Common Ragweed

  • Allergen search puff

    SEARCH FOR ALLERGENS

    Search ImmunoCAP allergens and allergen components. Note that all information is in English.

Code: w1
Latin name: Ambrosia elatior (Synonym: Ambrosia artemisifolia)
Source material: Pollen
Family: Asteraceae (Compositae)
Common names: Common ragweed, Annual ragweed, Short ragweed, Roman wormwood, American wormwood

Synonyms: A. artemisifolia

Allergen Exposure

Geographical distribution
Common (Short) ragweed is native to North America, but can also be found in Canada, Japan, Australia and Europe. It is a prime cause of allergy in the US, and now in Europe, in particular in the upper Rhône valley, the Balkan states and the Krasnodar district of the Russia.

Common (Short) ragweed is an erect summer annual herbaceous plant growing to 0.9 m. The leaves are soft, green and opposite or alternate. Each leaf is divided into narrow segments, which are in turn irregularly lobed. It closely resembles False ragweed. Short ragweed produces burs similar to those of Giant ragweed, but the former are considerably smaller (2 to 4 mm long).

Short (Common) ragweed flowers from August to October. It is wind-pollinated, releasing millions of pollen grains into the air. However, the presence of the pollen in honey indicates some insect pollination.

Male and female flowers are in separate heads on the same plant (a monoecious structure). The tiny, nodding, greenish staminate (male) flowers, usually drooping, are in slender racemes near the top of the plant, while the pistillate (female) flowers tend to cluster at the bases of the racemes.

The Ragweed pollination period extends from the beginning of August to mid-October with a peak from mid-August to the end of September. Ragweed pollen release begins at sunrise and continues during the morning, reaching its highest count around midday. Pollen release is maximal in sunny and dry weather, and when night temperature is above 10° C. The pollen of A. artemisiifolia is produced in enormous amounts compared to other grasses, and a single plant alone may produce millions of pollen grains. Since the pollen grains are small (18–22 µm), they are often transported long distances. Ragweed pollen is very allergenic, and very low concentrations such as 5–10 pollen by cubic meter of air are sufficient to trigger allergic reactions in sensitive patients (1).

Environment
Short Ragweed is found in woodland and waste places. It occurs on dry fields and pastures, along roadsides, and especially in disturbed soil sites. It can become a pernicious weed in cultivated soils.

Unexpected exposure
The leaves of the plant are used in herbal medications. A tea made from the roots is used as a herbal remedy. The pollen is harvested commercially and manufactured into homeopathic preparations for the treatment of allergies to the plant.

Allergens
Ragweed contains numerous allergens. Among these allergens, 22 are already well known and 6 are considered major. Several ragweed pollen allergens have been characterised at the molecular level. Amb a 1 is the most important allergen, since 95% of Ragweed-sensitive individuals react to the protein in skin tests and show high serum IgE antibody titers (1-4).

The following allergens have been characterised:

  • Amb a 1, a 38 kDa protein, a pectate lyase, also known as Antigen E, AgE, a24, a789 and previously as Amb a I, Amb e 1 (3,5-15).
  • Amb a 2, a 38 kDa protein, a pectate lyase, also known as Antigen K, AgK, and previously as Amb a II, Amb e 2 (3,7,10-11,14,16-17).
  • Amb a 3, a 9 kDa protein also known as Ra3, and previously as Amb a III, Amb e 3 (7,18-22).
  • Amb a 5, a 5 kDa protein, also known as Ra5, Ra5S, and previously as Amb a V, Amb e 5 (9,21,23-29).
  • Amb a 6, a 10 kDa protein, a lipid transfer protein, also known as Ra6 and previously as Amb a VI (2,7,21,30-33).
  • Amb a 7, a 12 kDa protein, also known as Ra7 (7,34.)
  • Amb a 8, a 14 kDa protein, a profilin (7,35-38).
  • Amb a 9, a 10kDa protein, a calcium-binding protein (7,36).
  • Amb a 10, a 10kDa protein, a calcium-binding protein (7,36,39-40).
  • Amb a Cystatin Prot Inhibitor (41).

Isoforms of Amb a 1 have been identified: Amb a 1.1, Amb a 1.2, Amb a 1.3, Amb a 1.3, and Amb a 1.4 (10).

Amb a 1 and Amb a 2 have been shown to display immunological cross-reactivity in ELISA studies (9).

