PMID- 38178177
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240108
IS  - 1710-1484 (Print)
IS  - 1710-1492 (Electronic)
IS  - 1710-1484 (Linking)
VI  - 20
IP  - 1
DP  - 2024 Jan 4
TI  - Pollen food allergy syndrome secondary to molds and raw mushroom 
      cross-reactivity: a case report.
PG  - 2
LID - 10.1186/s13223-023-00865-5 [doi]
LID - 2
AB  - BACKGROUND: Pollen food allergy syndrome (PFAS) is an immunoglobulin E (IgE) 
      mediated reaction that causes oropharyngeal pruritus or angioedema due to 
      homologous proteins present in the culprit food as well as a sensitizing 
      aeroallergen. This cross-reactivity has been well established between pollen and 
      fruits/vegetables. Given the evolutionary similarity between all fungi; 
      cross-reactivity between spore forming microfungi and edible macrofungi have been 
      suggested, however only a limited number of case reports have ever been published 
      on this phenomenon. We present a case of a patient who experiences pollen food 
      allergy syndrome-like symptoms following lightly cooked mushroom ingestion who 
      otherwise was able to tolerate cooked mushrooms. We then review the literature to 
      highlight the limited studies of an underrecognized PFAS cross-reactivity between 
      molds and mushrooms. CASE PRESENTATION: A 15-year-old male presents with symptoms 
      of seasonal and perennial allergic rhinitis was found to have multiple 
      environmental sensitizations to molds via skin prick testing (C. gramineum, A. 
      Pullulans and B. cinerea) and ImmunoCAP serum-specific IgE (A. alternata, C. 
      herbarum, and P. notatum). He developed throat pruritus and subjective throat 
      tightness following ingestion of mushroom containing pizza. ImmunoCAP serum 
      specific IgE to whole mushroom was negative but fresh food prick testing to fresh 
      portobello mushroom and cremini mushroom were both positive with a negative test 
      to canned mushroom. The patient then underwent a graded oral challenge and 
      successfully tolerated canned mushrooms. CONCLUSION: This case highlights the 
      potential cross-reactivity between microfungi aeroallergens and edible fungi, 
      leading to PFAS-like reactions in susceptible individuals. The patient's ability 
      to tolerate canned mushrooms suggests a possible heat-labile protein as the cause 
      of the reaction, similar to PFAS patients tolerating cooked but not raw 
      fruits/vegetables. Positive skin prick test to both spore-forming fungi and 
      edible fungi with negative and whole mushroom IgE results further support the 
      hypothesis of cross-reactivity and sensitization. Further research is needed to 
      identify the specific allergenic proteins involved in these cross-reactions and 
      the susceptible species of mold and mushroom. Understanding these components will 
      contribute to improved diagnosis and management of mold and mushroom allergies, 
      and enhance our knowledge of allergenic cross-reactivity in general.
CI  - (c) 2024. The Author(s).
FAU - Gauld, Ryan
AU  - Gauld R
AUID- ORCID: 0009-0008-1879-5418
AD  - Division of Clinical Immunology and Allergy, Department of Medicine, Western 
      University, London, ON, Canada.
FAU - Walter, Graham
AU  - Walter G
AD  - Division of Clinical Immunology and Allergy, Department of Medicine, Western 
      University, London, ON, Canada.
FAU - Zhu, Rongbo
AU  - Zhu R
AD  - Division of Clinical Immunology and Allergy, Department of Medicine, Western 
      University, London, ON, Canada. Rongbo.Zhu@lhsc.on.ca.
LA  - eng
PT  - Journal Article
DEP - 20240104
PL  - England
TA  - Allergy Asthma Clin Immunol
JT  - Allergy, asthma, and clinical immunology : official journal of the Canadian 
      Society of Allergy and Clinical Immunology
JID - 101244313
PMC - PMC10765729
OTO - NOTNLM
OT  - Cross-reactivity
OT  - Edible fungi
OT  - Mold aeroallergens
OT  - Pollen food allergy syndrome
OT  - Sensitization
COIS- RZ has been on advisory boards for Bausch Health and ValeoPharma. He has received 
      honoraria for speaker's bureaus for AstraZeneca, GSK, Sanofi, StallergenesGreer, 
      ValeoPharma, Medexus Pharmaceuticals.
EDAT- 2024/01/05 00:42
MHDA- 2024/01/05 00:43
PMCR- 2024/01/04
CRDT- 2024/01/04 23:49
PHST- 2023/08/13 00:00 [received]
PHST- 2023/12/06 00:00 [accepted]
PHST- 2024/01/05 00:43 [medline]
PHST- 2024/01/05 00:42 [pubmed]
PHST- 2024/01/04 23:49 [entrez]
PHST- 2024/01/04 00:00 [pmc-release]
AID - 10.1186/s13223-023-00865-5 [pii]
AID - 865 [pii]
AID - 10.1186/s13223-023-00865-5 [doi]
PST - epublish
SO  - Allergy Asthma Clin Immunol. 2024 Jan 4;20(1):2. doi: 10.1186/s13223-023-00865-5.