Background: Employees in strawberry greenhouses are highly exposed to several (potential) allergenic agents. However, no occupational allergy in this branch has been described before. First, the presence of work-related allergic symptoms in strawberry workers was explored. Second, we aimed to prove the concept that an IgE-mediated allergy could be responsible for work-related symptoms. To test the possibility of an IgE response secondary to cross-reactivity to birch or grass pollen, inhibition experiments were performed. Methods: First, a questionnaire survey concerning work-related allergic symptoms among strawberry workers in the Netherlands was carried out. Second, 3 workers with work-related symptoms were investigated in detail. Skin tests, serum-specific IgE tests with home-made extracts of strawberry pollen and other possible allergenic agents of the strawberry greenhouse environment were executed. Furthermore, immunoblots and nasal provocations with strawberry pollen extract were performed. In addition, inhibition experiments were performed. Results: 29 of 75 questionnaire respondents (38.7%) reported work-related symptoms. Sensitization to strawberry pollen was found in skin tests in all 3 employees with work-related symptoms. ELISA and immunoblotting with strawberry pollen showed positive results in 2 employees. Birch and grass pollen failed to inhibit IgE binding to strawberry pollen in 1 of 2 employees. Partial inhibition was seen in the second employee. Nasal provocation validated clinically relevant allergy to these pollens in 2 of 3 subjects. Conclusions: Allergic symptoms attributable to the workplace are present among a proportion of strawberry greenhouse employees. An IgE-mediated occupational allergy to strawberry pollen may contribute to these symptoms.

Keywords:
Allergy, Nasal provocation tests, Occupational allergy, Greenhouse, Strawberry pollen
1.
Gautrin D, Newman-Taylor AJ, Nordman H, Malo JL: Controversies in epidemiology of occupational asthma. Eur Respir J 2003;22:551–559.
2.
de Jong NW, Vermeulen AM, Gerth van Wijk R, de Groot H: Occupational allergy caused by flowers. Allergy 1998;53:204–209.
3.
Groenewoud GC, de Jong NW, van Oorschot-van Nes AJ, Vermeulen AM, van Toorenenbergen AW, Mulder PG, Burdorf A, de Groot H, Gerth van Wijk R: Prevalence of occupational allergy to bell pepper pollen in greenhouses in the Netherlands. Clin Exp Allergy 2002;32:434–440.
4.
Groenewoud GC, de Graaf in ‘t Veld, vVan Oorschot-van Nes AJ, de Jong NW, Vermeulen AM, van Toorenenbergen AW, Burdorf A, de Groot H, Gerth vWijk R: Prevalence of sensitization to the predatory mite Amblyseius cucumeris as a new occupational allergen in horticulture. Allergy 2002;57:614–619.
5.
Kronqvist M, Johansson E, Kolmodin-Hedman B, Oman H, Svartengren M, Hage-Hamsten M: IgE-sensitization to predatory mites and respiratory symptoms in Swedish greenhouse workers. Allergy 2005;60:521–526.
6.
Hermanides HK, Lahey-de Boer AM, Zuidmeer L, Guikers C, van Ree R, Knulst AC: Brassica oleracea pollen, a new source of occupational allergens. Allergy 2006;61:498–502.
7.
de Jong NW, van der Steen JJ, Smeekens CC, Blacquiere T, Mulder PG, Gerth van Wijk R, de Groot H: Honeybee interference as a novel aid to reduce pollen exposure and nasal symptoms among greenhouse workers allergic to sweet bell pepper (Capsicum annuum) pollen. Int Arch Allergy Immunol 2006;141:390–395.
8.
van Hage-Hamsten M, Kolmodin-Hedman B, Johansson E: Phytoseilus persimilis and Amblyseius cucumeris, used for biological crop protection, cause sensitization among greenhouse workers. Allergy 2000;suppl:55–30.
9.
Moscato G, Vandenplas O, Gerth van Wijk R, Malo JL, Quirce S, Walusiak J, Castano R, de Groot H, Folletti I, Gautrin D, Yacoub MR, Perfetti L, Siracusa A: Occupational rhinitis. Allergy 2008;63:969–980.
10.
NVAB: ‘Management of workers with asthma or COPD.’ Authorized Practice Guideline (in Dutch). Hulshof, CTJ, NVAB (Netherlands Society of Occupational Medicine), 2003.
11.
