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Pollen and Fungal
Allergy
F1 Chaloemchai Chumsaengchotsakul
14 June 2024
Pollen and Fungal Allergy
•Introduction
•Aeroallergen sampling
•Pollen identification and Pollen allergy
• Grass
• Weed
• Tree
•Fungus
•Climate change and Management
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
Quiz
•Monoporate aeroallergen ? :
•Major allergen in grass ? :
•Grass pollen ที่พบบ่อยที่สุดในไทย ? :
Introduction : Aeroallergen
• Aeroallergens are dispersed through the
air within particles of varying size and
arise from differing sources.
• Outdoor sources are likely to be of plant
origin, whereas animals are more common
indoor allergen sources, but there are
exceptions. Fungal spores may be
troublesome both inside and outdoors.
Middleton's Allergy: Principles and Practice, Ninth Edition
Introduction
• Induce allergic reactions in sensitized subject
• Deposit on:
• Conjunctival membranes: allergic conjunctivitis
• Nasal membranes: allergic rhinitis
• Lungs: allergic asthma (fragments smaller than 5 μm)
Middleton's Allergy: Principles and Practice, Ninth Edition
Introduction
Calendar of Seasonal Allergens in Texas | Allergy and Asthma Center of Texas (aactmd.com)
Introduction
• Anemophily: wind-pollinated
• Entomophily: insects-pollinated
• Insect-pollinated plants are uncommon inducers
of hay fever, but there are exceptions.
• Amphiphilous: spread by wind & insects
Middleton's Allergy: Principles and Practice, Ninth Edition
Wind-Pollinated Plants (Anemophily)
• Primitive vascular plants in the fossil record appeared to be wind-pollinated.
• Simpler process.
• Requiring a large amount of pollen to be produced to ensure successful
reproduction.
• A birch tree released more than 5.5 billion grains over a single year.
Middleton's Allergy: Principles and Practice, Ninth Edition
Hay Fever
• Thommen’s postulates
• Although most pollen grains
settle within meters of the
source, pollens can be
transported for hundreds of
miles.
Middleton's Allergy: Principles and Practice, Ninth Edition
Aeroallergen
sampling
•Gravimetric Samplers
•Volumetric Samplers
Impaction
Filtration
•Automated Samplers
Middleton's Allergy: Principles and Practice, Ninth Edition
Aeroallergen sampling
•Access types and quantities.
•Identification may be obtained by microscopic inspection and pattern
recognition, culture growth characteristics, or immunochemical assays using
monoclonal or polyclonal antibodies.
Middleton's Allergy: Principles and Practice, Ninth Edition
Gravimetric sampling
•Simple sampler Pollen capture highly dependent upon wind speed and direction
•no longer considered adequate for generation of meaningful data
Middleton's Allergy: Principles and Practice, Ninth Edition
Durham
Disadvantages of gravimetric samplers are that they can only be
quantified in terms of surface area (cm2) and do not give an
estimate of particle burden in a volume of air.
Volumetric Samplers
•Volumes of air over a given time interval.
•Particles per cubic meter per 24 hours.
•Examples Rotarod
•Impaction device that spins two small plastic “rods” at
fixed time intervals, usually adjusted at 1 minute out of
every 10 (144 minutes each 24 hours).
•Rod is greased with silicone.
Middleton's Allergy: Principles and Practice, Ninth Edition
Volumetric Samplers
•Capture efficiency : 85% to 90% for particles larger than
20 μm
•But is poor for particles smaller than 5 μm because of
turbulence and particle bounce.
•Loses capture efficiency as the surface becomes fully
impacted with particles.
•It cannot be run continually over 24 hours.
Middleton's Allergy: Principles and Practice, Ninth Edition
Volumetric Samplers
•Vacuum pumps
•Capture efficacy is best when the aperture is
facing into the wind and when the wind velocity
matches the intake flow and is at least 50% for
particles larger than 5 μm.
•Rotating 7-day drum.
Middleton's Allergy: Principles and Practice, Ninth Edition
Burkard suction drum Hirst-type spore trap
Volumetric Samplers
• Anderson
• Segregate particles by size through several
stages with progressively smaller-holed sieves
• Fungi by culture growth characteristics.
• High-volume suction
• Fitted with filters that can be scanned
microscopically or eluted and stained with
allergen-specific antibodies.
