Substance Info: (and synonyms)

Background Info:

Tomatoes are a vine fruit of the Nightshade family. They were used for food by the Indians of Peru before European arrival. From there the seeds were taken to Europe. Tomato is the most universally accepted vegetable in all cultural groups, and second only to Potato as a vegetable in world food production. A great variety of cultivars exist, from the tiny Cherry Tomato to giant prize varieties the size of Grapefruit; and though the sterotyped colour is red, colors can range from green to purple, and some varieties have stripes. Many wild forms are found, including the closely related species called currant tomato (L. pimpinellifolium).

Wild forms are found, but are not good to eat. Tomatoes are eaten raw or cooked, but the great bulk are processed into juice, canned goods, etc. They can be used as a savoury vegetable, especially in salads, and as a flavouring in soups and other cooked foods. The fruit can also be dried and ground into a powder that can be used as a flavouring and thickening agent in soups, breads, pancakes etc. An edible oil can be obtained from the seed. The fruit is rich in vitamins A and C, calcium and potassium.

The skin of Tomato fruits is a good source of lycopine, a substance that has been shown to protect people from heart attacks and to have a very beneficial effect on the prostate. Other remedies incorporating Tomato are for rheumatism, severe headaches, burns, scalds, sunburn, and toothache.

The pulped fruit is a skin-wash for oily skin. The oil can be used in making soap.

All green parts of the plant are poisonous. A spray made from Tomato leaves is an effective but very poisonous insecticide.

Allergenicity dependant on the ripeness of tomato.


Adverse Reactions:


[ 1 / 51 ]

Two cases of food and exercise-induced anaphylaxis (FEIA) in patients with a diagnosis of oral allergy syndrome (OAS) to the implicated foods. Patient A had FEIA attributed to fresh coriander and tomato and Patient B to fresh celery. These food allergens have been implicated in OAS and have structural antigenic similarity to that of birch and/or grass. Both patients' allergies were confirmed by fresh skin prick tests. In both cases, strenuous exercise was antecedent to the systemic anaphylaxis reaction and subsequent ingestion without exercise produced only local symptoms of perioral pruritus. The authors hypothesize that the inhibitory effects of exercise on gastric acid secretion decreases the digestion of oral allergens and preserves structural integrity, thereby allowing continued systemic absorption of the allergen whether it be profilins, lipid transfer proteins, or other antigenic determinants. (Chen 2013 ref.28871 5)

Chen JY, Quirt J, Lee KJ. Proposed new mechanism for food and exercise induced anaphylaxis based on case studies. Allergy Asthma Clin Immunol 2013;9(1):11

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Tomato contains many allergens but their clinical relevance is poorly defined and the usefulness of available diagnostic methods is unknown. This study assessed the clinical usefulness of current diagnostic methods for tomato allergy. Ninety-six adults with plant food allergy were grouped based on their reactivity to PR-10, profilin, and lipid transfer protein (LTP). Tomato allergy was ascertained by history and a positive skin prick test (SPT) to fresh tomato. SPT with a commercial extract and immunoglobulin (Ig) E measurements were carried out. In total, 36%, 8%, 28%, 18%, 8%, and 1% of patients were sensitized to PR-10, profilin, both PR-10 and profilin, LTP alone, LTP plus PR-10 or profilin, and genuine tomato allergens, respectively. Tomato allergy was detected in 32 (33%) of the 96 patients and was significantly associated with profilin hypersensitivity. The sensitivity of SPT was good in all subgroups, but specificity was poor in many cases. ImmunoCAP sensitivity was acceptable in profilin reactors, but very poor in PR-10 reactors. IgE levels were not associated with tomato allergy in any of the subgroups. Similarly, birch and peach-specific IgE levels were not associated with tomato allergy in PR-10/profilin or in LTP reactors, respectively. Both SPT and ImmunoCAP worked well in the only patients with true tomato allergy. Birch- and tomato-specific IgE levels were not associated in patients monosensitized to PR-10, but they were correlated in profilin groups. Peach- and tomato-specific IgE levels were correlated in LTP-allergic patients. In conclusion, tomato allergy occurs via sensitization towards different proteins. Component-resolved diagnosis helps to define clinical subgroups with different risk levels. (Asero 2013 ref.28990 9)

Asero R. Tomato allergy: clinical features and usefulness of current routinely available diagnostic methods. J Investig Allergol Clin Immunol 2013;23(1):37-42

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Specific food-dependent exercise-induced anaphylaxis (S-FDEIAn) is a distinct form of food allergy in which symptoms are elicited by exercise performed after ingesting food to which the patient has become sensitised. Non-specific FDEIAn (NS-FDEIAn) is a syndrome provoked by exercise performed after ingesting any food. This study sought to identify the culprit allergenic molecules in patients with FDEIAn, combining 'classic' allergy testing with an allergenic molecule-based microarray approach for IgE detection. Among 82 FDEIAn patients, the most frequent suspected foods were tomato, cereals, and peanut. SPT, P + P, and CAP displayed different degrees of sensitivity. Each test disclosed some positivities not discovered by others. Seventy-nine subjects were positive to at least one food (49 to more than 20), whereas three were negative. All suspected foods were positive to at least one of SPT, P + P, and CAP. When tested using the ISAC, 64 (78%) subjects were positive to Pru p 3, the peach lipid transfer protein, 13 were positive to other food allergen molecules, and five displayed negative results to all food allergenic molecules. Overall, 79 patients probably had S-FDEIAn and the other 3 NS-FDEIAn. Therefore multiple food hypersensitivity represents a clinical hallmark of a large percentage of FDEIAn patients. The very high prevalence of IgE to the LTP suggests a role of this allergen group in causing S-FDEIAn (Romano 2012 ref.28470 5)

Romano A, Scala E, Rumi G, Gaeta F, Caruso C, Alonzi C, Maggioletti M, Ferrara R, Palazzo P, Palmieri V, Zeppilli P, Mari A. Lipid transfer proteins: the most frequent sensitizer in Italian subjects with food-dependent exercise-induced anaphylaxis. Clin Exp Allergy 2012 Nov;42(11):1643-1653

