactions to grape (11 patients) or wine (3 patients) (Pastorello et al. 2003) [707]

        A 28-year-old woman with allergic systemic reaction after eating white grapes (Caiaffa et al. 2003) [708].

        14 children with allergic reactions after eating either fresh grapes or grape juice (Rodriguez et al. 2004) [960].

      • Summary of Results:

        Positive for 3 patients (Anton et al. 1997) [961]

        Positive for 2 patients (Guinnepain et al. 1998) [348].

        The test was highly positive with the three fruits (Giannoccaro et al. 1998) [341].

        Positive (Vaswani et al. 1999) [551].

        Test was positive for grapes, whereas other grapes were skin-test negative (Bircher et al. 1999) [869].

        The test was positive (Rodriguez et al. 2001) [705].

        Positive (Senna et al. 2001) [706].

        Positive (Garcia-Robaina et al. 2001) [340].

        SPTs with fresh grape provided positive results to all the patients (Pastorello et al. 2003) [707].

        The skin prick test performed with commercial extract was negative but the prick-by-prick performed with white grapes and juice was positive (Caiaffa et al. 2003) [708].

        The skin prick test performed with commercial extract was positive for one patient, but the tests performed with white pulp and peel grape were positive for 4 patients (Rodriguez et al. 2004) [960]

      IgE assay (by RAST, CAP etc)

      • Number of Studies:0
      • Food/Type of allergen:Grape extracts
      • IgE protocol:

        Anton et al. 1997 [961] used commercial discs (Immuno system CAP) and nitrocellulose discs coupled with their own extracts (RAST)

        CAP-RAST (Guinnepain et al. 1998) [348], Vaswani et al. 1999 [551], Senna et al. 2001 [706], Caiaffa et al. 2003 [708]

        RAST (Giannoccaro et al. 1998) [341].

        CAP (Bircher et al. 1999 [869], Rodriguez et al. 2001 [705], Pastorello et al. 2003 [707]).

      • Number of Patients:

        3 patients who suffered anaphylactic reaction after eating fresh grapes (Anton et al., 1997) [961].

        Two patients. One of them experienced anaphylactic shock and the second patient developed exercise-induced anaphylaxis (Guinnepain et al. 1998) [348].

        A 24-year-old man with no family history of allergy suffered from oral allergy syndrome (OAS) after eating fresh grapes and drinking either white or red wine (Giannoccaro et al. 1998) [341].

        A 28-year-old woman (Vaswani et al. 1999) [551].

        A 44-year-old man (Bircher et al. 1999) [869]

        A 5-year-old female (Rodriguez et al. 2001) [705].

        A 33-year-old woman showing exercise-induced anaphylaxis (Senna et al. 2001) [706].

        A 19-year-old man (Garcia-Robaina et al. 2001) [340].

        A 28-year-olg woman with allergic systemic reaction after eating white grapes (Caiaffa et al. 2003) [708].

        Fourteen patients, 10 women and 4 men (mean age, 30.5 years; age range 23-47 years), were selected on the basis of a documented history of severe allergic reactions to grape (11 patients) or wine (3 patients) (Pastorello et al. 2003) [707]
      • Summary of Results:

        Positive for all patients (Anton et al. 1997) [961].

        Positive in both patients (Guinnepain et al. 1998) [348].

        Serum gave a positive class 2 RAST (Giannoccaro et al. 1998) [341].

        Grape-specific serum IgE level was weakly positive (class 1) by RAST and negative by CAP (Vaswani et al. 1999) [551].

        No grape-specific IgE could be demonstrated in the patient’s serum (Bircher et al. 1999) [869].

        Specific IgE to grape was 1.1 KU/l (Rodriguez et al. 2001) [705].

        No grape-specific IgE could be demonstrated in the patient’s serum (Senna et al. 2001) [706].

        Specific IgE to grape was 4.13 KU/ml (Garcia-Robaina et al. 2001) [340].

        Grape-specific serum IgE level was 2.29 KUA/l (Caiaffa et al. 2003) [708].