Potential cross-reactivity

With the use of a serum pool from patients sensitive to Short ragweed, the cross-reactivity of IgE antibodies to six Ragweeds was studied through the radioallergosorbent test. Extracts were analysed for their inhibitory activities, with solid-phase allergens prepared from all of the Ragweed pollens. Also, samples of serum were absorbed with the various solid-phase allergens and the reactivity of the remaining IgE antibodies was determined. Two patterns of reactivity were observed. Short, Giant, Western, and False ragweeds displayed comparable reactivity in both inhibition and absorption experiments. Slender and Southern ragweed were considerably less active, indicating that they lacked allergenic groupings possessed by the other species. These same patterns of cross-reactivity were found using Ragweed pollens from four commercial sources (42).

Further cross-reactivity among the various Ragweeds can be inferred due to the high cross-reactivity among various other members of the genus Ambrosia and of the family Asteraceae. For example, cross-reactivity among Chamomile tea extract, pollen of Matricaria chamomilla, Artemisia vulgaris (Mugwort), and Ambrosia trifida (Giant ragweed) was demonstrated by an ELISA-inhibition study (43). Further evidence confirming cross-reactivity among members of the Ragweed genus was obtained in a study using a fluorescent allergosorbent test, in which similar antigenic determinants were found among Short and Giant ragweed, Cocklebur, Lamb’s quarters, Rough pigweed, Marshelder, and Goldenrod. Cocklebur and Giant ragweed were highly potent in their ability to competitively bind to Short ragweed IgE. The other pollens demonstrated lower potency of cross-reacting antigens (44). Also, a water-insoluble material, extracted from Short ragweed and False ragweed pollen, contained at least five proteins. Two (RFA2 and RFB2) were isolated and shown to possess antigenicity as well as allergenicity. Immunodiffusion tests of RFB2, isolated from False ragweed and Short ragweed, showed immunological identity (45).

However and surprisingly, Common ragweed and Giant ragweed are not allergenically equivalent because of allergenic differences involving both the major allergens Amb a 1-2 and Amb t 1-2 (all members of the pectate lyase family) and some minor allergens (46). This is illustrated by the example from an area north of Milan (a zone widely invaded only by Short ragweed), where about 50% of patients treated with specific immunotherapy (SIT) with Giant ragweed who showed little or no clinical response to SIT, but showed an excellent outcome if they were shifted to SIT with Short ragweed. These authors suggested that in patients allergic to Ragweed, both diagnosis in vivo and immunotherapy should always be performed by using the ragweed species present in that specific geographic area (49).

Sensitisation to Amb a 1, a pectate lyase, results in cross-reactivity only with other pectate lysase containing plants where a high degree of homology occurs. Not all proteins in this family are allergens. The allergens in this family include: Amb a 1, Amb a 2, Cha o 1 (Japanese Cypress tree), Cup a 1 (Arizona Cypress tree), Cry j 1 (Japanese Cedar tree), Jun a 1 (Mountain Cedar tree) (47).

Furthermore, Mugwort, Ragweed, and Timothy grass pollen share IgE epitopes with Latex glycoprotein allergens. The presence of common epitopes might in part explain clinical symptoms on contact with Latex in patients allergic to pollen. In this study, any previously known panallergen was not detected (48).

An association between Ragweed pollinosis and hypersensitivity to Cucurbitaceae vegetables (e.g., Watermelon, Cantaloupe, Honeydew Melon, Zucchini, and Cucumber) and Banana has been reported. Up to now three allergens have been identified as candidates for causing this cross-reactivity: profilin, Bet v 1, and a 60-69 kd allergen (49). Further evidence for cross-reactivity between Cucurbitaceae and Ragweed was found in a study that reported that of the sera of 192 allergic patients, 63% contained anti-Ragweed IgE, and among these patients, 28% to 50% had sera containing IgE specific for any single gourd family member. The extracts of Watermelon and Ragweed inhibited each other in a dose-dependent manner (50).

Ragweed profilin can be expected to result in cross-reactivity between this plant and other plants containing profilin. This has been demonstrated between Ragweed and Persimmon (44). In a second study, 35 of 36 patients’ sera containing IgE to Ragweed profilin reacted with profilin from Latex, indicating structural homologies between profilin from Latex and Ragweed. Because profilin is also present in Banana extract, it is likely to be involved in cross-sensitivity between Banana and Latex (43).

In addition to profilin, Mugwort and Ragweed pollen contain a number of other cross-reactive allergens, among them the major Mugwort allergen Art v 1. These cross-reactive IgE antibodies could result in clinically significant allergic reactions (34). Evidence of further cross-reactivity between Mugwort and other members of the Asteraceae family (of which Ragweed is a member) consists in the high degree of in vivo cross-reactivity between Matricaria chamomilla (Camomile) and Mugwort (51).