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Two patients who experienced allergic symptoms after Goji berry consumption, 1 of which was an anaphylactic reaction, after Goji berry ingestion. A positive skin prick test and specific IgE to Goji berry was detected in both cases. Serum samples recognized a 9-kDa band, probably related to lipid transfer proteins (LTPs). Cross-reactivity with tomato was analyzed by inhibition studies, which showed that the 9-kDa band was totally inhibited by the tomato extract. This study describes the first 2 cases of allergic reaction following Goji berry ingestion. LTPs seem to be involved in allergic sensitization to Goji berries, as evidenced by cross-reactivity with tomato. (Monzon 2011 ref.28423 6)

Monzon BS, Lopez-Matas MA, Saenz AD, Perez-Cinto N, Carnes J. Anaphylaxis associated with the ingestion of Goji berries (Lycium barbarum). J Investig Allergol Clin Immunol 2011;21(7):567-570

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In this study, the allergenic and biological activity of two different tomato cultivars were examined in tomato allergic subjects. Twenty-five subjects with tomato allergy identified using double-blind, placebo-controlled food challenges were recruited. The cultivar 'Reisetomate' induced significantly less positive skin reactions and elicited fewer symptoms after oral challenge compared with 'Matina'. IgE-binding profiles were variable on an interindividual basis, but no major differences between 'Reisetomate' and 'Matina' were detectable. In contrast, BAT underpinned the clinical differences evoked by the different tomato cultivars and showed a left-shift of the dose-response curve obtained for 'Matina' extract. Although tomato cultivars promote a distinct clinical reactivity in tomato allergic subjects, demonstrated using SPT, DBPCFC and BAT, the molecular background for these differences could not be clarified, as the IgE-binding profiles did not reveal significant alterations. This might be due to instabilities of physicochemical sensitive proteins and/or different isoform expression of allergens. (Dolle 2011 ref.27088 7)

Dolle S, Lehmann K, Schwarz D, Weckwert W, Scheler C, George E, Franken P, Worm M. Allergenic activity of different tomato cultivars in tomato allergic subjects. Clin Exp Allergy 2011 Nov;41(11):1643-1652

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Anaphylaxis induced by tomato. Inhibition studies carried out in-vitro showed the complete cross-reactivity between the relevant tomato allergen and purified peach lipid transferprotein (LTP). Tomato LTP may sometimes cause severe allergic reactions. (Asero 2011 ref.26984 7)

Asero R, Mistrello G, Amato S. Anaphylaxis caused by tomato lipid transfer protein. Eur Ann Allergy Clin Immunol 2011 Aug;43(4):125-126

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A patient with pollen allergy multi-sensitized to different pollens, who also reports symptoms of food allergy: oral syndrome, urticaria and exercise induced anaphylaxis. Results of IgE determinations using microarray technique (ISAC) showed that the aeroallergens involved were typical from a Mediterranean environment; exercised-induced anaphylaxis was certainly related to tomato LTP whereas for episodes of oral syndrome and urticaria from peach LTP, storage proteins from lentils and soya were likely also involved. (Pauli 2010 ref.26975 5)

Pauli G, Chivato T. Molecular study of allergies in practice: About a polysensitized patient presenting several severe food allergies. Rev Fr Allergol 2010;50(6):513-515

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An unusual case of both banana and tomato allergy is reported. A 17-year-old boy with slight rhinoconjunctivitis in springtime reported two distinct episodes of angioedema of the face, hypotension, and diarrhoea during the previous 2 months, both occurring about 30 min after the ingestion of banana and lasting for about 1 hour. The patient also reported a typical oral allergy syndrome (immediate itching of oral mucosa) following the ingestion of raw tomato. These symptoms were not related to the onset of the seasonal rhinoconjunctivitis> He tolerated all other foods. SPT showed strong skin reactivity to commercial extracts of tomato, banana and hazelnut, SPT with fresh tomato both raw and boiled at 100°C for 5 min scored intensely positive with no difference between the raw and the heat-processed food. In contrast, no skin reactivity to natural rubber latex extract and to purified date palm profilin (Pho d 2) was recorded. On immunoblot analysis IgE reactivity against proteins from 43 to 90 kDa in banana extract and against 43, 67, and 94 kDa proteins in tomato extract was found. Pre-absorption of patient's serum with banana abolished IgE reactivity to 67 and 94 kDa tomato allergens, whereas IgE reactivity against the 43-kDa-zone remained unchanged. The IgE reactivity to 67 and 94 kDa was possibly due to CCD in both tomato and banana. Therefore in vitro tests showed that both co-sensitization to and co-recognition of allergen in the two fruits were present. Interestingly, the patients showed IgE reactivity to hitherto not described, high molecular weight allergens. (Asero 2010 ref.25625 8)

Asero R, Mistrello G, Amato S. Co-sensitisation (but co-recognition also) to novel banana and tomato allergens. Eur Ann Allergy Clin Immunol 2010 Aug;42(4):159-162

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A report of a patient with pollen allergy to different pollens, and who also reported food allergy: oral syndrome, urticaria and exercise induced anaphylaxis. The etiology of the symptoms are discussed in context with the results of IgE determination by the microarray technique (ISAC). The aeroallergens involved were typical that of a Mediterranean environment; exercised-induced anaphylaxis was certainly related to tomato LTP whereas oral allergy syndrome and urticaria were in addition to peach LTP, probably also involved the storage proteins from lentil and soya. (G. 2010 ref.25409 9)

Pauli G, Chivato T. Allergologie moléculaire en pratique : à propos d’un patient polysensibilisé présentant plusieurs allergies alimentaires sévères / Molecular allergology in practice: about an polysensitized patients with multiple severe food allergies Revue Française d'Allergologie 2010;50(6):513-515

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Produce-induced contact urticaria and dermatitis: Solanaceae and Alliaceae. A 48-year-old, atopic (eczema and asthma history), female supermarket produce manager presented with a 10-year history of urticaria! lesions affecting, but not limited to, her palms, flexor surfaces of forearms, and antecubital fossae. Initially, the urticarial reactions were localized to her arms and exacerbated by occupational exposure. Later, oral and occupational skin contact would trigger more widespread urticaria affecting the face, neck, and chest, with bronchospasm, gastrointestinal discomfort, and hypotension. These reactions resulted in self-administration of subcutaneous epinephrine. e immediate-type signs and symptoms. She developed disabling anxiety, refusing to leave her home, and consuming a vegetable-free diet. Patch tests were positive for the following, divided by family:
Red bell pepper
Green bell pepper
Serrano pepper
Pasilla pepper