        Grape-specific serum IgE levels were between 0.95 and 18.9 KUA/l (Pastorello et al. 2003) [707]

      Immunoblotting

      • Immunoblotting separation:

        SDS-PAGE was performed on a 10% polyacrylmide gel (Senna et al. 2001) [706]

        The extracts were separated in a discontinuous buffer system in an SDS-polyacrylamide gradient gel with a 6% stacking gel and a 7.5% to 20% separation gradient gel under reducing conditions (Pastorello et al. 2003) [707]

      • Immunoblotting detection method:

        Proteins were transferred onto a nitrocellulose membrane. The membrane was saturated with 5% deffated dried milk before incubation with patients’ sera (1:2). Bound IgE was detected by peroxidase-conjugated anti-human IgE serum (Senna et al. 2001) [706]

        The separated proteins were electroblotted onto a nitrocellulose membrane. The nitrocellulose was incubated with each patient's serum diluted 1:4 in blocking solution. The bound specific antibodies were detected by means of incubation with iodine 125–labeled anti-human IgE antiserum and exposure on x-ray film (Pastorello et al. 2003) [707]

      • Immunoblotting results:

        A 31 kDa protein was recognised by IgE from the sera of the 3 patients (Anton et al. 1997) [961].

        A 94 kDa protein was recognised by IgE in sera from a single patient (Rodriguez et al. 2001) [705].

        A 30 kDa grape protein was recognised by IgE in sera from a single patient (Senna et al. 2001) [706]

        The patient had IgE against a 13 kDa protein (Garcia-Robaina et al. 2001) [340].

        IgE binding at proteins of 30 kDa (11/14, 79%), 9 kDa (10/14, 71%), and 24 kDa (3/14, 21%). Latex IgE immunoblotting shows that only 6 patients had positive IgE binding, whereas the others did not (Pastorello et al. 2003) [707]

        A 94 kDa grape protein was recognised by serum IgE from patient no. 8. Patient no. 9 bound to 100, 60, 34, 28, 24 and 17 kDa proteins bands, patient no. 12 to 31 and 24 kDa, no. 13 to a 34 kDa and no. 14 to a 17 kDa (Rodriguez et al. 2004) [960].

      Oral provocation

      • Number of Studies:1-5
      • Food used and oral provocation vehicle:

        A piece of grape pulp applied in the internal face of the lower lip for 10 min (Rodriguez et al. 2001) [705].

        Muscat de Hamburg’ grapes (Rodriguez et al. 2004) [960].

      • Blind:

        Lip open challenge (Rodiguez et al. 2001) [705].

        Open (Rodriguez et al. 2004) [960].

      • Number of Patients:

        A 5-year-old female (Rodriguez et al. 2001) [705].

        Two children (Rodriguez et al. 2004) [960].

      • Dose response:None
      • Symptoms:

        Erythema and vesicles in the contact area (Rodriguez et al. 2001) [705].

        Positive in 2 of 2 patients (Rodriguez et al. 2004) [960].

      IgE cross-reactivity and Polysensitisation

      Guinnepain et al. 1998 [348] reported a patient allergic to grape and peach and Giannoccaro et al. 1998 [341] to grape and cherry.

      Cross-reactivity between latex and grapes has been identified (Frankland et al. 1999) [777].

      An LTP-hypersensitive patient with Rosaceae allergy reported an allergic reaction after eating grapes (Asero et al. 2002) [667]

      Other Clinical information

      Reviews (0)

        References (15)

