1.

INTRODUCTION
1.1 Background of the Study
Allergy is a hypersensitivity type I disorder. It is characterized by typical clinical
reactions such as hay fever, asthma, food allergies, eczema and urticaria against
usually harmless substances. These manifestations are mostly mediated by
Immunoglobulin E (IgE) antibodies, highly specific binding proteins produced by
plasma cells. By recognizing a certain pattern on the surface of their antigen, the
epitope, antibodies elicit various immune reactions against these molecules. (Pfiffner,
2010)
The allergic reaction antibodies of the IgE subclass are required for type I
hypersensitivity reactions (Kay, 2000). Symptoms occurring during an allergic
response, like swelling and itching, are a result of mast cell and basophil
degranulation. Mast cells and basophils carry Fc receptors on their surface which are
able to bind to the Fc portion of IgE antibodies. The cells release mediators such as
histamine and serotonine into the surrounding tissue (Metzger, 1991; Nadler et al.,
2000), which causes the symptoms typical for allergy.
Plants are one of the major sources of allergens which elicit allergenic response by
immunoglobulin E (IgE) mediated allergies. These allergens may diffuse into the
body from the upper respiratory tract or enter the body through intake of vast range of
plant food or may cause external skin irritations (Sinha et al., 2013).
The most widespread groups of plant allergens that are reported belong to the seed
storage proteins, structural proteins, and pathogenesis related (PR) proteins (Sinha et
al., 2013)
Pollen allergy is characterized by a TH2-biased immune response to pollen-derived
allergens. It is well established that allergen specific TH2 cells are the key
orchestrators of allergic reactions, initiating and propagating inflammation through
the release of a number of TH2 cytokines. While the importance of TH2 cells in allergy
is well accepted, little is known about the mechanisms that control the initial TH2
polarization in response to exogenous allergens. While for some aeroallergens,
foremost house dust mite Der p 1, several intrinsic TH2 adjuvant effects have been
reported, most major pollen allergens seem to lack such characteristics. (Gilles et al.,
2009)
1.2 Statement of the Problem (LIN)
Allergies are among the most common chronic conditions worldwide. Allergy
symptoms have become increasingly prevalent in the Philippine
population. (Agbayani, 2011) A percentage of these allergy symptoms are due to
pollen grains. Avoidance of the offending allergens may be possible if the allergen is a
specific food. However, it becomes harder when the allergens are in the air. (National
Institutes of Health, 2011)
Airborne pollen is one of the most common allergen responsible for triggering allergic
disease. (Kiotseridis et al., 2013) Pollen grains have been reported to be present in the

Philippine atmosphere but studies regarding their allergenicity are limited. (Cabauatan
et al., 2012)
Pollen allergy, if not treated, can lead to more serious complications, including rhinitis
and asthma. Different equipment including air purifiers, and filters provide relief from
pollen allergy but none is 100 percent effective. Non-prescription and prescription
medications are also known to provide temporary relief to some. Immunotherapy or
allergy shots are also available for patients who do not find relief with antihistamines
or nasal steroids. However, current immunotherapy treatments are limited because of
potential side effects. (National Institutes of Health, 2011)
Hence, studies regarding the allergenicity of various allergen sources are important in
order to expand the different methods in treating allergic diseases.
1.3 Objectives of the Study (ARA)
1. 4 Significance of the Study (ARA)
According to Prof. Benigno Agbayani Sr. (2001), 21% in children, 26% in teenagers
and 36-47% in adults have allergy symptoms. Approximately 10% of Filipinos suffer
from allergic diseases. Philippines is considered to be the allergic rhinitis and allergic
asthma capital of Asia.
1.5 Scope and Limitations (LIN)
1.6 Hypothesis

2. RELATED LITERATURES
2.1 Allergy (ALLANA)
2.2 Pollen Allergy
Pollinosis, also known as seasonal allergic rhinitis, pollen allergy or hay fever, is the
result of sensitization to pollen components. The pollen allergens produce clinical
symptoms after contact with the airway mucosa and the conjunctiva of previously
sensitized individuals. Plants of the Poaceae family are the main source of grass
pollen allergens, due to their worldwide distribution and their significant pollenproducing capability (Taketomi et al, 2006)
An important feature of pollinosis is annual periodicity, with symptoms usually
occurring at the same time of the year, during pollination (Vieira, 2003).
Repetition of the classical symptoms of rhinoconjunctivitis associated or not with
bronchial asthma in two or more pollen seasons strongly suggests pollinosis. The use

