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w9 Ribwort Plantain

Whole Allergen
Code w9
LOINC LP13927-6
Family Plantaginaceae
Genus Plantago
Species Plantago lanceolata
Route of Exposure Airway (Inhalation)
Source Material Pollen
Latin Name Plantago lanceolata
Other Names English Plantain, Ribwort Plantain, Ribwort
Categories Weed Pollens

Summary

Ribwort plantain also identified as Plantago lanceolate is a very important species from the Plantaginaceae family. It is a perennial weed with high ecological plasticity. It grows abundantly mainly in regions such as humid meadows and beside roadsides. Plantain is one of the key reasons for pollinosis in temperate regions. Pla l 1 and Pla l 2 are the two registered allergens till date. Pla l 1 is primarily an indicative marker allergen responsible for the diagnosis of plantain pollen sensitization with high specificity. Pla l 2 is a profilin protein with a molecular weight of 12-15 kDa. It is a small actin-binding protein and is responsible for polysensitization. Plantain allergy is mainly responsible for seasonal allergic rhinitis, rhino-conjunctivitis and in some cases also asthma. Plantain allergen also shows cross-reactivity with pollens like grass, birch, ash, or olive pollen.

Allergen

Nature

Ribwort plantain (Plantago lanceolata) is a perennial herb, which forms several rosettes. It has long thin oval to elliptical leaves. The stems grow to a height of 20-70 cm, and the tips have 3-5 cm long spikes. The flowers of plantain blossom slowly from base to spike. A Japanese study revealed that Plantain pollens dispersed from May to September and the sensitized patients generally suffered from aggravated symptoms between April to October(1). A study conducted in the US showed that plantain growth rates were higher in September than in July, increasing by 62% in the normal and 29% in the wet treatment. (2)

Habitat

Plantain is a common perennial weed of arable fields and grassland. It is originating from grassy places on neutral or basic soils and is found abundantly in the UK. It is commonly found in lawns but less common as compared to greater plantain(3). Plantain belongs to the Plantaginaceae family with a perennial cosmopolitan species which shows high ecological plasticity. It is naturally found in grassy areas on roadsides, in pastures and in crops as weeds. It has moderate demands regarding soil and climatic factors. It also resists well in drought as well as cold winters and it can tolerate maritime exposure (2).

Taxonomy

Taxonomic tree of  Ribwort plantain  (4,5)  
Domain Eukaryota
Kingdom Plantae
Phylum Spermatophyta
Subphylum Angiospermae
Class Dicotyledonae 
Family Plantaginaceae
Genus Plantago
Species Plantago lanceolata

 

Tissue

Plantain is a periporate, wind-pollinated pollen with a verrucate surface pattern and is approximately 35 µm in size (6).

Epidemiology

Worldwide distribution

A large population study was conducted in Germany for over 20 years with skin prick testing (SPT) for 6220 individuals to evaluate sensitizations towards weed pollen aeroallergen. The patients were suspected of allergic rhinoconjunctivitis. 26.6% of patients from 1998 to 2007, showed positive results on SPT for plantain. Between 2008 and 2017 this percentage increased to 50.5% (7).

A Japanese study was conducted on 160 individuals suffering from allergic rhinitis. Among these 141 patients were tested with RAST and 12.8% of these showed positive results to plantain(1).

A study in China analyzing aeroallergen sensitization in individuals (n=480) suffering from allergic rhinitis showed 29.8% of these patients reported positive to skin prick test for plantain(8).

In one study conducted in a city Porto of Portugal to check the sensitization of plantain in patients with respiratory allergy, the result showed that 31 percent of the patients showed sensitization for plantain pollen. Plantain was responsible for about 3 percent of the yearly pollen load in the air of Porto. Plantain was found to be the ninth most common pollen in the air of Porto (9).

Risk factors

A study conducted in the UK found that 28% of patients (n=82) with a history of seasonal respiratory allergy tested positive for skin prick test for plantain pollen extract. The study has also shown when a patient’s sera with seasonal respiratory allergies were subjected to RAST testing with plantain pollen 34%showed positive results(10).

Sensitization to pollen allergens varies between different regions of the world and is closely related to climatic conditions, degree of urbanization, and plant distribution. In the Mediterranean countries or those with such climate, airborne plantain pollen, along with grass pollen, olive pollen, cypress pollen, plane tree pollen, dust mites, is considered as one of the most common triggers of respiratory allergy. (9)

Pediatric issues

A study was done on a Pacific island in the pediatric population who had wheezing bronchitis. The bronchitis episodes commonly occurred in children less than 4 years of age. The results of the skin test and the serologic test showed that hypersensitivity reaction to plantain allergens was related to bronchitis episodes. (11)

Environmental Characteristics

Worldwide distribution

The genus Plantago includes about 250 species Plantain is considered an important cause of pollinosis in the temperate regions of North America, Australia, and Europe. (12) It is an exotic species in Japan. Besides, it possesses excellent reproductive power and has proliferated more than the naturally growing plantain in Japan. This species is distributed all over the world, including Europe, North America and Australia(1).

Route of Exposure

Main

Plantain pollen is generally considered a causative allergen for airborne allergy in Europe. (13)

Detection

Allergic rhinitis

Plantain is responsible for about 20 to 30 percent of all the episodes of seasonal allergic rhinitis in the western population. A study was conducted in Japan in about 160 patients with allergic rhinitis to find out the prevalence of plantain pollinosis. The results showed a plantain RAST-positive rate of 12.8 percentage(1).

