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Cypress Pollinosis: from Tree to Clinic

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Abstract

Cypress (Cupressus sp.pl) is a genus within the Cupressaceae family. This family covers all of the Earth’s continents except for Antarctica, and it includes about 160 species. The most important taxa for allergic diseases belong to five different genera: Cupressus, Hesperocyparis, Juniperus, Cryptomeria, and Chamaecyparis. Cupressaceae species share a common pollen type that can even include the genus Taxus (Taxaceae) when this plant is also present. As Juniperus oxycedrus pollinates in October, Cupressus sempervirens in January and February, Hesperocyparis arizonica (prev. Cupressus arizonica) in February and March, and Juniperus communis in April, the symptomatic period is long-lasting. Due to global warming, the pollination period tends to last longer, and there is a trend for Cupressaceae bioclimate niches to migrate north. In Mediterranean areas, C. sempervirens (Italian cypress or Mediterranean cypress) is by far the most common pollinating species. It accounts for half of the total pollination level. The group 1 major allergens belong to the pectate-lyase family, and members share 70 to 97% sequence homology within the different Cupressaceae. Group 2 allergens correspond to the polygalacturonase protein family, while group 3, a minor allergen, belongs to the family of “thaumatin-like proteins,” a pathogenesis-related protein 5. Group 4 allergens are Ca++-binding protein (4 EF-hands). Aside from these four groups, about 15 other allergens have been reported. Prominent among these is a basic low-molecular mass cross-reactive allergen that was identified recently, and which is suspected to be involved in pollen food syndromes which are common with peach and citrus. The prevalence of cypress allergy in the general population ranges from 0.6 to 3%, depending on the degree of exposure to the pollen. Depending on the geographic area and the studied population, 9 to 65% of outpatients consulting an allergist may have sensitization to cypress pollen. Repeated cross-sectional studies performed at different time intervals have demonstrated a threefold increase in the percentage of cypress allergy around the Mediterranean area. Risk factors include a genetic predisposition and/or a strong exposure to pollen, and the natural history of cypress allergy allows identification of a subgroup of patients as allergic rather than atopic. Concerning the clinical expression, rhinitis is the most prevalent symptom, while conjunctivitis is the most disabling. Pharmacological treatment of cypress allergies is not different from that of other seasonal allergies. Immunotherapy has been used, initially by subcutaneous injections, but currently mostly through the sublingual route. Although clinical trials have included only a limited number of patients, it has proven effective and safe. Avoidance can be implemented at the individual level, as well as at the community level, through the use of alternative plants, low-pollinating cypresses, or by trimming hedges before pollination.

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Abbreviations

MM:

molecular mass

pI:

isoelectric point

SDS-PAGE:

sodium dodecyl sulfate polyacrylamide gel electrophoresis

IUIS:

International Union of Immunological Societies

LTP:

lipid transfer protein

PG:

polygalacturonase

BP14:

basic protein 14 kDa

TLP:

thaumatin-like proteins

PR:

pathogenesis-related proteins

IFR:

isoflavone reductase

CBP:

calcium-binding proteins

GRP:

gibberellin-regulated protein

CPLL:

combinatorial peptide ligand library

PBS:

phosphate buffer saline

HSP:

heat shock protein

PFS:

pollen food syndrome

API:

annual pollen index

P/m3 :

pollen grains per cubic meter of air

SEM:

scanning electron microscopy

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Acknowledgements

The authors wish to thank Dr. M. Thibaudon, National Network Monitoring Aerobiological, RNSA, Brussieu, (France), Dr. D. Vokou and Dr. A. Damialis. Dept. Ecology, School of Biology, and Dept. of Pulmonary Medicine, Faculty of Medicine, Aristotle University of Thessaloniki, (Greece), Dr. J. Subiza, Clínica Dr. Subiza, Madrid, (Spain), Dr. M. Msalle and S. Hadj Hamda, Laboratory of Palynology at the Olive Tree, Institute of Tunis, National Institute for the Agronomy, (Tunisia), Dr. N. M. Pinar, Ankara University, and Dr. Talip Çeter, Dr. Yavuz Türkmen, Kastamonu University (Turkey) who kindly contributed the aerobiological data used in this study.

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Authors and Affiliations

  1. Department of Pneumonology and Allergy, APHM and Inserm U1067 CNRS UMR 7333, Aix-Marseille University, Marseille, France

    Denis Charpin & Pascal Chanez

  2. UR 629 Ecology of Mediterranean Forests Unit, I.N.R.A, Avignon, France

    Christian Pichot

  3. Institute of Environmental Science and Technology, Universitat Autònoma de Barcelona, Barcelona, Spain

    Jordina Belmonte

  4. Department of Animal Biology, Plant Biology and Ecology, Universitat Autònoma de Barcelona, Barcelona, Spain

    Jordina Belmonte

  5. Armand Trousseau Children Hospital, AP-HP, Biochemistry Department, Allergy and Environment Research team, Paris, France

    Jean-Pierre Sutra, Hélène Sénéchal & Pascal Poncet

  6. University of Chemistry and Technology, Prague, Czech Republic

    Jarmila Zidkova

  7. Agricultural Research, Education and Extension Organisation (AREEO), Razi Vaccine and Serum Research Institute, Karaj, Iran

    Youcef Shahali

  8. CITECH Department, Pasteur Institute, 25-28 rue du Dr Roux, 75015, Paris, France

    Pascal Poncet

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  1. Denis Charpin
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  8. Hélène Sénéchal
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  9. Pascal Poncet
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Correspondence to Pascal Poncet.

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Funding

A part of the work on aerobiology was funded by the ICTA “Unit of Excellence” (MinECo, MDM2015-0552).

A part of the work on allergen identification was supported by the program Hubert Curien-Barrande 2015–2016 (France and Czech Republic scientific exchanges).

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

Human sera used for immunochemical studies (Allergens section) correspond to residues from biological analysis for diagnosis.

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Charpin, D., Pichot, C., Belmonte, J. et al. Cypress Pollinosis: from Tree to Clinic. Clinic Rev Allerg Immunol 56, 174–195 (2019). https://doi.org/10.1007/s12016-017-8602-y

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