Middleton's Allergy: Principles and Practice, Ninth Edition
Microscopic Identification
•Standard solution : Calberla’s solution
(Glycerol , Ethanol, Basic fuchsin)
•Stain outer wall of pollen
•400x for identification pollen
•1000x for fungal spore
Middleton's Allergy: Principles and Practice, Ninth Edition
Pollen Identification
• Size -> Pollen 5 to >200μm, Fungal spores; 5 -30μm
• Shape
• Aperture
• Colpus (Colpate) = furrows
• Pore (Porate)
• Both (Colporate)
• Ornamentation : air bladder (pine) , spike
Pollen Identification
Pollen Identification
Pollen Identification
Grass Pollen
• Monocots (Class Lilliopsida)
• A single family (Poaceae)
• Strongly cross reactivity in subfamily
• one of the more common types of seasonal allergy
• Pollination period: Spring to summer
• Size: 30-66 µm
• Shape: Spheroidal
• Monoporate
Middleton's Allergy: Principles and Practice, Ninth Edition
Bermuda
Cross-reactivity
•Rarely significant cross-allergenicity
between families
•Some degree of cross-allergenicity
between tribes or genera of families
•High degree of cross-allergenicity
between species of the same genus
Middleton's Allergy: Principles and Practice, Ninth Edition
Grass Pollen
Middleton's Allergy: Principles and Practice, Ninth Edition
Grass Pollen
EAACI Molecular Allergology User´s Guide
Grass Pollen
Molecular Allergology User’s guide 2.0
Subfamily Chloridoideae
• Bermuda grass (Cynodon
dactylon) หญ้าแพรก
(Golf courses)
Subfamily Panicoideae
•Johnson grass, Bahia
grass, sugarcane, and
corn
•Para grass (หญ้าขน)
•Johnson grass
•หญ้าพง
• Manila grass (Zoysia
matrella)
• หญ้ามวลน้อย
• นิยมปลูก ในสวน
Subfamily Pooideae
•The largest subfamily
•The most prominent in pollinosis in temperate regions
•Wide distribution throughout the United States and Western Europe
•Subfamily have strongly cross-reactive major pollen allergens
•Timothy grass, sweet vernal grass, meadow fescue, perennial rye, June grass,
Kentucky bluegrass, orchard grass, redtop grass, velvet grass, canary grass,
and the cereal grains including wheat, rye, and barley
Major Allergen
Middleton's Allergy: Principles and Practice, Ninth Edition
Group 1: β-expansin
• Found in all grass subfamilies
• IgE to group 1 allergen is a marker
of
• true grass pollen sensitization
Group 5: allergens are found only in
Pooideae (Timothy, Kentucky blue
grass)
-> the lack of cross-reactivity between
temperate northern pasture grasses
and southern subtropical grasses (the
Panicoideae and Chloridoideae)
Minor Allergen
Middleton's Allergy: Principles and Practice, Ninth Edition
Group 7: Polcalcins
• Pan-allergen: also common in
herbaceous dicotyledon and
tree pollens
• sequence similarity with Bet
V 4 (Profilins)
Group 12 : Profilin
Minor Allergen
Middleton's Allergy: Principles and Practice, Ninth Edition
Group 7: Polcalcins
• Pan-allergen: also common in
herbaceous dicotyledon and
tree pollens
• sequence similarity with Bet
V 4 (Profilins)
Group 12 : Profilin
Plan – food allergen
Oral allergy syndrome
Pollen and Fungal allergy: aeroallergy.pdf
Middleton's Allergy: Principles and Practice, Ninth Edition
ธูปฤาษี (กกช้าง)
หญ้ากก
บานไม่รู้โรย/ผักโขม
ชมพู่
ไมยราพ
กระถินณรงค์
กะลังตังช้าง
Prevalence of pollen and weed sensitization in Thailand
Asian Pac J Allergy Immunol. 2009;27(1):79–86.
Front Public Health. 2024 Mar 28;12:1301095. doi:
10.3389/fpubh.2024.1301095.
Bermuda grass (52.3%),para grass (49.4%), sedge
(45.9%), careless weed (45.4%)
Para grass highest number of positive SPT results 47%
(57/121), followed by Bermuda grass 39% (48/121),
Johnson grass 19% (24/121), Manila grass 16%
(20/121), and hurricane grass 16%
(20/121).
Prevalence of pollen and weed sensitization in Thailand
Asia Pac Allergy. 2018 Apr 24;8(2):e17. doi:
10.5415/apallergy.2018.8.e17.
Weed pollen allergy
•Herbaceous dicotyledon
species
•Invasive, undesirable plants
•Not trees or grasses
•Largest flowering plants
•Anemophilous
Weed pollen allergy
• Families may also be allergenic
• Asteraceae (ragweed, mugwort,
feverfew, sunflower)
• Amaranthaceae(Russian thistle,
goosefoot, or lamb’s quarters)
• Brassicaceae (oilseed rape and
turnip)
• Euphorbiaceae(annual mercury)
• Plantaginaceae (English
plantain)
• Urticaceae (wall pellitory) EAACI Molecular Allergology User´s Guide
Ambrosia : Ragweed
• Tricolporate with granular surface (short based
spine)
• Major allergens : group 1 pectate lyases, the group
3 plastocyanins, and the group 11 cysteine
proteases
• Most important allergenic
ragweeds: Amb a 1 (>90%)
Pectate lysate
Middleton's Allergy:
Principles and Practice,
Ninth Edition
Middleton's Allergy: Principles and Practice, Ninth Edition
• Major allergens in Ambrosia
species Include the group 1
(e.g. Amba1) pectate
lyases, the group 3
plastocyanins, and the
group 11 cysteineproteases
• In Asteraceae other than
Ambrosia species, the
major allergen groups
include Art V 1 (Defensins
like and PR-12) and Par H-1
as well as a protein of
unknown function (Hela1)
Artemisia : Mugwort
• Tricolporate with the outer wall (sexine) divided
into roof and floor separated by columns easily
discernible on light microscopy
Middleton's Allergy: Principles and Practice, Ninth Edition
Family Amaranthaceae
• Pigweeds
• บานไม่รู้โรย
• Cross-reactivity is very strong between Amaranthus
species
• The pollen grains of the entire family are periporate.