Yellow onion
Green onion (Chive)
(Alikhan 2009 ref.23722 0)

Alikhan A, Chan HP, Maibach HI. Produce-induced contact urticaria and dermatitis: Solanaceae and Alliaceae. Contact Dermatitis 2009 Mar;60(3):174-176

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The primary aim of the study was to evaluate the allergenic profile of commercial tomato products by skin prick tests (SPTs) and IgE/immunoblotting in tomato-allergic subjects. The secondary end point was the study of the IgE-binding profile of tomato peel, pulp, and seeds. Forty tomato-allergic patients, reporting oral allergy syndrome (OAS) at different grades of severity for fresh and, in some cases, also for cooked tomato, were selected on the basis of positive tomato allergy history or open food challenge (OFC). They were evaluated by SPTs with different experimental tomato extracts. Twenty-three patients (57.5%) presented first-grade OAS at the OFC, whereas 17 (42.5%) reported severe symptoms. Ten of these 17 patients (25%) reported allergic reactions to cooked tomatoes; in immunoblotting tests, their sera reacted only to lipid transfer protein (LTP). In commercial products, LTP was the only detectable allergen. In contrast to other LTP-containing fruits, in tomato, an IgE-binding LTP was identified not only in the peel but also in the pulp and seeds. This study demonstrates that, in fresh tomato, different LTP isoforms are present and allergenic. Industrial tomato derivatives still contain LTP, thus presenting a problem for LTP-allergic patients. (Pravettoni 2009 ref.24201 7)

Pravettoni V, Primavesi L, Farioli L, Brenna OV, Pompei C, Conti A, Scibilia J, Piantanida M, Mascheri A, Pastorello EA. Tomato allergy: detection of IgE-binding lipid transfer proteins in tomato derivatives and in fresh tomato peel, pulp, and seeds. J Agric Food Chem 2009 Nov 25;57(22):10749-10754.

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In this study of 98 patients with persistent mild-to-severe atopic eczema/ dermatitis syndrome (AEDS) aged 24–48 years, the authors conclude that the APTr (tomato ready-to-use APT), rather than APTf (fresh whipped tomato APT), can be a useful and safe diagnostic test, in addition to SPT, for the detection of offending foods in adult patients with AEDS, in whom trigger factors remain unknown. Enrolled subjects were introduced to increasing doses of tomato (0.5, 1, 2, 5,
10 g) every 30 min in hospital remaining under strict medical observation for 7 h. A reaction occurring within 2 h from the beginning of the test was considered an immediate-onset type response, while after this period, it was defined as a delayed-type reaction. If the challenge test was negative at the hospital, the patients performed the test at home during the following days, reaching a total dose of 100 g of fresh tomato at 7th day. Patients were instructed to recall the medical staff, if important reactions occurred. Repeated open food challenge was considered positive for a delayed-type food reactions in case of exacerbation of eczematous lesions (at least 10-points increase of the SCORAD score). Among 98 enrolled patients, SPT was positive in 12 patients (12.2%), specific tomato IgE was positive only in two subjects (2%). Tomato ready-to-use APT and APTf were positive in nine patients (9.2%) and in 10 patients (10.2%) respectively. On the total of enrolled subjects, 10 patients (10.2%) reacted positively to ROFC (the repeated open food challenge), experiencing eczematous lesions 24–96 h after the intake of the first dose of fresh tomato. The SCORAD values in these patients increased in a range between 10 and 14 points. Among eczematous challenge-positive patients, one subject manifested also diffuse urticaria 1 h after the first administration of tomato with positive results to SPT, APTf and APTr. (Di 2009 ref.23052 7)

Di LE, Nettis E, Cardinale F, Foti C, Ferrannini A, Vacca A. Tomato atopy patch test in adult atopic dermatitis: diagnostic value and comparison among different methods. Allergy 2009 Feb 5;

[ 13 / 51 ]

Immunological contact urticarial and/or protein contact dermatitis. Classically, the protein sources are divided into 4 main groups: group 1: fruits, vegetables, spices, plants, and woods; group 2: animal proteins; group 3: grains and group 4: enzymes. Taking into account the nature of the causal proteins, a wide variety of jobs can be affected. (Amaro 2008 ref.20923 7)

Amaro C, Goossens A. Immunological occupational contact urticaria and contact dermatitis from proteins: a review. Contact Dermatitis 2008 Feb;58(2):67-75.

[ 14 / 51 ]

This study reports on a case of primarily airborne sensitization to LTP that might explain the geographical distribution of this type of food allergy. A 21-year-old woman began having severe perennial rhinitis 6 months after she started working in a wholesale fruit storehouse in Southern Italy where large amounts of fruits, including peaches, were handled; symptoms subsided when she left the workplace for >5 days and relapsed as soon as she was back at work. Later on, she developed severe food allergies to peach, hazelnut, peanut, apricot, plum and tomato. In vivo and in vitro analyses showed sensitivity to LTP. The nasal challenge with peach peel extract (6 mug protein) induced acute, severe respiratory symptoms. On immunoblot with peach peel extract patient's serum reacted uniquely against LTP, as demonstrated by inhibition assays with the recombinant peach protein. The authors conclude that LTP may induce sensitization via the respiratory tract due to inhalation of air-dispersed food particles, and this may precede the onset of food allergy. They state that if this way of sensitization were effective in the majority of LTP allergic patients (e.g. by exposure to peaches showing intact fuzz in areas where peaches are grown and directly sold on the market) then these findings could explain the strange geographical distribution of this type of food allergy. (Borghesan 2008 ref.21783 3)

Borghesan F, Mistrello G, Roncarolo D, Amato S, Plebani M, Asero R. Respiratory allergy to lipid transfer protein. Int Arch Allergy Immunol 2008 Jun 6;147(2):161-165

[ 15 / 51 ]

A case of "pure" tomato allergy in an adult female. The responsible allergen was partially characterized. It had a molecular weight of about 9 kDa and was heat-labile and pepsin-resistant, thus confirming the clinical history. Unfortunately it was not possible to characterize the protein further. Based on a comparison with currently known tomato allergens, this seems to be a novel allergen protein. (Asero 2008 ref.23096 4)

Asero R, Mistrello G, Roncarolo D, Amato S, Arcidiacono R, Fortunato D. Detection of a novel allergen in raw tomato. J Investig Allergol Clin Immunol 2008;18(5):397-400.