Cross-reactivity between Sunflower and other Asteraceae pollens (Mugwort, Marguerite, Dandelion, Goldenrod, and Short ragweed) has also been demonstrated by RAST and immunoblotting inhibition experiments. Mugwort pollen exhibited the greatest degree of cross-reactivity with Sunflower pollen, whereas at the other end of the spectrum, Short ragweed showed fewer cross-reactive epitopes (52).

Celery cross-reacting to Ragweed has also been reported, but a panallergen was not identified in these studies (53-54).

Binding to IgE from Ginkgo pollen proteins (Ginkgo biloba L.) was shown to be almost completely inhibited by Oak, Ryegrass, Mugwort and Ragweed, but only partially by Japanese Hop and rBet v 2 (55). A panallergen may be indicated but was not isolated.

Sera from subjects allergic to White Cypress Pine, Italian cypress, Ryegrass or Birch pollen were shown to have IgE antibodies that reacted with pollens from these four species and from Cocksfoot, Couch grass, Lamb’s quarters, Wall pellitory, Olive, Plantain and Ragweed. The authors concluded that the presence of pollen-reactive IgE antibodies may not necessarily be a true reflection of sensitising pollen species (56).

The Japanese cypress tree pollen allergen, Cha o 1, has a 46 to 49% similarly to the major allergens of Short ragweed, Amb a 1 and Amb a 2 (57).

A panallergen has been identified in Birch pollen, Ragweed pollen, Timothy grass pollen, Celery, Carrot, Apple, Peanut, Paprika, Anise, Fennel, Coriander and Cumin. EAST inhibition and immunoblot inhibition demonstrated that cross-reactions between Mango fruits, Mugwort pollen, Birch pollen, Celery, and Carrot are based on allergens related to Bet v 1 and Art v 1, the major allergens of Birch and Mugwort pollen, respectively (58).

Pollen of Artemisia annua is considered to be one of the most important allergens in autumnal hay fever in China, just as Ragweed is in North America. Extracts of pollen-free Artemisia annua components were found to contain similar allergens to those of Ragweed pollen. In 52 subjects sensitive to Artemisia pollen, 92.3% were shown on skin prick testing to have allergen-specific IgE to this allergen, 100% gave positive responses in intradermal tests, 66.7% gave positive responses in intranasal challenges, and 59.3% gave positive responses in bronchial provocation tests (59).

Ragweed pollen appears to also be cross-reactive with pollen from Yellow dock (Rumex crispus). When monoclonal antibodies with different specificity were applied against the major allergenic components of Ragweed pollen, the monoclonal antibodies reacted with antigens of Yellow dock pollen. In a preliminary study, sera of 2 patients containing IgE antibodies to Ragweed pollen antigens also reacted to the 40K component of Yellow dock pollen. In allergen-specific IgE tests on 109 patients with bronchial asthma, 22 had a positive reaction to a crude extract of Ragweed pollen, and 18 also reacted to a crude extract of Yellow dock pollen (60).

Clinical Experience

IgE-mediated reactions
Ragweed, and in particular Short ragweed (A. artemisiifolia), is clinically the most important source of seasonal aeroallergens, as it is responsible for both the majority of cases and the most severe cases of allergic rhinitis (61-66). Ragweed pollen also contributes significantly to exacerbation of asthma and allergic conjunctivitis. Ragweed pollen has also been implicated in eustachian tube dysfunction in patients with allergic rhinitis (67) and contact dermatitis (68).

The efficacy of Ragweed pollen in exacerbating allergic symptoms may be due to the Ragweed pollen endopeptidase, which may be involved in the inactivation of regulatory neuropeptides during pollen-initiated allergic reactions (69). Studies have also shown that complement activation induced by the allergen may enhance the clinical symptoms of Ragweed allergy (70-71).

A genetic susceptibility to Ragweed allergens has been suggested based on HLA studies; Amb a V, Amb t V and Amb p V from Short ragweed, Giant ragweed and Western ragweed respectively are strongly associated with HLA-DR2 and Dw2 (DR2.2) in allergic Caucasoid individuals (72).

The measurement of specific IgE has been shown to be an accurate and useful diagnostic tool in the evaluation of sensitisation to Ragweed pollen (73-76).

Aerobiological and clinical studies from various cities in the USA have documented the importance of Ragweed pollen as an aeroallergen (77). Ragweed has been shown to contribute to symptoms in studies in Washington, DC (78), Tucson, Arizona (79), and Tulsa, Oklahoma (80).