Middleton's Allergy: Principles and Practice, Ninth Edition
Profilin , Ole e 1-related protein
Family Amaranthaceae
• ผักโขม
• Amaranthus viridis
• Careless weed
Middleton's Allergy: Principles and Practice, Ninth Edition
Tree pollen allergy
EAACI Molecular Allergology User´s Guide
• Angiosperms (flowering trees),
Gymnosperms (nonflowering conifers)
• The trees most commonly causing allergy
belong to the orders
• Fagales (alder, beech, birch, hazelnut, oak)
• Lamiales (ash, privet, olive, lilac)
• Proteales (plane tree, sycamore)
• Pinales (cypress, Japanese cedar, juniper) Gymnosperm
Angiosperm
EAACI Molecular Allergology User´s Guide
EAACI Molecular Allergology User´s Guide
Angiosperms: Fagales order
• Two main families
• Betulaceae : genera Alnus (alder), Betula (birch), Carpinus (hornbeam),
Corylus (hazelnut), and Ostrya (hop-hornbeam)
• Fagaceae: genera Castanea (chestnut), Fagus (beech), and Quercus (oak)
• Bet v 1 is considered a marker allergen for sensitization to Fagales pollens
(absence from other allergenic angiosperm or gymnosperm trees)
Allergy and Asthma The Basics to Best Practices
Betula (birch)
• The most dominant tree pollen types found
in Northern and Central Europe
• Birch trees like cool and moist areas and are
often found along the shores of rivers and
lakes
• Birch pollen is a particularly potent allergen,
and data suggests that up to 50% of the
population in some endemic areas may be
allergic.
Triporate
Betula (birch)
Middleton's Allergy: Principles and Practice, Ninth Edition
Bet v 1 family = PR-10
• Aln g 1 : Alder
• Car b1 : Hornbeam
• Ost c1 : Hop-hornbeam
• Cor a 1 : Hazelnut
• Fag s1 : Beech
• Cas s 1 : Chestnut
• Quea1 : Oak
PR -10
Pollen fruit syndrome
•Rosaceae (e.g. Mal d 1 from apple, Pyr c 1
from pear and Pru p 1 from peach)
•Apiaceae (api g 1 from celeray and Dau c 1
from carrot) = Not celery mugwort
Gly m 4 from soybean and Ara h 8 from
peanut
Middleton's Allergy: Principles and Practice, Ninth Edition
Pollen and Fungal allergy: aeroallergy.pdf
Pollen Fruit syndrome
Middleton's Allergy: Principles and Practice, Ninth Edition
Profilins and Procalcins
EAACI Molecular Allergology User´s Guide
Pollen Fruit syndrome
Oral allergy syndrome
• Sensitization to inhaled pollen is the primary event
• Secondary reactions occurring after ingestion of the
cross-reactive plant foods.
• Due to the production of cross-reactive sIgE
antibodies that are directed against structural
homologous allergens
• Local contact IgE-mediated mast cell activation
• Provokes the rapid onset of pruritus, tingling, and
angioedema of the lips, tongue, palate, and throat,
and it occasionally elicits a sensation of pruritus in
the ears or tightness in the throat. Carlson G, Coop C. A review of current available literature. Ann
Allergy Asthma Immunol. 2019
Oral allergy syndrome
Carlson G, Coop C. A review of current available literature. Ann
Allergy Asthma Immunol. 2019
Oral allergy syndrome
Carlson G, Coop C. A review of current available literature. Ann
Allergy Asthma Immunol. 2019
Middleton's Allergy: Principles and Practice, Ninth Edition
Salicaceae
• Aspens, Poplars, and cottonwoods.
• Pollen is inaperturate with a stressed
surface texturing.
• Willows pollen : Tricolpate with
reticulated surface.
Middleton's Allergy: Principles and Practice, Ninth Edition
Oleaceae
• Olive, ash, and privet
• European olive is a major allergenic tree of
Mediterranean basin.
• Cross reactivity is very strong.
• Major olive allergen : Ole e 1
Fungi
• Functional anatomy 2 basic types
• Yeasts: minority of species and grow as single cells by central division or by
budding
• Molds Branching threads-- Well-defined walls, reinforced with cellulose or chitin
Septa at intervals, some types cross wall are few or absent which allow free
streaming of cytoplasm Mycelium is a collection of hyphae, bear reproductive
part of many fungi
Fungi
• Fungi 5 major phyla recognized as allergic fungi
• Ascomycota Cladosporium, Alternaria,
Aspergillus, Penicillium, Candida Zygomycota
(typical bread molds) Mucor, Rhizopus
• Basidiomycota Mushrooms, puffballs, smuts, and
rusts
• Oomycota
• Deuteromycota
Grow on grasses and
grains
Wind turbulence
Dry windy afternoons
Increased humidity
or rainfall for spore
release
Ascomycota
Twaroch TE, Allergy Asthma Immunol Res. 2015
• Alternaria
• Cladosporium
• Curvularia
• Aspergillus
• Penicillium
Alternaria
• Found in all year but peak at late summer
to fall (July through October).
