+
For Patients & Caregivers
For Lab Professionals
Welcome! Click here for Patient or Laboratory Professional content
Are you a healthcare professional?

The information in this website is intended only for healthcare professionals. By entering this site, you are confirming that you are a healthcare professional.

Are you a laboratory professional?

The information in this website is intended only for laboratory professionals. By entering this site, you are confirming that you are a laboratory professional.

f25 Tomato

Code f25
LOINC 6266-1
Family Solanaceae
Genus Lycopersicon
Species Lycopersicon esculentum
Route of Exposure Ingestion and indirect contact with traces of tomato
Latin Name Lycopersicon esculatum
Other Names Garden Tomato, Love Apple
Categories Fruits, Food Of Plant Origin

Summary

Tomatoes are one of the most popularly consumed fruits in the world and are used for a variety of purposes. Wild variety of tomatoes are grown in a variety of geographical regions.  They are consumed in both raw and processed forms for their richness in various nutrients. However, tomatoes are very well-known to elicit allergic reactions in sensitized individuals. Tomato allergies are often seen associated with grass pollinosis or other food or related allergies. Major clinical manifestations of tomato allergies include Oral Allergy Syndrome (OAS), urticaria, dermatitis, systemic reactions, rhinitis, abdominal pain, and anaphylaxis. Identification and characterization of tomato allergens have been studied and consist of a variety of pan-allergens like lipid transfer proteins, 1-3 β-glucanases, profilins, etc. Allergens from tomatoes show an extensive cross-reactivity to birch pollen, grass pollens, bell peppers, cherry, pineapple, banana, nuts, rubber latex, apple, celery, yellow mustard, Japanese cedar pollen, peach, and members of the Rosaceae family. Tomato sensitive individuals are advised to avoid consumption or coming in contact with tomatoes to prevent an allergic reaction.

Allergen

Nature

Tomatoes are one of the most popularly consumed fruits around the globe for its health benefits (1), which are consumed as both fresh and processed (2). Tomatoes are grown in over 150 countries globally (3). Tomatoes are rich in antioxidants like lycopene, and other micronutrients (1, 4). Wild tomatoes are herbaceous, annual plants (5). Tomatoes are considered as one of the major allergy-inducing foods (6).

Habitat

Wild tomatoes typically grow in various habitats in South America, from sea level to 3300 m elevation, arid coastal lowlands of the Pacific, lower valleys, and uplands in the high Andes. Tomatoes have adapted to various ecological and soil conditions. These adaptations have contributed to the cultivation of tomatoes at different geographical locations, resulting in varieties of tomatoes (5).

Taxonomy

Taxonomic tree of Tomato (7)  
Domain Eukaryota
Kingdom Viridiplantae
Phylum Streptophyta
Class Magnoliopsida
Order  Solanales
Family Solanaceae
Genus Solanum
Subgenus Lycopersicon
Species Lycopersicon esculentum 


Tissue

Tomato fruits vary in size, color, and pubescence. Cultivated varieties usually have bilocular to multilocular fruits (5).

Epidemiology

Worldwide distribution

Tomatoes are one of the common causes of food allergy, ranging from 1.5% to 20% in the population with foodborne allergies (4). Tomato allergies have been reported in almost 1.5% of the entire population in Northern Europe, 16% in Italy and 5.6% in Germany (1, 8). Roughly about 3% tomato allergy is self-reported globally (9).

In a study, 39.2% of individuals with grass pollinosis were also allergic to tomatoes (1, 10). Similarly, 2.2- 4.3% of latex-sensitive individuals show an allergic reaction to tomatoes (1). In an epidemiological study of tomato allergy in Italy as high as 16% of people with pollen-food allergy syndrome are sensitive to allergens in tomato (11). Countries with high tomato consumption hold tomatoes as responsible for 20% of all Oral Allergy Syndromes (OAS) (3).

Food hypersensitivity was studied within students at the Finnish University. The subjects were grouped into 4 categories: with current atopic dermatitis (AD) and with and without allergic rhino-conjunctivitis (ARC) or asthma, history of AD with and without ARC or asthma, currently having ARC or asthma and without any clinically confirmed allergy. Hypersensitivity was found in 60% of the 286 students, more in women than in men and tomato accounted for 28% of these food hypersensitivities (12).

In another region-specific extensive study from 17 different clinics across 15 different countries in Europe, food hypersensitivity parameters were studied concerning 86 different types of food, tomato was the 8th most popular food for eliciting adverse allergic symptoms in sensitive individuals in Russia, Lithuania and Estonia (13). The allergenic potential of tomatoes is more dependent on cultivar and development stages than on the cultivation conditions (8).