        • Petrus M, Malandain H.
          [Food allergy to grape. A new observation in a four years old child]
          Revue francaise d’allergologie et d’immunolgie clinique 42: 806-809. 2002
          PUBMEDID:
        • Caiaffa MF, Tursi A, Macchia L.
          Grape anaphylaxis.
          J Investg Allergol Cli Immunol 13(3)211-212. 2003
          PUBMEDID: 14635473
        • Rodriguez A, Trujill MJ, Matheu V, Baeza ML, Zapatero L, Martinez M.
          Allergy to grape: a case report.
          Pediatr Allergy Immunl 12: 289-290. 2001
          PUBMEDID: 11737676
        • Senna G, Mistrello G, Roncarolo D, Crivellaro M, Bonadonna P, Schiappoli M, Passalacqua G.
          Exercise-induced anaphylaxis to grape.
          Allergy 56(12):1235-1236. 2001
          PUBMEDID: 11736764
        • Pastorello EA, Farioli L, Pravettoni V, Ortolani C, Fortunato D, Giuffrida MG, Perono Garoffo L, Calamari AM, Brenna O, Conti A.
          Identification of grape and wine allergens as an endochitinase 4, a lipid-transfer protein, and a thaumatin.
          J Allergy Clin Immunol. 111(2):350-359. 2003
          PUBMEDID: 12589356
        • Garcia-Robaina JC, de la Torre-Morin F, Sanchez-Machin I, Sanchez-Monge R, Barber D, Lombardero M
          Anaphylaxis induced by exercise and wine.
          Allergy 56:357-358.. 2001
          PUBMEDID: 11284812
        • Vaswani S.K. , Chang B.W., Carey R.N. and Hamilton G.
          Adult onset grape hypersensitivity causing life threatening anaphylaxis.
          Ann. Allergy 83: 25-26.. 1999
          PUBMEDID: 10437812
        • Anton E, Jimenez I, Polo F, Picans, I, Sanchez I, Jerez J
          Immediated hypersensitivity to grape: Study of cross-reactivity with other fruits
          Allergy 52(37 Suppl):119. 1997
          PUBMEDID:
        • Guinnepain M.T., Rassemont R., Claude M.F. and Laurent J.
          Oral allergy syndrome (OAS) to grapes.
          Allergy 53: 1225. 1998
          PUBMEDID: 9930603
        • Giannoccaro F., Munno G., Riva G., Pugliese S., Paradiso M.T. and Ferrannini A.
          Oral allergy syndrome to grapes.
          Allergy 53: 451-452.. 1998
          PUBMEDID: 9574893
        • Dohi M., Suko M., Sugiyama H., Yamashita N., Tadokoro K., Juji F., Okudaira H., Sano Y., Ito K. and Miyamoto T.
          Food-dependent, exercise-induced anaphylaxis: A study on 11 Japanese cases.
          J. Allergy Clin. Immunol 87: 34-40.. 1991
          PUBMEDID: 1991921
        • Bircher, AJ, Bigliardi, P, Yilmaz, B
          Anaphylaxis resulting from selective sensitization to Americana grapes
          J Allergy Clin Immunol 104 (5)1111-1113. 1999
          PUBMEDID: 10550763
        • Asero R, Mistrello G, Roncarolo D, Amato S, Caldironi G, Barocci F, van Ree R.
          Immunological cross-reactivity between lipid transfer proteins from botanically unrelated plant-derived foods: a clinical study.
          Allergy 57(10):900-906. 2002
          PUBMEDID: 12269935
        • Frankland AW
          Latex-allergic children
          Pediatr Allergy Immunol 10; 152-159. 1999
          PUBMEDID: 10565555
        • Rodriguez A, Matheu V, Trujillo MJ, Martinez MI, Baeza ML, Barranco R, Frutos C, Zapatero L.
          Grape allergy in paediatric population
          Allergy. 59(3):364. 2004
          PUBMEDID: 14982527

        Biochemical Information for Chitinase class I protein

        • Allergen Name:Chitinase class I protein
        • Alternatve Allergen Names:
        • Allergen Designation:Major
        • Protein Family:

          Chitin recognition protein Pfam PF00187

          Chitinase class I Pfam PF00182

        • Sequence Known?:

          yes

        • Allergen accession No.s:

          O24530: Swissprot: http://us.expasy.org/cgi-bin/niceprot.pl?O24530

          U97521; AAB65776.1; - [EMBL / GenBank

        • 3D Structure Accession No.:None
        • Calculated Masses:

        • Experimental Masses:30 kDa
        • Oligomeric Masses:None
        • Allergen epitopes:Not determined
        • Allergen stability:
          Process, chemical, enzymatic:
        • Nature of main cross-reacting proteins:
        • Allergen properties & biological function:Chitinases have antifungal properties and are classified in the pathogenesis related (PR) families as PR3.
        • Allergen purification:

          Chitinase class I protein was extracted by homogenisation in PBS. 2% (w/v) polyvinylpyrrolidone, 2mM EDTA, 10mM diethyldithiocarbamate, 3mM NaN3. Extracts were clarified by centrifugation (16,000xg) at 4C, 30min, dialysed against PBS and concentrated in a centrifugal concentrator (3kDa cut-off filter). This extract was loaded onto a Resource-S cation exchange column equilibrated in 30mM sodium citrate buffer pH 5 and the proteins eluted with 1M NaCl. A gel-permeation chromatography step on Superdex 75 in citrate buffer (pH 5) was then performed and a final step onto a Resource-Q anion exchange column (Pastorello et al 2003) [707]

        • Other biochemical information:The results of both MALDI and ESI MS/MS analysis indicate that this component might be an isoform of the grape class IV endochitinase VVCHI4B that is slightly different from that described by Robinson et al. 1997

        References (2)

        • Robinson SP, Jacobs AK, Dry IB
          A class IV chitinase is highly expressed in grape berries during ripening
          Plant Physiol. 114:771-8. 1997
          PUBMEDID: 9232868
        • Pastorello EA, Farioli L, Pravettoni V, Ortolani C, Fortunato D, Giuffrida MG, Perono Garoffo L, Calamari AM, Brenna O, Conti A.
          Identification of grape and wine allergens as an endochitinase 4, a lipid-transfer protein, and a thaumatin.
          J Allergy Clin Immunol. 111(2):350-359. 2003
          PUBMEDID: 12589356

        Biochemical Information for Thaumatin-like protein

        • Allergen Name:Thaumatin-like protein
        • Alternatve Allergen Names:
        • Allergen Designation:Minor
        • Protein Family:

          Thaumatin-like proteins, Pfam PF00314

        • Sequence Known?:N-terminal sequence only
        • Allergen accession No.s:None
        • 3D Structure Accession No.:None
        • Calculated Masses:
        • Experimental Masses:24 kDa
        • Oligomeric Masses:None
        • Allergen epitopes:Not determined
        • Allergen stability:
          Process, chemical, enzymatic:

          The thaumatin-like proteins (TLPs) contain 8 disulfide bridges and so it might be expected to be thermostable. The TPLs are generally resistant to proteases and pH-induced denaturation (Breiteneder, H. 2004) [1001]

        • Nature of main cross-reacting proteins:IgE binding to the 24 kDa grape component in grape extract was totally inhibited by cherry extract, probably by cherry thaumatin-like protein Pru av 2.
        • Allergen properties & biological function:Due to high sequence identitiy of grape thaumatin-like protein and Pru av 2 (42% identity and 78 % similarity) it is though to display similar functions as other thaumatin-like proteins. These proteins have been included in the pathogenesis-related proteins classification as PR5 and are thought to be produced in response to pathogen infection or to osmotic stress.
        • Allergen purification:

          Thaumatin-like protein was extracted by homogenisation in PBS. 2% (w/v) polyvinylpyrrolidone, 2mM EDTA, 10mM diethyldithiocarbamate, 3mM NaN3. Extracts were clarified by centrifugation (16,000xg) at 4C, 30min, dialysed against PBS and concentrated in a centrifugal concentrator (3kd cut-off filter). This extract was loaded onto a Resource-S cation exchange column equilibrated in 30mM sodium citrate buffer pH 5 and the protein eluted with 1M NaCl. A gel-permeation chromatography step on Superdex 75 in citrate buffer (pH 5) was then performed and a final step onto a Resource-Q anion exchange column (Pastorello et al 2003) [707]

        • Other biochemical information:This protein might belong to the thaumatin-like protein family althouth this would be confirmed when the full sequence is available.