• Warm climate
• Commonly grows on vegetation
• Associated with epidemics of severe
asthma exacerbation
Spores : club-shaped
(wide end : base, narrow
handle : apex), segmented,
medium brown
Middleton's Allergy: Principles and Practice, Ninth Edition
Cladosporium
• Most common molds found worldwide
• Found throughout the year, peak levels in
the late summer to fall
• Dead plants, vegetable matter
• Associated with severe or life- threatening
asthma (little weaker than Alternaria)
Conidia: cigar-shaped occurring in
long, branched chains
Spores: smooth to finely verrucose
surface. Attachment scars at the ends
are birefringent
Middleton's Allergy: Principles and Practice, Ninth Edition
Aspergillus
• Allergic rhinitis, asthma, allergic
fungal sinusitis, ABPA
• Indoor allergen
• House dust, dead vegetation
• A. fumigatus
• A. oryzae : soy sauce, commercial
enzyme • Conidiophore is stalked with a globus vesicle
• The conidia are formed in chains
Middleton's Allergy: Principles and Practice, Ninth Edition
Penicillium
• Indoor allergen
• Implicated cereals, citrus, and fruits
• Used commercially in processing of
cheeses and sausage and antibiotics
• Risk factor for asthma
• Conidiophore does not have a globus vesicle and looks
more like a paintbrush
• The conidia are formed in chains
Helminthosporium-type fungus
• Drechsclera, Bipolaris, Exserohilum, and
Cuvuluria.
• Some population is sensitized to those
spores more than Alternaria or Penicillium.
• Wall are thick with transverse pseudosepta.
Middleton's Allergy: Principles and Practice, Ninth Edition
Curvularia
• The conidia = spores → multicelled
• Pigmented
• Slightly curved
• The end cells paler than the central cells
Aureobasidium pullulans
• Worldwide distribution
• Causes storage rot in several fruits and is
common contaminant in pillows.
• Production of biodegradable, water-soluble
polysaccharide used to make oxygen-
impermeable films and adhesives.
Middleton's Allergy: Principles and Practice, Ninth Edition
Basidiomycota
• Mushrooms, bracket fungi, smuts and rusts.
• Epidemic asthma in New Orleans, as well as
worsening pulmonary function, increased asthma
rescue medication use, and increased asthma
admissions.
• Parasites of plant especially cereals and grasses.
Middleton's Allergy: Principles and Practice, Ninth Edition
• Wall are thick with
transverse pseudosepta.
Pollen and Fungal allergy: aeroallergy.pdf
• Cross sectional study was performed at Showa University
hospital
• Between Sep 2014 and Dec 2014
• 160 asthmatic patients (mean age 58.9 year)
• Underwent: BMI, PFT, FeNo, total IgE, sIgE to aeroallergens
Tanake A, Ann Allergy Asthma Immunol.2016.
Tanake A, Ann Allergy Asthma Immunol.2016.
Aspergillus Avoidance
•Aspergillus (Asp f 1) and Alternaria
(Alt a 1)
• Controlling humidity
•Removing sites for fungal growth
• Avoiding basements living
environments by allergic
individuals
• Cleaning surfaces with fungicides
Middleton's Allergy, Principles and Practice, 9th Edition
Climate Change
D’Amato G, Allergy.2007.
• Pollens grains can be carried by
thunderstorm at ground level
• Pollen rupture would release
allergenic biological aerosols of
pauci-micronic size --> penetrate
lower airway
• Subjected affected by pollen
allergy should be informed about a
possible risk of asthma attack at
the beginning of a thunderstorm
during pollen season
Climate Change
Middleton's Allergy: Principles and Practice, Ninth Edition
• CO2 increased -> pollen production of ragweed increased from 61 to 90%
• Urban site averaged 2°C higher and 30% higher CO2 -> urban ragweed grew faster, flowered
earlier , produced more pollen than rural site.
• Next quarter century, Ragweed sensitization will be doubled from 33 to 77 million in Europe.
Climate Change
Middleton's Allergy: Principles and Practice, Ninth Edition
Management
Allergen immunotherapy: A practice parameter third update. 2011
Management : Grass
• Pooideae : Temperate grass
share major allergens
• Phl p 5 share allergen in
Pooideae
• Grass standardized
Middleton's Allergy: Principles and Practice, Ninth Edition
Molecular Allergology User’s guide 2.0
Management : Grass
• Subtropical grass :
Panicoideae (Bahia , Johnson
,Para) and Chloridoideae
(Bermuda) show greater
diversity
Middleton's Allergy: Principles and Practice, Ninth Edition
Molecular Allergology User’s guide 2.0
Management : Grass
• Subtropical grass :
Panicoideae (Bahia , Johnson
,Para) and Chloridoideae
(Bermuda) show greater
diversity
Middleton's Allergy: Principles and Practice, Ninth Edition
Molecular Allergology User’s guide 2.0
AIT
Molecular Allergology User’s guide 2.0
Major allergen
Minor allergen
Pan allergen
Tree allergen
Profilin - OAS
AIT
Molecular Allergology User’s guide 2.0
AIT
Molecular Allergology User’s guide 2.0
The use of one of the locally prevalent members (eg, birch and
alder) should be adequate for fagales.
