Tree pollens Allergy – Which allergens? Author: Dr Harris Steinman, Allergy Resources International, P O Box 565, Milnerton 7435, South Africa, [email protected]. All rights reserved. No part of this publication may be reproduced in any form without the written consent of Phadia AB. ©Phadia AB, 2008 Design: RAK Design AB, 2008 Printed by: Åtta.45 Tryckeri AB, Solna, Sweden ISBN 91-973440-5-2 Contents Introduction .........................................................................5 t19 Acacia (Acacia longifolia) .........................................11 t5 American beech (Fagus grandifolia) ...........................14 t73 Australian pine (Casuarina equisetifolia) ....................17 t37 Bald cypress (Taxodium distichum) ...........................20 t56 Bayberry (Myrica cerifera) .........................................22 t1 Box-elder (Acer negundo) .........................................24 t212 Cedar (Libocedrus decurrens) ...................................27 t45 Cedar elm (Ulmus crassifolia) ...................................29 t206 Chestnut (Castanea sativa) .......................................32 t3 Common silver birch (Betula verrucosa) .....................35 t14 Cottonwood (Populus deltoides) ................................45 t222 Cypress (Cupressus arizonica) ...................................49 t214 Date (Phoenix canariensis) .......................................56 t207 Douglas fir (Pseudotsuga taxifolia) .............................59 t205 Elder (Sambucus nigra) ............................................60 t8 Elm (Ulmus americana)............................................62 t18 Eucalyptus, Gum-tree (Eucalyptus spp.) ....................65 t25 European ash (Fraxinus excelsior) .............................68 t2 Grey alder (Alnus incana) .........................................73 t44 Hackberry (Celtis occidentalis) ..................................78 t4 Hazel (Corylus avellana) ...........................................80 t209 Horn beam (Carpinus betulus) ..................................84 t203 Horse chestnut (Aesculus hippocastanum) .................87 t23 Italian/Mediterranean/ Funeral cypress (Cupressus sempervirens) ..................89 t17 Japanese cedar (Cryptomeria japonica) ......................93 t208 Linden (Tilia cordata) .............................................101 t11 Maple leaf sycamore, London plane (Platanus acerifolia) ..........................103 t21 Melaleuca, Cajeput-tree (Melaleuca leucadendron) ...108 t20 Mesquite (Prosopis juliflora) ...................................110 t6 Mountain juniper (Juniperus sabinoides) ..................115 t70 Mulberry (Morus alba) ............................................119 t7 Oak (Quercus alba) ................................................122 t223 Oil Palm (Elaeis guineensis) ...................................126 t9 Olive (Olea europaea) .............................................128 t219 Paloverde (Cercidium floridum) ...............................138 t22 Pecan, Hickory (Carya illinoinensis) .........................139 t217 Peppertree (Schinus molle) ....................................142 t213 Pine (Pinus radiata) ...............................................144 t210 Privet (Ligustrum vulgare) ......................................148 t72 Queen palm (Syagrus romanzoffiana) .......................151 t57 Red cedar (Juniperus virginiana) .............................153 t71 Red mulberry (Morus rubra) ....................................156 t54 Russian olive (Elaeagnus angustifolia) .....................158 t55 Scotch broom (Cytisus scoparius) ............................160 t201 Spruce (Picea excelsa) ...........................................161 Contents t211 Sweet gum (Liquidambar styraciflua) .......................163 t218 Virginia live oak (Quercus virginiana) .......................165 t10 Walnut (Juglans californica) ....................................168 t15 White ash (Fraxinus americana) ..............................170 t41 White hickory (Carya tomentosa syn. C. alba) ...........173 t16 White pine (Pinus strobus) .....................................175 t12 Willow (Salix caprea) ..............................................178 Mixes tx1, tx2, tx3, tx4, tx5, tx6 .....................................181 tx7, tx8, tx9, tx10 .................................................182 Tree pollen allergens Trees are an important cause of pollen evergreens) are the biggest pollen shedders, allergy. One reason for this is that they are but within this group the Pine is relatively both widespread and dense in the human benign, because its large pollen tends to fall environment, probably accounting for most straight down and not travel – but Cypresses, of the world’s pollen plants under