[ 16 / 51 ]

Some common foods in daily life have been found to have anti-allergic effects. These authors have reported that tomato extract could possibly inhibit histamine release and mouse ear-swelling responses. This study evaluated the anti-allergic effect of tomato extract in a randomized, double-blind, placebo-controlled study in 33 patients with perennial allergic rhinitis using oral administration of 360mg tomato extract per day or placebo for 8 weeks. Sneezing score significantly decreased in the tomato extract group at the end of the trial compared to the beginning (P < 0.05). There were decreasing tendencies of rhinorrhea and nasal obstruction in this group. The patients' quality of life was significantly improved after 8 weeks of treatment (P < 0.05), but not in placebo group. A significant improvement in total symptom scores, combining sneezing, rhinorrhea and nasal obstruction, was observed after oral administration of tomato extract for 8 weeks (P < 0.01). (Yoshimura 2007 ref.20378 5)

Yoshimura M, Enomoto T, Dake Y, Okuno Y, Ikeda H, Cheng L, Obata A. An evaluation of the clinical efficacy of tomato extract for perennial allergic rhinitis. Allergol Int 2007 Sep;56(3):225-230

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Angio-oedema in a child due to eating tomatoes after exercise. (Caffarelli 2006 ref.22296 3)

Caffarelli C, Zinelli C, Trimarco G, Petroccione T, Bernasconi S. Angio-oedema in a child due to eating tomatoes after exercise. Clin Exp Dermatol 2006 Mar;31(2):294-5.

[ 18 / 51 ]

This study sought to achieve stable inhibition of expression of the allergenic nonspecific lipid transfer protein Lyc e 3 in tomato and to analyze the reduction of allergenicity. The study was conducted using serum from 5 tomato allergic individuals, age ranging from 22 to 41 years of age. 5 had OAS, 4 had skin reactions, 2 had respiratory tract symptoms, 3 had GIT symptoms, 1 had cardiovascular symptoms. Serum specific IgE ranged from 1.6 to 51.5. All showed skin specific IgE. (Lorenz 2006 ref.15729 5)

Lorenz Y, Enrique E, Lequynh L, Fotisch K, Retzek M, Biemelt S, Sonnewald U, Vieths S, Scheurer S. Skin prick tests reveal stable and heritable reduction of allergenic potency of gene-silenced tomato fruits. J Allergy Clin Immunol 2006 Sep;118(3):711-718

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A 12-year-old girl with a clinical history of abdominal pain, nausea, and general malaise after tomato intake which completely remitted with antihistamines. Skin prick tests and specific IgE to tomato were negative while the food challenge was positive. The patient underwent an oral rush desensitizing treatment, at the end of which she could eat a maintenance dose of 100 g of tomato daily with no side effects at all. (Nucera 2006 ref.16687 3)

Nucera E, Schiavino D, Buonomo A, Roncallo C, Pollastrini E, Lombardo C, Alonzi C, Pecora V, De PT, Patriarca G. Oral rush desensitization with tomato: a case report. J Investig Allergol Clin Immunol 2006;16(3):214-217

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A report on 16 cases of childhood OAS in a Japanese study. The rate of sensitization against four major pollens (Japanese cedar, orchard grass, short ragweed, alder) among 1067 pediatric patients with allergic diseases was investigated. OAS in childhood differs from that in adulthood in some ways. One is that childhood OAS does not always accompany with pollinosis. The most frequent allergen in this study was kiwi fruit followed by tomato, orange and melon. The sensitization rate against alder was equivalent as that against orchard grass and short ragweed, but less than that against Japanese cedar. The study concludes that Childhood OAS may have different mechanisms from adulthood OAS which almost always accompanies with pollinosis or latex allergy. (Sugii 2006 ref.16084 3)

Sugii K, Tachimoto H, Syukuya A, Suzuki M, Ebisawa M. Association between childhood oral allergy syndrome and sensitization against four major pollens (Japanese cedar, orchard grass, short ragweed, alder). [Japanese] Arerugi 2006 Nov;55(11):1400-1408

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A 6 years old girl with a grass pollen allergy sensitised to group 1 and 5 allergens, and grass profilin, who presents and OAS to multiple fresh plant foods related to the profilin sensitisation. The girl presented with a mild atopic dermatitis and since the age of 3 years experencied rhinoconjunctival symptoms in spring. At 3.5 years she presented OAS after the intake of watermelon. Since then until the last visit she presented OAS with other plant foods including apple, kiwi, apricot, plum, peach, nectarine, pear, strawberry, grape, orange, tangerine, banana, tomato, cucumber and hazelnut. She tolerated processed fruits (juices, jam) and latex contact.
Skin prick tests to inhalants were positive to grass, olive, plane tree, mugwort, and plantain pollens. SPTs with commercial extracts of fruits were negative, but positive results were observed to some of them tested fresh (prick-prick). An oral challenge with fresh plum elicited oropharyngeal pruritus and labial angioedema. SPT and serum specific IgE to Pru p 3 were negative. SPT with nPho d 2 (date palm profilin) was positive. CAP to latex was 3.03 kU/L, with negative results to the recombinant latex allergens 1, 3, 5, 6.01 and 6.02. CAP inhibition assays of pollens, plant foods and latex were performed with rBet v 2 with the following inhibitions: > 85% to rBet v 2 and rPhl p 12, 40- 100% to watermelon, orange, apple, tomato, banana, 100% to latex, > 70% to mugwort, plane tree and olive pollens, no inhibition to grass and Phleum. (Rodriguez 2006 ref.23498 2)

Rodriguez del Rio P, Rodriguez-Jimenez B, Plaza A, Reig I, Sanchez-Lopez J, Vazquez-Cortes S, Martinez-Cocera C, Fernandez-Rivas M. Early onset of profilin sensitation. EAACI Congress, Vienna-Austria. 2006 Jun; Oral Abstract 1513.