of a mixed extract containing pollen from different grass species has been
recommended, as there may be cross-reactivity between grasses (Weber, 2003).
In a dry atmosphere pollen may remain stable for centuries. Anemophilous pollen (in
which wind-mediated pollination takes place) has allergenic importance. In general, a
pollen grain may be transported for 175 kilometers at a velocity of 10 meters/second
and will sediment in still air at an approximate average velocity of 3.1 cm/second
(
Stanley & Linskens, 1974).
Pollen allergens are water-soluble proteins or glycoproteins, which make them readily
available biologically, being capable of evoking an IgE antibody-mediated allergic
reaction in seconds. Allergenic particles are expelled from the cytoplasm by at least
two suggested mechanisms. In the first mechanism, allergens rapidly diffuse when the
pollen grain is in direct contact with the mucosa in an isotonic medium, leading to
immediate allergic symptoms on the accessible mucosa surfaces such as the
conjunctiva and the nose. In the second mechanism a hypotonic medium (such as rain
water) allows rapid hydration of the pollen grain which expels allergen-containing
inhalable materials that, due to their reduced size, reach lower airways and induce
asthma (Suphioglu, 1998). Thus, allergen release from pollen grains is a prerequisite
for its effect in sensitized individuals.
Grass pollen grains have diameters between 20 to 55mm, and are unlikely to reach
lower airways to cause allergy. Grass pollen allergens have been found in association
with smaller particles. These particles are small enough to reach the lower airways
and therefore may cause allergic reactions in the distal portions of the lung. (Taketomi
et al, 2006)
Pollen grains release allergens in conditions other than high humidity or hydration.
Behrendt et al. (2001) showed that pollen grains may secrete significant amounts of
eicosanoid-like substances (substances that cross-react with leukotriene B4 and
prostaglandin E2) depending on the pH, time and temperature. The pollen grain,
therefore, could itself activate the airway mucosa epithelium by the secretion of proinflammatory mediators (Behrendt et al. 2001).
When hydrated, pollen grains may also release a variety of enzymes, including
proteases. These proteases are biologically important as they may cause epithelial
damage, and are not inactivated by endogenous protease inhibitors (Hassim,
Maronese, & Kumar, 1998). Protease release may generally cause rupture of epithelial
junctions, facilitating protein transport, which in turn may sensitize individuals,
resulting in increased allergen access to antigen-presenting subepithelial dendritic
cells (Robinson, 1997).
2.3 Cannabis Allergy
As expected with most plant aeroallergens, Cannabis pollen inhalation has been noted
to cause symptoms of allergic rhinitis, conjunctivitis, and asthma. Cannabis pollen or
smoke exposure has resulted in nasal congestion, rhinitis, sneezing, conjunctival
injection, pharyngeal pruritus, coughing, wheezing, and dyspnea (Ocampo & Rans,
2014) A case of erythema multiforme-like recurrent drug eruption thought to be
associated with Cannabis use also has been described (Ozyurt et al., 2014)

Positive Cannabis pollen skin prick test reactionswere seen in 8.3% of 48 Indian
patients with allergic rhinitis or bronchial asthma (Prasad et al. 2009). Of those with a
positive skin test reaction, none had a reaction larger than 50% of the positive
histamine control wheal. In addition, a specific correlation between clinical allergic
symptoms and Cannabis exposure or other aeroallergen sensitizations was not
addressed. In Islamabad, Pakistan, 22% of 1,000 patients demonstrated a positive skin
test reaction to C sativa pollen defined by a wheal larger than 2 mm (Abbas et al.,
2012).
In the American Southwest, Freeman (1983) studied 129 unselected patients
presenting to an allergy clinic. In an area where Cannabis pollen was noted to be a
minor aeroallergen, 70% of these patients found to be atopic demonstrated Cannabis
sensitization by pollen skin prick or intradermal testing. However, all patients also
demonstrated other aeroallergen sensitivities and no data were collected regarding
marijuana use or specific Cannabis pollen exposures, making it challenging to clarify
a specific mode of sensitization or clinical relevance.
2.4 Pinaceae Allergy (LIN)
2.5 Rubiaceae Allergy
Karr et al. (1978) examined symptomatic coffee workers with skin prick and
serological tests based on green coffee extracts and found exclusively positive results.
Later on, type I allergies to green coffee beans were diagnosed by skin prick tests and
coffee dust provocation (Manavski, 2012). Since then, an increasing number of workrelated airway disorders have been reported in coffee workers. The prevalence of eye
and/or airway symptoms in coffee workers is stated between 13 and >50% (Thomas,
1991). Therefore, a relevant number of affected people have to be assumed in terms of
worldwide coffee processing of 7 million tons per year.
In a study of occupational asthma caused by roasted coffee, immunologic evidence
has been suggested that roasted coffee contains the same antigens as green coffee, but
at a lower concentration. Although nine to 10 protein bands of 15 to 60 kDa were
identified for the green coffee bean extract, only one band of approximately 43 kDa
was present in the roasted coffee bean extract, and was shown to be a major band in
the green coffee bean extract as well (Lemiere, 1996).
A 50-year-old female developed rhinitis and conjunctivitis following exposure to a
Coffee plant used for indoor decoration. A skin-specific IgE test, serum-specific IgE
and rhinoconjunctival provocation test to Coffee leaf allergen extract were all
positive. The commercially available serum-specific IgE test for Green Coffee beans
was said to be appropriate for diagnosing allergy to the potted Coffee plant (Axelsson,
1994).
A 39-year-old woman who had been working in a coffee bar for 12 years reported
chronic hand dermatitis: erythema, scaling and fissuring on the palms, fingertips and
lateral aspects of the 1st, 2nd and 3rd fingers of both hands. When she prepared
espresso coffee her symptoms worsened, following each contact with roasted coffee
powder and coffee drink. Patch tests with roasted coffee powder and coffee drink

were both positive. Prick tests with coffee extract showed weak positivity. Scratch
tests with roasted coffee powder were negative, as were open patch tests on
previously-affected hand skin (Piraccini, 1990)
2.6 Cottonwood Allergy (ARA)