Risk factors

Clinical allergy to tomatoes is more prevalently seen in association with other airborne or food allergies (11). The most common clinical manifestations in tomato allergy are observed as urticaria, oral allergy syndrome (OAS), dermatitis, rhinitis, abdominal pain, exercise-induced anaphylaxis. Severe allergic symptoms to tomatoes have been rarely reported (6).

Pediatric issues

Sensitization to tomato in children from a study conducted on an Italian population monosensitized to inhalant allergens ranged from 1.7% to 39%. Sensitization to tomato was reported more in children with grass pollinosis than in cases of allergy to mites (6). Sensitization to tomato is frequently reported in the pediatric and adolescent populations in Mediterranean countries (14). A 6-month-old female child with a family history of urticaria and rhino-conjunctivitis developed urticaria due to tomatoes (15). In a study involving 817 children with atopic dermatitis, (aged between 12-24 months), 24.6% of these cases showed acute urticaria by food ingestion or by contact with a range of foods. This included tomato as one of the foods, causing the allergy (16).

Environmental Characteristics

Worldwide distribution

Tomatoes are the fourth popularly consumed vegetables globally (5). Tomatoes are native from Central and South America and grow in Andes, Peru, Chile and Galapagos (4, 5). Wild cherry tomato, the ancestor of cultivated tomatoes, is distributed more extensively in Mexico, Bolivia, Columbia, and other regions of South America. Owing to accidental introduction or naturalization, they grow more rapidly in tropical and subtropical regions worldwide (5).

At present, tomato is cultivated in more than 150 countries. China is the main producer of tomatoes accounting for 21.8% of total tomato production followed by the USA. In the US, California and Florida are the major players in the market for tomatoes (5). Mexico, till dates, harbors the most varieties of cultivated tomatoes (3). North Europe, Canada, and New Zealand produce tomatoes under greenhouse conditions. Greece and Libya have the highest preference for tomatoes in their diet (5).

 

Route of Exposure

Main

The onset of allergic reactions takes place upon direct consumption of tomatoes including skin symptoms, OAS, rhinitis, or abdominal pain (8).

Secondary

Consumption of even minor quantities of tomatoes from tomato-containing products can elicit an allergic reaction (2).

Detection

Oral Allergy Syndrome

The most common clinical response to tomato allergies is seen as an Oral Allergy Syndrome (OAS), in which symptoms are seen locally at the oral mucosa (1). In Italy, a study showed that 20.6% of 262 patients with OAS showed symptoms with tomatoes (17, 18). According to studies published in the literature, OAS was most frequently reported to be the major clinical manifestation of tomato allergy in the young population with allergic pollinosis (14).

Allergic rhinitis and rhino-conjunctivitis

From a study of 113 tomato SPT-positive individuals, 18 patients reported clinical symptoms, and all showed sensitization to Artemisia and Platanus pollens. 83.3% of these 18 pollen-associated food allergic patients showed rhinitis, asthma, and/or rhino-conjunctivitis. The same study also showed that more subjects were sensitized to peel extracts (110 patients) than pulp extracts (47 patients). Individuals sensitized to both pulp and peel reported mild asthma-like symptoms than those sensitive to only peel (6). 9% of birch pollen-allergic patients showed adverse reactions to tomatoes (19). In another study based out of six allergy centers along the Mediterranean coast in Spain, out of 1734 subjects reporting for respiratory or cutaneous symptoms, 6.5% showed sensitization to tomato. 97.4% of these sensitized individuals were also sensitive to inhalant allergens diagnosed to have rhinitis, conjunctivitis or both, and other skin and lower respiratory illnesses (6).

Other diseases

Urticaria and dermatitis

Allergic reactions to tomatoes can cause skin symptoms like urticaria and dermatitis (8). Two patients were presented with urticaria every time they consumed tomatoes, which was seen to fade away once tomatoes were removed from their diet (20). Urticaria was reported as the major symptom of tomato allergy in a female-dominated study of adolescent population with allergic pollinosis and latex-allergy (14). Pollen associated food allergies have been reported to cause urticaria (21).

A case study of 39 -year-old women showed sensitization to both latex and uncooked tomatoes and potatoes that caused fingertip-dermatitis. Dermatitis aggravated upon eating only uncooked tomatoes. Along with dermatitis, she also complained of facial erythema and oral tingling (22). 29.41 % of 119 pediatric patients with atopic dermatitis showed sensitization to tomatoes (23).

