Correspondence

Airway Disease and Thaumatin-like Protein in an Olive-Oil Mill Worker

N Engl J Med 2008; 358:1306-1308March 20, 2008

Article

To the Editor:

The olive fruit is frequently consumed as food and used as raw material to obtain olive oil. Olive oil is pressed in mills, where workers are exposed daily to inhalation of particles derived from this processing. Despite widespread consumption, allergies to olive fruit and derivative products have seldom been documented.1-4

We report on a 41-year-old man who had been working since 1993 in an olive-oil mill. He was first seen in 2006, when the olive-oil mill was operating in Jaén, Spain; he had a 2-year history of episodic rhinitis, shortness of breath, chest tightness, and wheezing. Symptoms occurred within 30 minutes after he arrived at the workplace and partially improved immediately after he left it. He controlled the symptoms by using salbutamol as needed and formoterol–budesonide twice a day on a regular basis. Baseline spirometric measurements showed a forced expiratory volume in 1 second (FEV₁) of 3.74 liters (87% of the predicted value), with a ratio of FEV₁ to forced vital capacity of 76%. Methacholine challenge showed a 20% decrease in FEV₁ at 1.2 mg per milliliter. The peak expiratory flow (PEF) varied, depending on workplace exposure (Figure 1AFigure 1Peak Expiratory Flow in the Patient and Immunoblotting Results with Olive-Fruit Protein Extract and Purified Protein.). The patient had a diurnal variation in PEF rates that was greater than 20% on 11 working days, whereas no significant changes were observed on days away from the workplace.

Olive pulp from the mill was lyophilized, powdered, and extracted with ether–ethanol (3:1 ratio). The pellet was extracted with phosphate-buffered saline (pH 7.0). The supernatant obtained by centrifugation was dialyzed against 0.05 M ammonium bicarbonate (pH 8.0), lyophilized, and stored at −20°C. All the steps were performed at 4°C. A skin-prick test with this extract at 6 mg per milliliter was positive in the patient (wheal area, 50 mm²) and was negative in control subjects.

We investigated sensitization to olive-fruit allergens as possible causative agents. Immunoblotting with the patient's serum revealed a reactive 23-kD band in olive-fruit protein extract (Figure 1B) that was purified by size-exclusion chromatography and reverse-phase high-performance liquid chromatography. The purified protein was IgE-reactive (Figure 1C), and Edman degradation gave the amino acid sequence ATFXIVNQXTYTVXAAASP, which showed homology to allergenic thaumatin-like proteins (TLPs) from plant foods and pollen.5

A skin-prick test with purified TLP at 1 μg per milliliter was positive in the patient (wheal area, 9 mm²) and was negative in control subjects. We performed a nasal challenge test in the patient by measuring nasal resistance with active anterior rhinomanometry, using TLP (0.1 μg per milliliter); the result was positive, with nasal obstruction, sneezing, and runny nose. A nasal challenge test with TLP (100 μg per milliliter) was negative in four healthy subjects and three patients who were allergic to olive pollen.

Our findings indicate that occupational asthma can be caused by a thaumatin-like protein from olive fruit.

Oscar Palomares, Ph.D.
Universidad Complutense de Madrid, 28040 Madrid, Spain

Manuel Alcántara, M.D.
Joaquín Quiralte, M.D.
Complejo Hospitalario de Jaén, 23007 Jaén, Spain

Mayte Villalba, Ph.D.
Universidad Complutense de Madrid, 28040 Madrid, Spain

Francisco Garzón, M.D.
Complejo Hospitalario de Jaén, 23007 Jaén, Spain

Rosalía Rodríguez, Ph.D.
Universidad Complutense de Madrid, 28040 Madrid, Spain
rrg@bbm1.ucm.es

Supported by grants from Ministerio de Educación y Ciencia (SAF2005-01847) and Ministerio de Sanidad (FIS 01/1234) of Spain.

Drs. Rodríguez, Villalba, and Palomares report receiving grant support from ALK-Abelló. Drs. Rodríguez and Villalba report receiving speaking fees from ALK-Abelló, and Dr. Quiralte from AstraZeneca. No other potential conflict of interest relevant to this letter was reported.

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Citing Articles (8)

Citing Articles

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   C. Esteve, C. Montealegre, C.M.L. Marina, M.C. García. (2012) Analysis of olive allergens. Talanta
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   Clara Esteve, Benito Cañas, Estefanía Moreno-Gordaliza, Carmen Del Río, María Concepción García, María Luisa Marina. (2011) Identification of Olive (Olea europaea) Pulp Proteins by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry and Nano-Liquid Chromatography Tandem Mass Spectrometry. Journal of Agricultural and Food Chemistry 59:22, 12093-12101
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3. 3

   Santiago Quirce, Jonathan A. Bernstein. (2011) Old and New Causes of Occupational Asthma. Immunology and Allergy Clinics of North America 31:4, 677-698
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4. 4

   M.G. Alvarez-Eire, F. Pineda de la Losa, S. Varela Losada, C. González de la Cuesta, R. Ricardo Palacios. (2011) Anaphylaxis to olive fruit due to lipoprotein sensitization. Allergologia et Immunopathologia
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   F. Pineda, R. Palacios, R. Vilella, M. Pascal, J. Bartra. (2011) Anaphylactic reactions caused by oil body fraction lipoproteins. Allergy 66:5, 701-702
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   Andrea Vereda, Sofía Sirvent, Mayte Villalba, Rosalía Rodríguez, Javier Cuesta-Herranz, Oscar Palomares. (2011) Improvement of mustard (Sinapis alba) allergy diagnosis and management by linking clinical features and component-resolved approaches. Journal of Allergy and Clinical Immunology 127:5, 1304-1307
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   André Cartier. (2010) The Role of Inhalant Food Allergens in Occupational Asthma. Current Allergy and Asthma Reports 10:5, 349-356
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   A. Palacín, L. Tordesillas, P. Gamboa, R. Sanchez-Monge, J. Cuesta-Herranz, M. L. Sanz, D. Barber, G. Salcedo, A. Díaz-Perales. (2010) Characterization of peach thaumatin-like proteins and their identification as major peach allergens. Clinical & Experimental Allergy 40:9, 1422-1430
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