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Tomato-induced OAS has been reported in 33 of 50 patients with tomato allergy. (Westphal 2004 ref.9291 0)

Westphal S, Kempf W, Foetisch K, Retzek M, Vieths S, Scheurer S. Tomato profilin Lyc e 1: IgE cross-reactivity and allergenic potency. Allergy 2004;59(5):526-32

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In a study of 10 CCD-positive and 2 CCD-negative sera from patients with tomato allergy, the study concluded that approximately one third of the CCD-positive sera from patient s with tomato allergy have biologically relevant CCD-specific IgE antibodies, and therefore, the general claim that CCD-specific IgE is clinically irrelevant has to be reconsidered critically. Hence IgE specific for CCDs should be taken into consideration in the diagnosis and therapy of certain allergies. (Foetisch 2003 ref.7771 2)

Foetisch K, Westphal S, Lauer I, Retzek M, Altmann F, Kolarich D, Scheurer S, Vieths S. Biological activity of IgE specific for cross-reactive carbohydrate determinants. J Allergy Clin Immunol 2003;111(4):889-96

[ 24 / 51 ]

Eight patients with ages between 12 and 27 years who suffered from anaphylaxis episodes after eating raw tomatoes. The wheals obtained in prick tests were significantly higher with the extracts of tomato treated with ethylene and salicylic acid and the patients who presented greater wheal diameters in skin tests were those who had more severe episodes of anaphylaxis. (Armentia 2003 ref.7753 7)

Armentia A, Callejo A, Diaz-Perales A, Martin-Gil FJ, Salcedo G. Enhancement of tomato allergenicity after treatment with plant hormones. Allergol Immunopathol (Madr) 2003;31(1):44-6

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Tomato has been reported as a food that causes allergic reactions after ingestion in patients with food allergy. (Jager 2002 ref.15746 7)

Jager La WB. Nahrungsmittelallergien und-Intoleranzen. 2nd ed. Urban & Fischer; Munchen/Jena (Germany) 2002.

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A 39-year-old atopic woman with 2-year history of fingertip dermatitis. She complained that rubber gloves irritated her hands and that handling uncooked potatoes and tomatoes aggravated her dermatitis. Uncooked tomatoes, but not cooked, resulted in oral tingling and facial erythema in a 39-year-old woman. Cooked potato did not affect her. Serum specific IgE was moderatly increased to natural rubber latex, tomato and potato. It may be that her allergy to latex arose secondarily via primary sensitization to potato or tomato.(Tavidia 2002 ref.7253 4)

Tavidia S, Morton CA, Forsyth A. Latex, potato and tomato allergy in restaurateur. Contact Dermatitis 2002;47(2):109

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Although tomatoes are a commonly consumed food, severe allergic reactions to tomatoes are unusual or rarely reported. Previously reported allergic manifestations to tomato include urticaria/angioedema, dermatitis, perioral dermatitis, Oral Allergy Syndrome, rhinitis, and abdominal pain. Tomato pollen may trigger rhinitis and/or conjunctivitis. This study reports on two patients with significant immediate hypersensitivity reactions to tomato. Both adults experienced laryngeal edema and one had anaphylaxis. (Zacharisen 2002 ref.5806 3)

Zacharisen MC, Elms NP, Kurup VP. Severe tomato allergy (Lycopersicon esculentum). Allergy Asthma Proc 2002;23(2):149-52

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This study reports that tomatoes, cereals and peanuts were the most common foods in food-dependent exercise-induced anaphylaxis. (Romano 2001 ref.4305 7)

Romano A, Di Fonso M, Giuffreda F, Papa G, Artesani MC, Viola M, Venuti A, et al Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol 2001;125(3):264-72

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In 25 patients with recurrent otitis media with effusion and food allergy demonstrated by positive skin testing, the most common food found to be associated was milk, egg, beans, citrus, and tomato. The elimination of the food diet led to a significant amelioration of the otitis in 22 patients. A subsequent challenge with the suspected offending food provoked a recurrence of the otitis problem. (Arroyave 2001 ref.7020 3)

Arroyave CM. Recurrent otitis media with effusion and food allergy in pediatric patients. [Spanish] Rev Alerg Mex 2001;48(5):141-4

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A girl is reported with anaphylaxis to a few milliliters of cow’s milk formula at 5 months of age. At 6 months, urticaria to egg, soy, peanut butter tomatoes. At 18 months she developed generalised urticaria when a few drops of milk accidentally spilt on her head. Acute urticaria and upper respiratory symptoms while in a bathtub in which a few drops of cow’s milk accidentally was spilled by her younger brother. A 26 month old boy challenged with 3 drops of cow’s milk after 14 months of cow’s milk avoidance resulted in generalised urticaria, sneezing, rhinorrhoea and red itchy eyes within a few minutes. Despite 3 years of strict avoidance, the continues to get localised urticaria whenever kissed by is sister if she just ingested ice cream or milk. (Tan 2001 ref.10161 6)

Tan BM, Sher MR, Good RA, Bahna SL. Severe food allergies by skin contact. Ann Allergy Asthma Immunol 2001;86(5):583-6

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11 patients with oral allergy syndrome (OAS) to tomatoes. (Kondo 2001 ref.4917 3)

Kondo Y, Urisu A, Tokuda R. Identification and characterization of the allergens in the tomato fruit by immunoblotting. Int Arch Allergy Immunol 2001;126(4):294-299

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This study investigated the cross-reactivity to non-Rosaceae LTPs. IgE antibodies to Rosaceae LTPs reacted to a broad range of vegetable foods were evaluated in 498 subjects (age > 12 years) with Rosaccae allergy as judged by skin prick test with fresh fruits and (in most cases) clinical history. The majority had OAS (>97%), and only a minority (approximately 10%) showed urticaria/angioedema, gastrointestinal symptoms, food-induced rhinitis, asthma, or anaphylaxis. Sera from 37 patients were available for follow-up studies. Peach was identified most frequently as an offending Rosaceae food (in 30/37 patients), followed by apple (16/37), apricot (11/37), cherry (9/37), plum (8/37), almond (7/37) and pear (6/37). Four patients did not have any clinical symptoms related to Rosaccae fruits, despite a positive SPT with commercial plum extract and peach peel extract. All 37 patients were interviewed for allergies to other foods. Walnut and hazelnut were most frequently reported as offending foods (19/37 and 15/37, respectively), closely followed by peanut (9/37). For the other 33 different foods, the number of patients reporting symptoms ranged from 1 to 5. These foods were found among all major groups of vegetable foods, including cereals (corn, wheat), legumes (soybean, string bean, white bean, chick pea, lentils, lupine), Solanaceae (potato, tomato, eggplant) Brassicaceae (cabbage, mustard), Umbelliferae (celery, fennel), Rutaceae (lemon, orange), and several other plant families. This article contains a table of the 37 patients and the effecting foods and symptoms of each patient.
(Asero 2000 ref.3711 7)

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 2000;122(1):20-32

[ 33 / 51 ]

Food-dependant exercise-induced anaphylaxis. (Shadick 1999 ref.6602 1)

Shadick NA, Liang MH, Partridge AJ, Bingham C, Wright E, Fossel AH, Sheffer AL. The natural history of exercise anaphylaxis: survey results from a 10-year follow-up study. J Allergy Clin Immunol 1999 Jul;104(1):123-7.