        References (2)

        • Breiteneder H.
          Thaumatin-like proteins -- a new family of pollen and fruit allergens
          Allergy. 59:79-81.. 2004
          PUBMEDID: 15080826
        • Pastorello EA, Farioli L, Pravettoni V, Ortolani C, Fortunato D, Giuffrida MG, Perono Garoffo L, Calamari AM, Brenna O, Conti A.
          Identification of grape and wine allergens as an endochitinase 4, a lipid-transfer protein, and a thaumatin.
          J Allergy Clin Immunol. 111(2):350-359. 2003
          PUBMEDID: 12589356

        Biochemical Information for Vit v 1

        • Allergen Name:Vit v 1
        • Alternatve Allergen Names:
        • Allergen Designation:Major
        • Protein Family:

          Protease inhibitor/seed storage/LTP family, Pfam PF00234

          non specific lipid transfer protein (nsLTP)

        • Sequence Known?:N-terminal amino acid sequence
        • Allergen accession No.s:Fragment. Swissprot http://us.expasy.org/cgi-bin/niceprot.pl?P80274
        • 3D Structure Accession No.:Not determined
        • Calculated Masses:Two isoforms have been detected of masses of 9085.8 and 9157 Da
        • Experimental Masses:9 kDa
        • Oligomeric Masses:None
        • Allergen epitopes:

          None determined

        • Allergen stability:
          Process, chemical, enzymatic:

          Not known but likely to be thermostable and resistant to proteases as other members of the nsLTP family (Asero et al. 2000 [10]).

        • Nature of main cross-reacting proteins:Grape LTP has 80 % identity to peach LTP. IgE binding of the grape LTP was totally inhibited by cherry extract, probably by cherry nsLTP Pru av 3.
        • Allergen properties & biological function:

          Due to the high sequence identity of grape LTP to peach LTP it is though to display similar functions as other plant nonspecific lipid-transfer proteins. They are thought to be involved in transport of fatty acids both intracellular and extracellularly and of cutin monomers to the cuticular layer of leaves and fruits. There is an expandable cavity between the four alpha-helices which can bind one or two lipids. nsLTPs have also been reported to act as plant defense proteins against bacterial and fungal infections and form the PR14 family of pathogenesis related proteins. It is possible that a lipid-like post-translational modification is involved (Lindorff-Larsen et al. 2001 [903]).

        • Allergen purification:

          Grape LTP was extracted by homogenisation in PBS. 2% (w/v) polyvinylpyrrolidone, 2mM EDTA, 10mM diethyldithiocarbamate, 3mM NaN3. Extracts were clarified by centrifugation (16,000xg) at 4C, 30min, dialysed against PBS and concentrated in a centrifugal concentrator (3kd cut-off filter). This extract was loaded onto a Resource-S cation exchange column equilibrated in 30mM sodium citrate buffer pH 5 and the LTP eluted with 1M NaCl. A gel-permeation chromatography step on Superdex 75 in citrate buffer (pH 5) was then performed and a final step onto a Resource-Q anion exchange column (Pastorello et al 2003) [707]

        • Other biochemical information:

        References (4)

        • Pastorello EA, Farioli L, Pravettoni V, Ortolani C, Fortunato D, Giuffrida MG, Perono Garoffo L, Calamari AM, Brenna O, Conti A.
          Identification of grape and wine allergens as an endochitinase 4, a lipid-transfer protein, and a thaumatin.
          J Allergy Clin Immunol. 111(2):350-359. 2003
          PUBMEDID: 12589356
        • Pravettoni V, Conti A, Farioli L, Rivolta F, Calamari AM, Trambaioli C, Fortunato D, Pastorello EA
          Identification of the major allergens of grape
          Proceedings of the 8th International Symposium on Immunological, Chemical and Clinical Problems of Food Allergy, Venice March 11-13th 2001.. 2001
          PUBMEDID:
        • Lindorff-Larsen K, Lerche MH, Poulsen FM, Roepstorff P, Winther JR.
          Barley lipid transfer protein, LTP1, contains a new type of lipid-like post-translational modification.
          J Biol Chem. 276(36):33547-33553.. 2001
          PUBMEDID: 11435437
        • Asero R, Mistrello G, Roncarolo D, de Vries SC, Gautier MF, Ciurana CL, Verbeek E, Mohammadi T, Knul-Brettlova V, Akkerdaas JH, Bulder I, Aalberse RC, van Ree R.
          Lipid transfer protein: a pan-allergen in plant-derived foods that is highly resistant to pepsin digestion.
          Int Arch Allergy Immunol. 122:20-32.. 2000
          PUBMEDID: 10859466