cultivation. Junipers and Cedars are among the most From ancient times they have been considered troublesome of all allergenic trees. But the beautiful and in some cases sacred, and they angiosperms or flowering trees (mostly have had a number of vital uses in human deciduous) are also important, particularly culture, producing not only food but material Birch, Alder, Beech, Elm and Hazel. Because for shelter, fuel and implements. Trees are of human mobility and intervention in the so congenial to most people that they are environment, moreover, the allergy diagnosis accompaniments to buildings (especially and management that are necessitated homes) almost wherever space, climate and soil by exposure to such allergens have been allow. The intensely developed metropolis, and complicated. Olive trees, often planted for the impoverished, environmentally degraded their fruit, now occur in many places where the rural village or urban slum in the developing climate is suitable (including southern Africa), world, are considered unwholesome in part not just in the Mediterranean. Cedars and because of the absence of trees. Birches may still be considered characteristic of Japan and Scandinavia respectively, but As far as allergy is concerned, deforestation this allows no firm deductions as to where and urbanisation in the world overall are specimens of these trees cannot have been tendencies that need to be considered in balance introduced, beyond the most obvious places against reforestation and suburbanisation in (Antarctica, the Congo basin, the Sahara, and many industrialised countries – which are a few others). The Eucalyptus was exclusive the main territory of allergy and the main to Australia before colonial settlement of focus of allergy studies. Also, the increasing that continent, but is now one of the most preference in Europe, America and the Far widespread “alien” trees, and in many places a East is to provide for “green space” in urban significant pest. The worldwide mix of trees is planning (while the newer cities of Australia probably more diverse now than at any other and New Zealand have tended to be heavily time in human history, with all the problems “green” from the beginning), and trees are this implies for dealing with allergy. normally included. The public health benefits of trees’ absorption of carbon dioxide from human activities are held to far outweigh Allergen exposure any detriments from tree pollen. Tree pollen As far as allergenic trees are concerned, the allergen exposure therefore remains high in “pollen season” can begin in early spring with the developed world, or is even increasing. the flowering of trees such as Birch, long before Exacerbating the situation for pollen-allergic grass and weed pollens. On the other hand, individuals is the preference for male trees as some trees flower in autumn or twice a year, ornamentals, in order to avoid the trouble of which can confuse expectations about pollen harvesting or cleaning up from the ground exposure. Rhinitis, asthma and conjunctivitis the fruit of female trees. When a species is not are typical in tree pollen allergy, and as self-fertilising, it is of course the male tree that with grass and weed pollen allergies, there produces the pollen, and this must be light, is a tendency to accept discomfort and not mobile pollen – with far greater allergenic pursue suitable diagnostic and management potential. strategies, opting either for no treatment or The second reason for the importance possibly inappropriate chronic medication. of trees in allergy is their huge production But the influence of tree pollens on asthma, of pollens. This must, however, be taken in and important patterns of cross-reactivity, the context of individual tree species: the make it very desirable that tree pollen allergy gymnosperms or cone-bearing trees (mostly be adequately addressed clinically. Cross-reactivity Cross-reactivity can be expected to roughly follow botanical relationships. The classifica- tion in figure 1 on the next page (representing widespread if not universal taxonomical opin- ion) shows some of the most common allergy provoking trees available for ImmunoCAP® testing. The families of the Fagales order, here represented by Betulaceae, Casuarinaceae, Fagaceae, Juglandaceae and Myricaceae, are closely related and cross-reactivity can occur between members of different families within the order. The other orders contain a variety of non-related families where cross-reactivity can be expected only between members of the same family (1-13). Broader cross-reactivity encompasses weed and grass pollens and plant-derived foods and other substances from distantly related species. Oral Allergy Syndrome, especially relating to Birch pollen, is a phenomenon that