Systemic reactions

Allergy to tomatoes has also known to cause systemic reactions which can cause severe effects. Some cases of allergy-induced anaphylaxis have also been reported (1, 24). Reaction to lipid transfer protein (LTP) allergens in tomato caused more severe symptoms like angioedema, dyspnea and urticaria in 15% of 40 tomato-allergic patients in Italy. These individuals also exhibited symptoms with tomato-derived products (25). Pollen associated food allergies have reported symptoms of anaphylaxis (21). Among 54 patients in a study, 48 reported at least one episode of food-dependent exercise-induced anaphylaxis and tomatoes were one of the major suspected foods (26). Eight patients between 12-27 years suffered from anaphylaxis after eating uncooked or raw tomatoes. Severe episodes of anaphylaxis were marked by larger wheal diameters during skin tests of these patients (24).

Other topic

Tomatoes contain a high level of nickel which is found to be responsible for abdominal pain, meteorism and dyspepsia in highly allergic patients. A 12-year girl was reported with these symptoms along with nausea and general malaise after consuming tomatoes (27). Patients with known Eosinophilic Esophagitis were tested for food-induced allergies and tomatoes were identified as one of the sources for allergy (28).

Prevention and Therapy

Allergen immunotherapy

Pollen allergen-specific subcutaneous immunotherapy (SCIT) effectively reduced the basophil activation from tomato and Japanese cedar pollen in patients with Japanese cedar pollen-tomato allergy, indicating that the therapy might be beneficial in alleviating the pollen-food allergy syndrome (PFAS). The suppression was seen over a period of 1 year in this study. A similar reduction in basophil activation has been reported in food-specific immunotherapy as well (29).

Prevention strategies

Avoidance
Tomatoes, even in small amounts, can elicit allergic reactions and thus, individuals sensitive to tomatoes are advised to avoid consumption of the fruit. This is the reason why food items containing tomatoes are asked for proper labeling in South Korea (2). However, the majority of allergic individuals can tolerate processed or cooked forms of tomatoes (30).

Molecular Aspects

Allergenic molecules

Allergens in tomatoes have been identified and characterized much recently. To-date, 26 proteins, including isoforms, from tomatoes have been reported to be potential allergens (8). The allergens listed in the WHO/IUIS database include (1). All allergens, except Sola 15, have been classified as food allergens.

Allergen

Biochemical name

Molecular weight (kDa)

Sola 11

Profilin, named previously as Lyc e 1

16 

Sola l  2

β-fructofuranoside, previously named as Lyc e 2

50

Sola 1 3

nsLTP 1, lipid transfer protein, previously named as Lyc e 3

9

Sola 1 4

Bet v 1- related protein, previously named as Lyc e 4

-

Sola l 5

Cyclophilin

19

Sola 1 6

Non-specific lipid transfer protein 2 (nsLTP 2)

7

Sola 17

nsLTP 1

12.5

Sola 1

Chitinase

31

Sola 1

Glucanase

55

Sola 1

Peroxidase

45

Sola 1

Globulin 11S

30

Sola 1

PG-Polygalactouranse

36

Sola 1 PME

Pectinesterase

36

Sola 1 TLP

Thaumatin-like protein

27

Sola 1 vicilin

7S vicilin

65

Sola 1 ARP60S

Ribosomal protein P2

-

Sola 1

SOD: superoxide dismutase

15.3

 

Sola 1 1 is a minor allergen and was present in 22% of patients allergic to tomatoes and accounts for the major IgE reactivity (42%) from tomato fruit extracts (31, 32). Sola 12 was present in 17% of tomato-allergic individuals (31). In another study, from 32 patients who showed adverse reactions to tomatoes, 44% showed IgE to tomato profilin and two patients showed sensitization to lipid transfer proteins (LTP) in tomatoes (19). LTPs are extremely resistant to heat and digestion while Sola 1 4 and Sola 1 1 are heat-labile and prone to degradation by digestion enzymes (1). LTP is the main allergen in Mediterranean countries involved in plant food allergies (9).

Cross-reactivity

Profilins are highly conserved across various plant species and this is the reason for extensive cross-reactivity between profilin allergens from different plant sources. A high cross-reactivity is seen between profilins from bell peppers and tomato fruit, showing 91% identity at the protein level (33). Sola 1 1 also shows high sequence similarity to other plant profilins like Pru av 4 from cherry, Ana c 1 from pineapple, Mus xp1 from banana, Dau c4 from carrot and Bet v 2 of birch (31).