[ 34 / 51 ]

Of 59 consecutive subjects 2 to 40 years old with spina bifida, latex sensitization was present in 15 patients (25%) (presence of IgE specific to latex, as detected by a skin prick test in 9 and/or RAST CAP in 13.) Five latex sensitized patients (33.3%) had clinical manifestations, such as urticaria, conjuctivitis, angioedema, rhinitis and bronchial asthma, while using a latex glove and inflating a latex balloon. Atopy was present in 21 patients (35.6%). In 14 patients (23%) 1 or more skin tests were positive for fresh foods using a prick plus prick technique. Tomato, kiwi, and pear were the most common skin test positive foods. Univariate analysis revealed that a history of 5 or more operations, atopy and positive prick plus prick tests results for pear and kiwi were significantly associated with latex sensitization. (Bernardini 1998 ref.21757 0)

Bernardini R, Novembre E, Lombardi E, Mezzetti P, Cianferoni A, Danti AD, Mercurella A, Vierucci A. Prevalence of and risk factors for latex sensitization in patients with spina bifida. J Urol 1998 Nov;160(5):1775-8.

[ 35 / 51 ]

Anaphylaxis induced by exercise and related to multiple food intake. Three patients with food-dependent exercise-induced anaphylaxis. In Patient 1, tomato, zucchini, and wheat resulted in adverse reactions: in Patient 2, potato, peanuts, and tomato; in Patient 3, rice and peanuts. SPTs and RASTs to foods predisposing the reaction were positive. Food-exercise combined challenge may be useful in identifying foods that favor FDEI in children with multiple food-dependent FDEI. (Caffarelli 1997 ref.617 37)

Caffarelli C, Cataldi R, Giordano S, Cavagni G. Anaphylaxis induced by exercise and related to multiple food intake. Allergy Asthma Proc 1997;18(4):245-8

[ 36 / 51 ]

In a study of 47 latex allergic patients, immunological reactivity to foods was found in 33. Seventeen patients manifested a clinical allergy to at least one food including 11 with anaphylaxis, and 14 with local sensitivity reactions. Positive food skin tests occurred most frequently with avocado (53%), potato (40%), banana (38%), tomato (28%), chestnut (28%), and kiwi (17%). Latex-allergic patients (23%) recognize a protein that had sequence homology to a broad class of plant proteins known as patatins. Crossreactivity between latex and several potato proteins was observed by immunoblot inhibition analysis. Potatoes and tomatoes are newly reported cross-reacting foods. (Beezhold 1996 ref.84 675)

Beezhold DH, Sussman GL, Liss GM, Chang NS. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy 1996;26(4):416-22

[ 37 / 51 ]

Food-dependant exercise-induced anaphylaxis. (Guinnepain 1996 ref.823 12)

Guinnepain MT, Eloit C, Raffard M, Brunet-Moret MJ, Rassemont R, Laurent J. Exercise-induced anaphylaxis: useful screening of food sensitization. Ann Allergy 1996;77(6):491-6

[ 38 / 51 ]

Insects have been and still are an important source of human nutrition. The ingested insects are primarily grasshoppers, cicadas, caterpillars and adult moths, grubs and adult beetles, wasps, bees, larvae and pupae of ants, winged ants, and a variety of aquatic insects. In the Western world, gastrointestinal exposure to insect allergens usually occurs from insect debris found on tomatoes, ketchup, tomato juice, dried fruit, pickles, wine, chocolate, cereals, nuts, grains, flour, cornmeal, and oatmeal. (Freye 1996 ref.1912 3) (DeFoliart 1992 ref.14033 7)

Freye HB, Esch RE, Litwin CM, Sorkin L. Anaphylaxis to the ingestion and inhalation of Tenebrio molitor (mealworm) and Zophobas morio (superworm). Allergy Asthma Proc 1996;17(4):215-219

[ 39 / 51 ]

Food-dependant exercise-induced anaphylaxis in two patients.
A 19-year-old girl experienced for 2 years, several episodes of urticaria, angioedema, swelling of the tongue and rhinoconjunctivitis after dancing or playing basketball for 10 mins. Tomato and wheat appeared to be the responsible foods on challenge.
A 19-year-old boy had two episodes of anaphylaxis in the preceeding two months after playing basketball for 30 mins. He had pruritus of the palms, which progressed to urticaria, angioedema, conjunctivitis, dyspnea, hypotension, and eventually loss of consciousness. Potato, peanut and tomato appeared to be responsible foods on challenge. (Caffarelli 1996 ref.6604 3)

Caffarelli C, Cavagni G, Giordano S, Terzi V, Perrone F. Reduced pulmonary function in multiple food-induced, exercise-related episodes of anaphylaxis. J Allergy Clin Immunol 1996;98:762-765

[ 40 / 51 ]

Food-dependant exercise-induced anaphylaxis. (Romano 1995 ref.1292 8)

Romano A, Di Fonso M, Giuffreda F, Quaratino D, Papa G, Palmieri V, Zeppilli P, Venuti A. Diagnostic work-up for food-dependent, exercise-induced anaphylaxis. Allergy 1995;50(10):817-24

[ 41 / 51 ]

Food allergy / atopic dermatitis in children. (Ottolenghi 1995 ref.1289 3)

Ottolenghi A, De Chiara A, et al Diagnosis of food allergy caused by fruit and vegetables in children with atopic dermatitis [Italian]. Pediatr Med Chir 1995;17(6):525-30