Thank you
Chaloemchai Chumsaengchotsakul, M.D.

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Pollen and Fungal allergy: aeroallergy.pdf

  • 1. Pollen and Fungal Allergy F1 Chaloemchai Chumsaengchotsakul 14 June 2024
  • 2. Pollen and Fungal Allergy •Introduction •Aeroallergen sampling •Pollen identification and Pollen allergy • Grass • Weed • Tree •Fungus •Climate change and Management
  • 6. Quiz •Monoporate aeroallergen ? : •Major allergen in grass ? : •Grass pollen ที่พบบ่อยที่สุดในไทย ? :
  • 7. Introduction : Aeroallergen • Aeroallergens are dispersed through the air within particles of varying size and arise from differing sources. • Outdoor sources are likely to be of plant origin, whereas animals are more common indoor allergen sources, but there are exceptions. Fungal spores may be troublesome both inside and outdoors. Middleton's Allergy: Principles and Practice, Ninth Edition
  • 8. Introduction • Induce allergic reactions in sensitized subject • Deposit on: • Conjunctival membranes: allergic conjunctivitis • Nasal membranes: allergic rhinitis • Lungs: allergic asthma (fragments smaller than 5 μm) Middleton's Allergy: Principles and Practice, Ninth Edition
  • 10. Calendar of Seasonal Allergens in Texas | Allergy and Asthma Center of Texas (aactmd.com)
  • 11. Introduction • Anemophily: wind-pollinated • Entomophily: insects-pollinated • Insect-pollinated plants are uncommon inducers of hay fever, but there are exceptions. • Amphiphilous: spread by wind & insects Middleton's Allergy: Principles and Practice, Ninth Edition
  • 12. Wind-Pollinated Plants (Anemophily) • Primitive vascular plants in the fossil record appeared to be wind-pollinated. • Simpler process. • Requiring a large amount of pollen to be produced to ensure successful reproduction. • A birch tree released more than 5.5 billion grains over a single year. Middleton's Allergy: Principles and Practice, Ninth Edition
  • 13. Hay Fever • Thommen’s postulates • Although most pollen grains settle within meters of the source, pollens can be transported for hundreds of miles. Middleton's Allergy: Principles and Practice, Ninth Edition
  • 14. Aeroallergen sampling •Gravimetric Samplers •Volumetric Samplers Impaction Filtration •Automated Samplers Middleton's Allergy: Principles and Practice, Ninth Edition
  • 15. Aeroallergen sampling •Access types and quantities. •Identification may be obtained by microscopic inspection and pattern recognition, culture growth characteristics, or immunochemical assays using monoclonal or polyclonal antibodies. Middleton's Allergy: Principles and Practice, Ninth Edition
  • 16. Gravimetric sampling •Simple sampler Pollen capture highly dependent upon wind speed and direction •no longer considered adequate for generation of meaningful data Middleton's Allergy: Principles and Practice, Ninth Edition Durham Disadvantages of gravimetric samplers are that they can only be quantified in terms of surface area (cm2) and do not give an estimate of particle burden in a volume of air.
  • 17. Volumetric Samplers •Volumes of air over a given time interval. •Particles per cubic meter per 24 hours. •Examples Rotarod •Impaction device that spins two small plastic “rods” at fixed time intervals, usually adjusted at 1 minute out of every 10 (144 minutes each 24 hours). •Rod is greased with silicone. Middleton's Allergy: Principles and Practice, Ninth Edition
  • 18. Volumetric Samplers •Capture efficiency : 85% to 90% for particles larger than 20 μm •But is poor for particles smaller than 5 μm because of turbulence and particle bounce. •Loses capture efficiency as the surface becomes fully impacted with particles. •It cannot be run continually over 24 hours. Middleton's Allergy: Principles and Practice, Ninth Edition
  • 19. Volumetric Samplers •Vacuum pumps •Capture efficacy is best when the aperture is facing into the wind and when the wind velocity matches the intake flow and is at least 50% for particles larger than 5 μm. •Rotating 7-day drum. Middleton's Allergy: Principles and Practice, Ninth Edition Burkard suction drum Hirst-type spore trap