Lec2SA, a postulated allergen from tomato shows high cross-reactivity with major allergens from Brazil nut and yellow mustard (34).

Tomato fruit cross-reacts with grass pollens and Japanese cedar pollen and the cross-reactivity is attributed structurally to profilins and N-glycans in these allergens. Cry j 2 from Japanese cedar show a 40% identity with polygalacturonase from tomatoes (35). Inhibition studies with tomato extract and extracts from birch pollen, mugwort pollen, apple and celery showed marked inhibition thereby implying extensive cross-reactivity among these plant species (18).

Various binding and inhibition studies with both natural and recombinant extract of LTPs from the family Rosaceae showed cross-reactivity with tomatoes (36). In another study, 75% of 298 patients with walnut allergy showed reactivity against tomato (37). 20% of patients with IgE to LTPs from peach showed skin reactivity to tomatoes (38).

Allergy to natural rubber latex is associated with various food-borne allergies, 40% which is attributed to tomatoes and chestnut (39). The cross-reactive component was identified to be Class I chitinases in latex-fruit associated allergies including tomato (40). In addition to this, another study found that the component responsible for cross-reactivity of tomatoes with potato and latex is a 44- 46 kDa storage protein patatin (14).

Compiled By

Author: Turacoz Healthcare Solutions

Reviewer: Dr. Fabio Iachetti

 