[ 42 / 51 ]

Atopic dermatitis. (Ottolenghi 1995 ref.6803 1)

Ottolenghi A, De Chiara A, Arrigoni S, Terracciano L, De Amici M. Diagnosis of food allergy caused by fruit and vegetables in children with atopic dermatitis. [Italian] Pediatr Med Chir 1995;17(6):525-30

[ 43 / 51 ]

Food-dependant exercise-induced anaphylaxis. 3 patients, age 7-19 yrs, with recurrent episodes of ElAn. A baseline exercise challenge was negative. A second challenge was performed an hour after the intake of each of the 16 foods suspected to favour the reaction. Tomato, wheat, rice and chestnut provoked anaphylactic symptoms. Skin prick tests and specific IgE were positive to these foods, suggesting an IgE mechanism. However their sensitivity was poor. (Caffarelli 1994 ref.6609 8)

Caffarelli C, Giordano S, Stapane I, Rossi C, Cavagni G. Unusual triggering factors of the food-dependent exercise-induced anaphylaxis. Ann Allergy 1994;72:75

[ 44 / 51 ]

In 91 patients with eczema, it improved in 49 of 66 (74 %) after stopping cows' milk, eggs and various other foods. (Sloper 1991 ref.1698 6)

Sloper KS, Wadsworth J, Brostoff J. Children with atopic eczema. I: Clinical response to food elimination and subsequent double-blind food challenge. Q J Med 1991;80(292):677-93

[ 45 / 51 ]

Oral Allergy Syndrome. (Ortolani 1989 ref.39 313)

Ortolani C, Ispano M, Pastorello EA, Ansaloni R, Magri GC. Comparison of results of skin prick tests (with fresh foods and commercial food extracts) and RAST in 100 patients with oral allergy syndrome. J Allergy Clin Immunol 1989;83:683-690

[ 46 / 51 ]

Oral allergy syndrome. (Ortolani 1988 ref.6933 4)

Ortolani C, Ispano M, Pastorello E, Bigi A, Ansaloni R. The oral allergy syndrome. Ann Allergy 1988;61(6 Pt 2):47-52

[ 47 / 51 ]

Atopic dermatitis. (Veien 1987 ref.1775 2)

Veien NK, Hattel T, et al. Dermatitis induced or aggravated by selected foodstuffs. Acta Derm Venereol 1987;67(2):133-8

[ 48 / 51 ]

A case of eosinophilic cystitis induced by the ingestion of specific foodstuffs (tomatoes, coffee, carrots) and strong smells (petrol) in a female patient with clinical history of extrinsic permanent rhinitis and Quincke's oedema. Skin tests and RAST were negative to these. Provocative tests were used to make the definitive diagnosis. They were carried out when the patient was symptomless and the following parameters were taken into account: the time elapsed until the appearance of the symptoms, the intensity of urinary symptoms, polakiuria, urgency and prepubic pain, cystoscopy, bladder histology, urine volume and pre-and post-test histaminuria in 24 hours. Bladder histology subsequent to the intake of tomato showed capillary congestion and severe inflammatory infiltration with a clear predominance of eosinophils. The histaminuria values after the ingestion of tomatoes, carrots and coffee were superior to basal determinations, amounting to a maximum of 1229 mcg./l. in 24 hours. (Sanchez 1984 ref.1031 8)

Sánchez Palacios A, Quintero de Juana A, Martínez Sagarra J, Aparicio Duque R. Eosinophilic food-induced cystitis. Allergol Immunopathol (Madr) 1984;12(6):463-9

[ 49 / 51 ]

Food-dependant exercise-induced anaphylaxis. (Kidd 1983 ref.332 14)

Kidd JM, Cohen SH, Sosman AJ, Fink N. Food-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol 1983;71:407-411

[ 50 / 51 ]

Rhinitis. Angioedema and laryngeal oedema. Atopic dermatitis. Urticaria. One of the commonest causes of contact dermatitis of the hands. (Sinha 1977 ref.340 5)

Sinha SM, Pasricha JS, Sharma R, Kandhari KC. Vegetables responsible for contact dermatitis of the hands. Arch Dermatol 1977;113:776-779

[ 51 / 51 ]

Urticaria and Angioedema. (Bleumink 1966 ref.431 81)

Bleumink E, Berrens L, Young E. Studies on the atopic allergen in ripe tomato fruits. I. Isolation and identification of the allergen. Int Arch Allergy 1966;30:132-145

Non-Immune reactions

[ 1 ]

A 62 years old woman with pollakiuria and sharp pain at the time of urinary bladder distention. Anti-H1-antagonist but not antibiotics was partially effective against the symptoms and as some specific food ingestion appeared to increase the bladder pain, she was referred. Elimination of food products that revealed the presence of specific IgE antibodies and positive skin reaction resulted in a favorable clinical response. Interstitial cystitis was established. (Ogawa 2005 ref.12819 7)

Ogawa H, Nakamura Y, Tokinaga K, Sakakura N, Yamashita M. A case of interstitial cystitis accompanied by food allergy. [Japanese] Arerugi 2005 Jul;54(7):7-645

[ 2 ]

In 33 patients with chronic urticaria and pseudoallergic reactions to food (proved by means of elimination diet and subsequent re-exposure with provocation meals), oral provocation tests were performed with field-grown tomatoes. 76% of the group reacted to tomato. The authors tested for salicylates, histamine, and other components, and attribute the reactions to aromatic volatile ingredients in food, which are novel agents that elicit pseudoallergic reactions in chronic urticaria. Histamine, salicylate, and a direct mast-cell histamine release were not involved in this reactivity to naturally occurring pseudoallergens. (Zyberbier 2002 ref. 5090 4)

Zuberbier T, Pfrommer C, Specht K, Vieths S, Bastl-Borrmann R, Worm M, Henz BM. Aromatic components of food as novel eliciting factors of pseudoallergic reactions in chronic urticaria. J Allergy Clin Immunol 2002;109(2 Pt 1):343-8

[ 3 ]

Gustatory sweating, and to orange juice. (Freeman 1998 ref.966 10)

Freeman GL. Gustatory sweating in the differential diagnosis of food allergy. Allergy Asthma Proc 1998;19:1-2

[ 4 ]