Dreborg S: The skin prick test in the diagnosis of atopic allergy. J Am Acad Dermatol 1989;21:820–821.
12.
Norman PS, Rose NR, Friedman H: Skin testing; in Manual of Clinical Immunology. Washington, American Society for Microbiology, 1980, pp 789–793.
13.
de Jong NW, Hoorn E, de Groot H, Gerth van Wijk R: Estimation of HEIC-index of ICT and SPT reactions with a scanning program. Analyse 2003;9:261–265.
14.
Niemeijer NR, Fluks AF, de Monchy JG: Optimization of skin testing. II. Evaluation of concentration and cutoff values, as compared with RAST and clinical history, in a multicenter study. Allergy 1993;48:498–503.
15.
Dreborg S, Frew A: Allergen standardization and skin tests. Allergy position paper, European Academy of Allergology and Clinical Immunology, 1993;48(suppl):49–75.
16.
Watanabe N, Kamei S, Ohkubo A, Yamanaka M, Ohsawa S, Makino K, Tokuda K: Urinary protein as measured with a pyrogallol red-molybdate complex, manually and in a Hitachi 726 automated analyzer. Clin Chem 1986;32:1551–1554.
17.
van Toorenenbergen AW, Waanders J, Gerth van Wijk R, Vermeulen AM: Immunoblot analysis of IgE-binding antigens in paprika and tomato pollen. Int Arch Allergy Immunol 2000;122:246–250.
18.
de Graaf in ‘t Veld, Garrelds IM: Nasal Hyperreactivity and Inflammation in Perennial Allergic Rhinitis; thesis, Rotterdam 1995.
19.
Lebel B, Bousquet J, Morel A, Chanal I, Godard P, Michel FB: Correlation between symptoms and the threshold for release of mediators in nasal secretions during nasal challenge with grass-pollen grains. J Allergy Clin Immunol 1988;82:869–877.
20.
Monso E: Occupational asthma in greenhouse workers. Curr Opin Pulm Med 2004;10:147–150.
21.
Grattan CE, Harman RR: Contact urticaria to strawberry. Contact Dermatitis 1985;13:191–192.
22.
Weltfriend S, Kwangsukstith C, Maibach HI: Contact urticaria from cucumber pickle and strawberry. Contact Dermatitis 1995;32:173–174.
23.
Demir AU, Karakaya G, Kalyoncu AF: Allergy symptoms and IgE immune response to rose: an occupational and an environmental disease. Allergy 2002;57:936–939.
24.
Crespo JF, Rodriguez J, James JM, Daroca P, Reano M, Vives R: Reactivity to potential cross-reactive foods in fruit-allergic patients: implications for prescribing food avoidance. Allergy 2002;57:946–949.
25.
Moscato G, Malo JL, Bernstein D: Diagnosing occupational asthma: how, how much, how far? Eur Respir J 2003;21:879–885.
26.
Weisel CP, Weiss SH, Tasslimi A, Alimokhtari S, Belby K: Development of a Web-based questionnaire to collect exposure and symptom data in children and adolescents with asthma. Ann Allergy Asthma Immunol 2008;100:112–119.
27.
Nicolson PJ, Cullinan P, Newman Taylor AJ, Burge PS, Boyle C: Evidence-based guidelines for the prevention, identification and management of occupational asthma. Occup Environ Med 2005;62:290–299.
28.
Bousquet J, Vignola AM, Demoly P: Links between rhinitis and asthma. Allergy 2003;58:691–706.
29.
Malo JL, Lemière C, Gautrin D, Labrecque M: Occupational asthma. Curr Opin Pulm Med 2004;10:57–61.
30.
Petsonk EL: Work-related asthma and implications for the general public. Environ Health Perspect 2002;110(suppl):569–572.
31.
Musidlowska-Persson A, Alm R, Emanuelsson C: Cloning and sequencing of the Bet v 1-homologous allergen Fra a 1 in strawberry (Fragaria ananassa) shows the presence of an intron and little variability in amino acid sequence. Mol Immunol 2007;44:1245–1252.
32.
Zuidmeer L, Salentijn E, Rivas MF, Mancebo EG, Asero R, Matos CI, Pelgrom KT, Gilissen LJ, van Ree R: The role of profilin and lipid transfer protein in strawberry allergy in the Mediterranean area. Clin Exp Allergy 2006;36:666–675.
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2009
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