  • 20. Volumetric Samplers • Anderson • Segregate particles by size through several stages with progressively smaller-holed sieves • Fungi by culture growth characteristics. • High-volume suction • Fitted with filters that can be scanned microscopically or eluted and stained with allergen-specific antibodies. Middleton's Allergy: Principles and Practice, Ninth Edition
  • 21. Microscopic Identification •Standard solution : Calberla’s solution (Glycerol , Ethanol, Basic fuchsin) •Stain outer wall of pollen •400x for identification pollen •1000x for fungal spore Middleton's Allergy: Principles and Practice, Ninth Edition
  • 22. Pollen Identification • Size -> Pollen 5 to >200μm, Fungal spores; 5 -30μm • Shape • Aperture • Colpus (Colpate) = furrows • Pore (Porate) • Both (Colporate) • Ornamentation : air bladder (pine) , spike
  • 26. Grass Pollen • Monocots (Class Lilliopsida) • A single family (Poaceae) • Strongly cross reactivity in subfamily • one of the more common types of seasonal allergy • Pollination period: Spring to summer • Size: 30-66 µm • Shape: Spheroidal • Monoporate Middleton's Allergy: Principles and Practice, Ninth Edition Bermuda
  • 27. Cross-reactivity •Rarely significant cross-allergenicity between families •Some degree of cross-allergenicity between tribes or genera of families •High degree of cross-allergenicity between species of the same genus Middleton's Allergy: Principles and Practice, Ninth Edition
  • 28. Grass Pollen Middleton's Allergy: Principles and Practice, Ninth Edition
  • 29. Grass Pollen EAACI Molecular Allergology User´s Guide
  • 31. Subfamily Chloridoideae • Bermuda grass (Cynodon dactylon) หญ้าแพรก (Golf courses) Subfamily Panicoideae •Johnson grass, Bahia grass, sugarcane, and corn •Para grass (หญ้าขน) •Johnson grass •หญ้าพง • Manila grass (Zoysia matrella) • หญ้ามวลน้อย • นิยมปลูก ในสวน
  • 32. Subfamily Pooideae •The largest subfamily •The most prominent in pollinosis in temperate regions •Wide distribution throughout the United States and Western Europe •Subfamily have strongly cross-reactive major pollen allergens •Timothy grass, sweet vernal grass, meadow fescue, perennial rye, June grass, Kentucky bluegrass, orchard grass, redtop grass, velvet grass, canary grass, and the cereal grains including wheat, rye, and barley
  • 33. Major Allergen Middleton's Allergy: Principles and Practice, Ninth Edition Group 1: β-expansin • Found in all grass subfamilies • IgE to group 1 allergen is a marker of • true grass pollen sensitization Group 5: allergens are found only in Pooideae (Timothy, Kentucky blue grass) -> the lack of cross-reactivity between temperate northern pasture grasses and southern subtropical grasses (the Panicoideae and Chloridoideae)
  • 34. Minor Allergen Middleton's Allergy: Principles and Practice, Ninth Edition Group 7: Polcalcins • Pan-allergen: also common in herbaceous dicotyledon and tree pollens • sequence similarity with Bet V 4 (Profilins) Group 12 : Profilin
  • 35. Minor Allergen Middleton's Allergy: Principles and Practice, Ninth Edition Group 7: Polcalcins • Pan-allergen: also common in herbaceous dicotyledon and tree pollens • sequence similarity with Bet V 4 (Profilins) Group 12 : Profilin Plan – food allergen Oral allergy syndrome
  • 37. Middleton's Allergy: Principles and Practice, Ninth Edition ธูปฤาษี (กกช้าง) หญ้ากก บานไม่รู้โรย/ผักโขม ชมพู่ ไมยราพ กระถินณรงค์ กะลังตังช้าง
  • 38. Prevalence of pollen and weed sensitization in Thailand Asian Pac J Allergy Immunol. 2009;27(1):79–86. Front Public Health. 2024 Mar 28;12:1301095. doi: 10.3389/fpubh.2024.1301095. Bermuda grass (52.3%),para grass (49.4%), sedge (45.9%), careless weed (45.4%) Para grass highest number of positive SPT results 47% (57/121), followed by Bermuda grass 39% (48/121), Johnson grass 19% (24/121), Manila grass 16% (20/121), and hurricane grass 16% (20/121).
  • 39. Prevalence of pollen and weed sensitization in Thailand Asia Pac Allergy. 2018 Apr 24;8(2):e17. doi: 10.5415/apallergy.2018.8.e17.