May produce erythema-multiforme-like eruptions. Phytodermatitis. A total of 15 patients presenting with phytodermatitis was examined. Fresh parts of the plants and standard allergen battery were used for epicutaneous testing. Tests with parts of the plants were carried out in 8 cases and in 5 controls. A total of 38 plants was examined. Positive PT was found for sisal, willow, parsnip, carrot, celery, spinach, green tomato, broomcorn, lemon skin, pyracantha, arborvitae, yucca, ficus, juniper tree, plane tree and greenhouse grass. In cases of positive PT for willow, carrot, celery, green tomato and grass, positive PT for Peru balsam (PB) was also detected, while in positive PT for lemon skin, a positive PT on turpentine was found as well. (Poljacki 1993 ref.1055 3)

Poljacki M, Paravina M, Jovanovic M, Subotic M, Duran V. Contact allergic dermatitis caused by plants. [Serbo-Croatian] Med Pregl 1993;46(9-10):371-5

[ 5 ]

Hypercarotenaemia in a tomato soup faddist. (Ghandi 1988 ref.1027 3)

Gandhi M, Walton S, Wyatt EH. Hypercarotenaemia in a tomato soup faddist. BMJ 1988;297(6664):1635

[ 6 ]

Walnuts, strawberries and tomatoes may be implicated as causing recurrent aphthous stomatitis on a subjective basis, but this study of 218 students could not confirm this with objective evidence. (Eversole 1982 ref.2755 0)

Eversole LR, Shopper TP, Chambers DW Effects of suspected foodstuff challenging agents in the etiology of recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1982;54(1):33-38

[ 7 ]

Foods, including orange juice, can cause reflux esophagitis (heartburn). (Price 1978 ref.1023 3)

Price SF, Smithson KW, Castell DO. Food sensitivity in reflux esophagitis. Gastroenterology 1978;75(2):240-3

[ 8 ]

Six common foods can cause the clinical entity called "idiopathic" pruritus ani. They are coffee, tea, cola, beer, chocolate, and tomatoes. Pruritus ani occurs in 24 to 48 hours when a patient consumers more than a threshold amount of one or more of these foods and disappears spontaneously in a few days provided the threshold is not exceeded again. (Friend 1977 ref.26410 2)

Friend WG. The cause and treatment of idiopathic pruritus ani. Dis Colon Rectum 1977 Jan-Feb;20(1):40-2.

[ 9 ]

Other substances present, e.g., histamine, tyramine, may mimic certain allergic reactions (see individual substances).

Editor Comment Editorial comment, common knowledge, or still to add - -

Occupational reactions

[ 1 ]

Tomato pollen-induced occupational asthma in a greenhouse worker. A report on the clinical and immunologic findings in a 33-year-old tomato greenhouse worker who developed occupational asthma and rhinitis 4 years to tomato pollen after starting employment in a greenhouse where tomatoes were grown. He experienced chest tightness, wheezing, and cough while working in the greenhouse. He also reported severe rhinoconjunctivitis symptoms, including nasal and ocular itching, sneezing, rhinorrhea, and nasal blockage. Initially symptoms occurred about 3 hours after entering the greenhouse and improved after leaving the workplace, although asthma symptoms often recurred during the night, but over the following 2 years, the symptoms worsened progressively and no longer improved on weekends. Skin prick testing was positive to the flower extract and less to the leaf extract. An inhalation challenge with tomato flower extract was positive. Prick-to-prick testing with fresh tomato induced a 6-mm skin response. Tomato-specific IgE antibodies against tomato was 7.3 lU/mL and other plants belonging to the Solanaceae family, including potato (3.1 lU/mL), sweet bell pepper (2.1 IU/ mL), eggplant (2.4 lU/mL), and chili pepper (1.9 lU/mL), as well as against natural rubber latex, mugwort, timothy grass, birch, and rBet v 1. The patient's serum showed a predominant IgE binding to proteins with molecular masses of 10, 22, and 28/ 30 kd in both tomato flower and pulp extracts. Immunoblotting of the tomato pulp extract showed additional IgE binding to a 45-kd protein. The IgE-binding bands did not correspond to the currently characterized tomato allergens, including Lyc e 1 (profilin), Lyc e 2, and Lyc e 3 (lipid transfer protein). (Vandenplas 2008 ref.22411 0)

Vandenplas O, Sohy C, D'Alpaos V, Nootens C, Thimpont J, Weigand D, Scheurer S. Tomato-induced occupational asthma in a greenhouse worker. J Allergy Clin Immunol 2008 Sep 12;[ahead of print]

[ 2 ]

Occupational protein contact dermatitis to coriander, carrot and potato in a 22-year-old chef, who had developed pruritic hand dermatitis from handling raw potatoes, tomatoes, carrots, and curry. Dermatitis developed on his face if juice of these vegetables splashed on it. (Kanerva 2001 ref.5088 8)

Kanerva L, Soini M. Occupational protein contact dermatitis from coriander. Contact Dermatitis 2001;45(6):354-5

[ 3 ]

Allergy symptoms in workers growing tomatoes may in fact be due to the presence of red spider mite on the plant rather than to tomato.

Erlam AR, Johnson AJ, Wiley KN. Occupational asthma in greenhouse tomato growing. Occup Med (Oxf) 1996;46(2):163-4

[ 4 ]

To estimate the prevalence of dermatitis and risk factors for skin disease in California farm workers, a cross-sectional survey was conducted among grape, citrus, and tomato workers. The prevalence of contact dermatitis was 2% and lichenified hand dermatitis was 13%. Grape workers were more likely to report rashes in the last 12 months than were tomato workers or citrus workers. Grape workers were more likely to have contact dermatitis and lichenified hand dermatitis than were citrus or tomato workers. (Gamsky 1992 ref.22386 6)

Gamsky TE, McCurdy SA, Wiggins P, Samuels SJ, Berman B, Shenker MB. Epidemiology of dermatitis among California farm workers. J Occup Med 1992 Mar;34(3):304-10.

[ 5 ]

Occupational asthma in tomato growers following an outbreak of the fungus Verticillium albo-atrum in the crop.

Davies PD, Jacobs R, Mullins J, Davies BH Occupational asthma in tomato growers following an outbreak of the fungus Verticillium albo-atrum in the crop. J Soc Occup Med 1988;38(1-2):13-17

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