Last reviewed: November 2020

References
  1. Słowianek. Allergenic Potential of Tomatoes Cultivated in Organic and Conventional Systems. Plant Foods for Human Nutrition, 71(1): 35–41. 2016.
  2. Kiyota. Detection of the tomato allergen Sola L 1 and evaluation of its reactivity after heat and papain treatment. Food and Agricultural Immunology  2017; 28(6); 1450-1459 2017.
  3. OECD. Consensus document on compositional considerations for new varieties of tomato: key food and feed nutrients, toxicants and allergens. 2008. Available from: https://www.oecd.org/env/ehs/biotrack/46815296.pdf.
  4. Quynh Le L. LY. Design of tomato fruits with reduced allergenicity by dsRNAi-mediated inhibition of ns-LTP (Lyc e 3) expression. Plant Biotechnology Journal  2006; 4: 231-242. 2006.
  5. Peralta. History, origin and early cultivation of tomato (Solanaceae). Genetic Improvement of Solanaceous crops  2006;2. 2006.
  6. Larramendi. Sensitization to tomato peel and pulp extracts in the Mediterranean coast of Spain: prevalence and co-sensitization with aeroallergens. Clinical and Experimental Allergy  2007; 38: 169-177. 2007.
  7. NCBI. txid4081. National Centre of Biotechnology Information. 2020.
  8. Kurze. Effect of tomato variety, cultivation, climate and processing on Sola l 4, an allergen from Solanum lycopersicum. PLoS ONE 2018; 13(6): 1-18 2018.
  9. Mascheri. Hypersensitivity to tomato (Lycopersicon esculentum) in peach-allergic patients: rPru p 3 and rPru p 1 are predictive of symptom severity. Investig Allergol Clin Immunol 2015; 25(3): 183-189. 2015.
  10. de Martino M NE. Sensitivity to tomato and peanut allergens in children monosensitized to grass pollen. . Allergy 1988 Apr;43(3):206-13 doi: 101111/j1398-99951988tb00420x PMID: 3377144. 1988.
  11. Asero. Tomato allergy: clinical features and usefulness of current routinely available diagnostic methods. J Investig Allergol Clin Immunol 2013; 23(1): 37-42. 2013.
  12. Mattila. Food hypersensitivity among Finnish University students: association with atopic diseases. . Clin Exp Allergy  2003; 33: 600-606. 2003.
  13. Eriksson. Self-reported hypersensitivity in Sweden, Denmark, Estonia, Lithuania and Russia. J Invest Allergol Clin Immunol 2004; 14(1): 70-79. 2004.
  14. Reche. Tomato allergy in children and young adults: cross-reactivity with latex and potato. Allergy  2001; 56: 1197-1201. 2001.
  15. Tan. Severe food allergies by skin contact. Ann Allergy Asthma Immunol, 2001; 86: 583-586. 2001.
  16. Simons. Prevention of acute urticaria in young children with atopic dermatitis. J Allergy Clin Immunol 2001;107(4):703-6. 2001.
  17. Ortolani. The oral allergy syndrome. . Ann Allergy 1988 Dec;61(6 Pt 2):47-52 PMID: 3264668. 1988.
  18. Petersen. Ubiquitous structures responsible for IgE cross- reactivity between tomato fruit and grass pollen allergens. J Allergy Clin Immunol 1996; 98 (4): 805-815. 1996.
  19. Foetisch. Tomato (Lycopersicon esculentum) allergens in pollen-allergic patients. Eur Food Red Technol 2001; 231: 259-266. 2001.
  20. Gupta. Urticaria due to tomato. Journal of Pakistan Association of Dermatologists 2014; 24(1): 99-100. 2014.
  21. Seitz. Food allergy in adults: an over- or underrated problem? Dtsch Arztebl Int, 2008; 105(42): 715-723. 2008.
  22. Tavadia. Latex, potato and tomato allergy in restaurateur. Contact Dermatitis  2002; 47 (109). 2002.
  23. Pourpak. The role of cow milk allergy in increasing the severity of atopic dermatitis. Immunological Investigations  2004; 33(1): 69-79. 2004.
  24. Armentia. Enhancement of tomato allergenicity after treatment with plant hormones. Allergologia et Immunopathologia 2003;31(1):44-46. 2003.
  25. Pravettoni. Tomato Allergy: Detection of IgE-Binding Lipid Transfer Proteins in Tomato Derivatives and in Fresh Tomato Peel, Pulp, and Seeds. Journal of Agricultural and Food Chemistry, 2009; 57(22): 10749–10754. 2009.
  26. Romano. Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol 2001; 125: 264-272. 2001.
  27. Nucera. Oral rush desensitization with tomato: a case report. J Investig Allergol Clin Immunol 2006; 16(3): 214-217. 2006.
  28. Roy-Ghanta. Atopic characteristics of adult patients with eosinophilic esophagitis. Clinical Gastroenterology and Hepatology 2008; 6: 531-535. 2008.
  29. Inuo. Japanese cedar pollen-based subcutaneous immunotherapy decreases tomato fruit-specific basophil activation. Int Arch Allergy Immunol 2015;167: 137-145. 2015.
  30. EFSA. Scientific opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. European Food Safety Authority EFSA Journal, 2014. 2014.
  31. Westphal. Tomato profilin Lyc e 1: IgE cross-reactivity and allergenic potency. Allergy 2004; 59: 526-532. 2004.
  32. Quynh Le L. MV. Reduced allergenicity of tomato fruits harvested from Lyc e 1-silenced transgenic tomato plants. J Allergy Clin Immunol 2006; 118(5): 1176-1183. 2006.
  33. Willerroider. Cloning and molecular and immunological characterization of two new food allergens, Cap a 2 and Lyc e 1, profilins from bell pepper (Capsicum annum) and Tomato (Lycopersicon esculentum). International Archives of Allergy and Immunology  2003; 131(4): 242-255. 2003.
  34. Oguri. Characterization and sequence of tomato 2S seed albumin: a storage protein with sequence similarities to the fruit lectin. Planta 2003; 216: 976-984. 2003.
  35. Kondo. Assessment of cross-reactivity between Japanese cedar (Cryptomeria japonica) pollen and tomato fruit extracts by RAST inhibition and immunoblot inhibition. Clin Exp All 2002; 32: 590-594. 2002.
  36. Asero. Lipid transfer protein: a pan allergen in plant-derived foods that is highly resistant to pepsin digestion. Int Arch Allergy Immunol 2000; 122: 20-32. 2000.
  37. Asero. Detection and clinical characterization of patients with oral allergy syndrome caused by stable allergens in Rosaceae and nut. Annals of Allergy, Asthma and Immunology 1999; 83: 377-383. 1999.
  38. Asero. Relationship between peach lipid transfer protein specific IgE levels and hypersensitivity to non-Rosaceae vegetable foods in patients allergic to lipid transfer protein. Annal of Allergy, Asthma and Immunology 2004; 92: 268-272. 2004.
  39. Tucke. Latex type I sensitization and allergy in children with atopic dermatitis. Evaluation of cross-reactivity to some foods” Pediatr Allergy Immunol 1999; 10: 160-167. 1999.
  40. Diaz-Perales. Cross-reactions in the latex-fruit syndrome: A relevant role of chitinases but not of complex asparagine-linked glycans. J Allergy Clin Immunol 1999 Sep;104(3 Pt 1):681-7 doi: 101016/s0091-6749(99)70342-8 PMID: 10482846. 1999.