  • 40. Weed pollen allergy •Herbaceous dicotyledon species •Invasive, undesirable plants •Not trees or grasses •Largest flowering plants •Anemophilous
  • 41. Weed pollen allergy • Families may also be allergenic • Asteraceae (ragweed, mugwort, feverfew, sunflower) • Amaranthaceae(Russian thistle, goosefoot, or lamb’s quarters) • Brassicaceae (oilseed rape and turnip) • Euphorbiaceae(annual mercury) • Plantaginaceae (English plantain) • Urticaceae (wall pellitory) EAACI Molecular Allergology User´s Guide
  • 42. Ambrosia : Ragweed • Tricolporate with granular surface (short based spine) • Major allergens : group 1 pectate lyases, the group 3 plastocyanins, and the group 11 cysteine proteases • Most important allergenic ragweeds: Amb a 1 (>90%) Pectate lysate Middleton's Allergy: Principles and Practice, Ninth Edition
  • 43. Middleton's Allergy: Principles and Practice, Ninth Edition • Major allergens in Ambrosia species Include the group 1 (e.g. Amba1) pectate lyases, the group 3 plastocyanins, and the group 11 cysteineproteases • In Asteraceae other than Ambrosia species, the major allergen groups include Art V 1 (Defensins like and PR-12) and Par H-1 as well as a protein of unknown function (Hela1)
  • 44. Artemisia : Mugwort • Tricolporate with the outer wall (sexine) divided into roof and floor separated by columns easily discernible on light microscopy Middleton's Allergy: Principles and Practice, Ninth Edition
  • 45. Family Amaranthaceae • Pigweeds • บานไม่รู้โรย • Cross-reactivity is very strong between Amaranthus species • The pollen grains of the entire family are periporate. Middleton's Allergy: Principles and Practice, Ninth Edition Profilin , Ole e 1-related protein
  • 46. Family Amaranthaceae • ผักโขม • Amaranthus viridis • Careless weed Middleton's Allergy: Principles and Practice, Ninth Edition
  • 47. Tree pollen allergy EAACI Molecular Allergology User´s Guide • Angiosperms (flowering trees), Gymnosperms (nonflowering conifers) • The trees most commonly causing allergy belong to the orders • Fagales (alder, beech, birch, hazelnut, oak) • Lamiales (ash, privet, olive, lilac) • Proteales (plane tree, sycamore) • Pinales (cypress, Japanese cedar, juniper) Gymnosperm Angiosperm
  • 49. EAACI Molecular Allergology User´s Guide Angiosperms: Fagales order • Two main families • Betulaceae : genera Alnus (alder), Betula (birch), Carpinus (hornbeam), Corylus (hazelnut), and Ostrya (hop-hornbeam) • Fagaceae: genera Castanea (chestnut), Fagus (beech), and Quercus (oak) • Bet v 1 is considered a marker allergen for sensitization to Fagales pollens (absence from other allergenic angiosperm or gymnosperm trees)
  • 50. Allergy and Asthma The Basics to Best Practices Betula (birch) • The most dominant tree pollen types found in Northern and Central Europe • Birch trees like cool and moist areas and are often found along the shores of rivers and lakes • Birch pollen is a particularly potent allergen, and data suggests that up to 50% of the population in some endemic areas may be allergic. Triporate
  • 51. Betula (birch) Middleton's Allergy: Principles and Practice, Ninth Edition
  • 52. Bet v 1 family = PR-10 • Aln g 1 : Alder • Car b1 : Hornbeam • Ost c1 : Hop-hornbeam • Cor a 1 : Hazelnut • Fag s1 : Beech • Cas s 1 : Chestnut • Quea1 : Oak PR -10 Pollen fruit syndrome •Rosaceae (e.g. Mal d 1 from apple, Pyr c 1 from pear and Pru p 1 from peach) •Apiaceae (api g 1 from celeray and Dau c 1 from carrot) = Not celery mugwort Gly m 4 from soybean and Ara h 8 from peanut Middleton's Allergy: Principles and Practice, Ninth Edition
  • 54. Pollen Fruit syndrome Middleton's Allergy: Principles and Practice, Ninth Edition
  • 55. Profilins and Procalcins EAACI Molecular Allergology User´s Guide
  • 57. Oral allergy syndrome • Sensitization to inhaled pollen is the primary event • Secondary reactions occurring after ingestion of the cross-reactive plant foods. • Due to the production of cross-reactive sIgE antibodies that are directed against structural homologous allergens • Local contact IgE-mediated mast cell activation • Provokes the rapid onset of pruritus, tingling, and angioedema of the lips, tongue, palate, and throat, and it occasionally elicits a sensation of pruritus in the ears or tightness in the throat. Carlson G, Coop C. A review of current available literature. Ann Allergy Asthma Immunol. 2019
  • 58. Oral allergy syndrome Carlson G, Coop C. A review of current available literature. Ann Allergy Asthma Immunol. 2019
  • 59. Oral allergy syndrome Carlson G, Coop C. A review of current available literature. Ann Allergy Asthma Immunol. 2019
  • 60. Middleton's Allergy: Principles and Practice, Ninth Edition Salicaceae • Aspens, Poplars, and cottonwoods. • Pollen is inaperturate with a stressed surface texturing. • Willows pollen : Tricolpate with reticulated surface.