Asthma

A study was conducted with 866 patients suffering from allergic rhinoconjunctivitis (ARC) and asthma using skin prick tests to evaluate seasonal allergy. Among these 38.79% were suffering from asthma and ARC. The study reported 45.7% showed positive skin prick test results towards plantain pollen allergen(14).

Prevention and Therapy

Prevention strategies

Avoidance

It is generally difficult to avoid pollens on daily bases. Some measures that can be taken are to wear, sunglasses and mask. Keep windows of an allergic individual’s house (especially if situated in a tall building) and in a moving car shut. One can also try to avoid walking over open grassy areas, especially during high pollen count (15). 

Molecular Aspects

Allergenic molecules

A study on plantain pollen‘s IgE binding protein profile showed several molecular bands ranging from 70kDa to 13 kDa. The 1D gel electrophoresis showed 8 prominent groups of IgE-reactive allergens. The mass spectroscopy revealed several peptides, among these 2 immunoreactive proteins of around 39 kDa and 37 kDa, corresponding to fructose-bisphosphate aldolase and glyceraldehyde-3-phosphate dehydrogenase, respectively. Proteomic analysis revealed that these two peptides are known to work together in metabolic pathways such as glycolysis and were also recognized as IgE-binding proteins in ryegrass (Lolium perenne) pollen extracts. Another peptide Glyceraldehyde-3-phosphate dehydrogenase was also found to be a wheat (Triticum aestivum) food allergen. Other identified peptide is α-1,4-glucan-protein synthase is known to be involved in the synthesis of cellulose and shows allergenic activity in date palm (Phoenix dactylifera) pollen aldolase(9).

Allergen Pla l 1 in plantain pollen has been identified and purified. Other allergens identified as specific to plantain include a cytochrome c protein and a calcium-binding protein. (9).

Pla l 2 is the second allergen found in plantain. Pla l 2 is a profilin, with a molecular weight of 12-15 kDa, a small actin-binding protein. It is responsible for polysensitization. From its purified form, a total of four peptides are recognized which have similarities ranging from 73% to 86% with other pollen profilin. In a profilin diagnostic study, around 87.5% percent of the serum samples identified Pla l 2. (16)

Biomarkers of severity

Pla l 1 constitutes the only indicative marker allergen for the diagnosis of genuine plantain pollen sensitization. Without considering Pla l 1 as a marker molecule for genuine sensitization, most of the patients would have been diagnosed positive solely because of cross-reactivity to grass, olive, birch, or ash allergens. (17) The allergenic significance of Pla l 1 has been studied in vitro with sera of allergic patients sensitized to plantain. Of the 22 sera analyzed, 19 had IgE antibodies to Pla l 1. In addition, Pla l 1 was responsible for 80% of the total IgE-binding capacity of the whole extract, which was determined by competitive ELISA.(4).

Cross-reactivity

Patients with a true monosensitization to plantain are rarely found. The vast majority of the plantain pollen-sensitized patients show concomitant sensitizations and allergies to other pollen allergen sources, such as grass, birch, ash, or olive pollen. Recent studies showed a lack of IgE cross-reactivity of Pla l 1 with homologous allergens. However, plantain pollen also contains the panallergens such as profilin and polcalcin which are present in other pollen sources. (17).

Compiled By

Author: Turacoz Healthcare Solutions

Reviewer: Dr. Christian Fischer

 

Last reviewed: October  2020

References
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  2. 2.                       Grigore A, Bubueanu C, Pirvu L, Ioni   L, Toc  G, editors. Plantago lanceolata L. CROPS - SOURCE OF VALUABLE RAW MATERIAL FOR VARIOUS INDUSTRIAL APPLICATIONS2015.
  3. W Bond GD, R Turner. The biology and non-chemical control of Ribwort Plantain (Plantago lanceolata L.) November 2007
  4. Calabozo B, Barber D, Polo F. Purification and characterization of the main allergen of Plantago lanceolata pollen, Pla l 1. Clin Exp Allergy. 2001;31(2):322-30.
  5. CABI. Ribwort plantain (Plantago lanceolata) 2020. Available from: https://www.cabi.org/isc/datasheet/41813#toidentity.
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  10. Mehta V, Wheeler A. IgE-mediated sensitization to English plantain pollen in seasonal respiratory allergy: identification and partial characterisation of its allergenic components. International Archives of Allergy and Immunology. 1991;96(3):211-7.
  11. Kuberski T, Holdaway D, Turner KJ, Nemaia H. Wheezing bronchitis in children on a South Pacific Island. Am J Trop Med Hyg. 1981;30(1):264-72.
  12. Gadermaier G, Hauser M, Ferreira F. Allergens of weed pollen: an overview on recombinant and natural molecules. Methods. 2014;66(1):55-66.
  13. Asero R, Mistrello G, Roncarolo D, Casarini M. Detection of allergens in plantain (Plantago lanceolata) pollen. Allergy. 2000;55(11):1059-62.
  14. Yalcin AD, Basaran S, Bisgin A, Polat HH, Gorczynski RM. Pollen aero allergens and the climate in Mediterranean region and allergen sensitivity in allergic rhinoconjunctivitis and allergic asthma patients. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2013;19:102.
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  17. Stemeseder T, Metz-Favre C, de Blay F, Pauli G, Gadermaier G. Do Plantago lanceolata Skin Prick Test-Positive Patients Display IgE to Genuine Plantain Pollen Allergens? Investigation of Pollen Allergic Patients from the North-East of France. Int Arch Allergy Immunol. 2018;177(2):97-106.