  • 61. Middleton's Allergy: Principles and Practice, Ninth Edition Oleaceae • Olive, ash, and privet • European olive is a major allergenic tree of Mediterranean basin. • Cross reactivity is very strong. • Major olive allergen : Ole e 1
  • 62. Fungi • Functional anatomy 2 basic types • Yeasts: minority of species and grow as single cells by central division or by budding • Molds Branching threads-- Well-defined walls, reinforced with cellulose or chitin Septa at intervals, some types cross wall are few or absent which allow free streaming of cytoplasm Mycelium is a collection of hyphae, bear reproductive part of many fungi
  • 63. Fungi • Fungi 5 major phyla recognized as allergic fungi • Ascomycota Cladosporium, Alternaria, Aspergillus, Penicillium, Candida Zygomycota (typical bread molds) Mucor, Rhizopus • Basidiomycota Mushrooms, puffballs, smuts, and rusts • Oomycota • Deuteromycota Grow on grasses and grains Wind turbulence Dry windy afternoons Increased humidity or rainfall for spore release
  • 64. Ascomycota Twaroch TE, Allergy Asthma Immunol Res. 2015 • Alternaria • Cladosporium • Curvularia • Aspergillus • Penicillium
  • 65. Alternaria • Found in all year but peak at late summer to fall (July through October). • Warm climate • Commonly grows on vegetation • Associated with epidemics of severe asthma exacerbation Spores : club-shaped (wide end : base, narrow handle : apex), segmented, medium brown Middleton's Allergy: Principles and Practice, Ninth Edition
  • 66. Cladosporium • Most common molds found worldwide • Found throughout the year, peak levels in the late summer to fall • Dead plants, vegetable matter • Associated with severe or life- threatening asthma (little weaker than Alternaria) Conidia: cigar-shaped occurring in long, branched chains Spores: smooth to finely verrucose surface. Attachment scars at the ends are birefringent Middleton's Allergy: Principles and Practice, Ninth Edition
  • 67. Aspergillus • Allergic rhinitis, asthma, allergic fungal sinusitis, ABPA • Indoor allergen • House dust, dead vegetation • A. fumigatus • A. oryzae : soy sauce, commercial enzyme • Conidiophore is stalked with a globus vesicle • The conidia are formed in chains Middleton's Allergy: Principles and Practice, Ninth Edition
  • 68. Penicillium • Indoor allergen • Implicated cereals, citrus, and fruits • Used commercially in processing of cheeses and sausage and antibiotics • Risk factor for asthma • Conidiophore does not have a globus vesicle and looks more like a paintbrush • The conidia are formed in chains
  • 69. Helminthosporium-type fungus • Drechsclera, Bipolaris, Exserohilum, and Cuvuluria. • Some population is sensitized to those spores more than Alternaria or Penicillium. • Wall are thick with transverse pseudosepta. Middleton's Allergy: Principles and Practice, Ninth Edition
  • 70. Curvularia • The conidia = spores → multicelled • Pigmented • Slightly curved • The end cells paler than the central cells
  • 71. Aureobasidium pullulans • Worldwide distribution • Causes storage rot in several fruits and is common contaminant in pillows. • Production of biodegradable, water-soluble polysaccharide used to make oxygen- impermeable films and adhesives. Middleton's Allergy: Principles and Practice, Ninth Edition
  • 72. Basidiomycota • Mushrooms, bracket fungi, smuts and rusts. • Epidemic asthma in New Orleans, as well as worsening pulmonary function, increased asthma rescue medication use, and increased asthma admissions. • Parasites of plant especially cereals and grasses. Middleton's Allergy: Principles and Practice, Ninth Edition • Wall are thick with transverse pseudosepta.
  • 74. • Cross sectional study was performed at Showa University hospital • Between Sep 2014 and Dec 2014 • 160 asthmatic patients (mean age 58.9 year) • Underwent: BMI, PFT, FeNo, total IgE, sIgE to aeroallergens Tanake A, Ann Allergy Asthma Immunol.2016.
  • 75. Tanake A, Ann Allergy Asthma Immunol.2016.
  • 76. Aspergillus Avoidance •Aspergillus (Asp f 1) and Alternaria (Alt a 1) • Controlling humidity •Removing sites for fungal growth • Avoiding basements living environments by allergic individuals • Cleaning surfaces with fungicides Middleton's Allergy, Principles and Practice, 9th Edition
  • 77. Climate Change D’Amato G, Allergy.2007. • Pollens grains can be carried by thunderstorm at ground level • Pollen rupture would release allergenic biological aerosols of pauci-micronic size --> penetrate lower airway • Subjected affected by pollen allergy should be informed about a possible risk of asthma attack at the beginning of a thunderstorm during pollen season
  • 78. Climate Change Middleton's Allergy: Principles and Practice, Ninth Edition • CO2 increased -> pollen production of ragweed increased from 61 to 90% • Urban site averaged 2°C higher and 30% higher CO2 -> urban ragweed grew faster, flowered earlier , produced more pollen than rural site. • Next quarter century, Ragweed sensitization will be doubled from 33 to 77 million in Europe.
  • 79. Climate Change Middleton's Allergy: Principles and Practice, Ninth Edition
  • 80. Management Allergen immunotherapy: A practice parameter third update. 2011
  • 81. Management : Grass • Pooideae : Temperate grass share major allergens • Phl p 5 share allergen in Pooideae • Grass standardized Middleton's Allergy: Principles and Practice, Ninth Edition Molecular Allergology User’s guide 2.0
  • 82. Management : Grass • Subtropical grass : Panicoideae (Bahia , Johnson ,Para) and Chloridoideae (Bermuda) show greater diversity Middleton's Allergy: Principles and Practice, Ninth Edition Molecular Allergology User’s guide 2.0
  • 83. Management : Grass • Subtropical grass : Panicoideae (Bahia , Johnson ,Para) and Chloridoideae (Bermuda) show greater diversity Middleton's Allergy: Principles and Practice, Ninth Edition Molecular Allergology User’s guide 2.0
  • 84. AIT Molecular Allergology User’s guide 2.0 Major allergen Minor allergen Pan allergen Tree allergen Profilin - OAS
  • 86. AIT Molecular Allergology User’s guide 2.0 The use of one of the locally prevalent members (eg, birch and alder) should be adequate for fagales.