The prevalence of Ragweed pollinosis in central Pennsylvania was shown to be significantly greater in the rural subjects than in inner-city ones (81). In Boston women, socio-economic differences in sensitisation to Ragweed differed between the highest and lowest poverty areas (49% vs. 23%) (82). Ragweed was shown to be a major aeroallergen in the Tampa Bay area, Florida (83).

In Chicago residents with asthma, Ragweed sensitivity occurred in 45%, more than those sensitised to pollen from all other weeds (42%) (84).

In a collaborative study on Parthenium hysterophorus pollen compared to an extract of Western Ragweed, a study contributed to by 22 physicians from 18 Gulf Coast cities, 65.6% overall of the sera tested were positive for one or both of the pollen extracts examined. Thirty-five percent of the sera were sensitive to Parthenium hysterophorus and 57.6% were sensitive to Ragweed. Thirty percent of the sera were positive to Western Ragweed only, 8% were positive to Parthenium hysterophorus only, and 27.9% were positive to both extracts (85-86). These studies support the findings of another study that examined cross-reactivity of allergens from the pollen of Parthenium hysterophorus (American Feverfew) and Ragweed in 2 groups of patients with different geographic distributions. Parthenium-sensitive Indian patients, who were never exposed to Ragweed, had positive skin reactions to Ragweed pollen extracts. A significant correlation in the RAST scores of Parthenium- and Ragweed-specific IgE was observed with the sera of Parthenium- and Ragweed-sensitive Indian and US patients, respectively. RAST inhibition experiments demonstrated that in the sera of Ragweed-sensitive patients the binding of IgE antibodies to Short and Giant ragweed allergens could be inhibited by up to 94% by Parthenium pollen extracts. Inhibition up to 82% was obtained when the sera of Parthenium rhinitis patients were incubated with Ragweed allergen extracts. The high degree of cross-reactivity between Parthenium and Ragweed pollen allergens suggests that individuals sensitised to Parthenium may develop type-I hypersensitivity reactions to Ragweed even though they never had contact with Ragweed, and vice versa (87).

In Canada, Ragweed pollinosis studies have been conducted in Quebec. Of 3,371 subjects with a clinical diagnosis of symptomatic asthma or rhinitis, Ragweed sensitisation was documented in 44.9% (88). Ragweed pollen was shown to be the principal allergen causing allergic rhinitis (89).

In Europe, the severity of Ragweed pollinosis varies according to geographical region. Expansion of the Ragweed genus is occurring across Europe, in particular in France, northern Italy, Austria, and Hungary (90).

Ragweed pollinosis has become a rapidly emerging problem in Italy (64). In 21 centres across Italy, in 2,934 consecutive outpatients with respiratory pathology of suspected allergic origin, 28.2% were positive to at least one “emerging” pollen: Birch, Hazelnut, Alder, Hornbeam, Cypress, or Ragweed. Ragweed pollen was shown to provoke asthma much more frequently than any of the other pollens (91). Children appear to be less sensitised to Ragweed pollen than adults are; only 5.9% of 507 asthmatic children aged between 1 and 17 years from a central Italian area had IgE antibodies to Ragweed species (92).

Ragweed pollinosis also has been documented in France (93-95). An epide-miological study of Ragweed allergy was conducted on 646 employees of 6 factories located in the Rhône valley south of the city of Lyon. In this study, 5.4% of subjects were symptomatic to Ragweed pollen, whereas 5.9% were shown to have allergen-specific IgE to this pollen (96). The spread of Ragweed in the middle Rhône area over the last ten years has been considerable; this is especially true of the Drome, along the river Rhône, but also of remote, very sheltered localities to the east and southeast of the province. Although Ragweed is said to grow only in the plains, in this area it appears to be extending into the mountains (97).

Ragweed has been found in the central region of Coahuila, Spain (98). In Canton Ticino, in the southern part of Switzerland, 17% of 503 consecutive patients suffering from hay fever were shown to be sensitised to Ragweed (99).

Ragweed pollinosis is very prevalent in Hungary. In the south of Hungary, among patients with hay fever symptoms during the late summer, 63% were sensitised to Ragweed pollen (100). In Budapest, 64.8% of allergic patients were sensitised to weed pollens, and 59% to Ragweed pollen (101). In other areas, Ragweed sensitisation has been shown to affect up to 83% of patients with late-summer seasonal allergic rhinitis (65).

Ragweed pollinosis is also spreading across Asia.

As Ragweed becomes widespread over China, Ragweed pollinosis tends to be more frequent. A survey of the distribution of Ragweed in the Qingdao district recorded that Ambrosia artemisiifolia was found to be widespread in many areas. Ragweed pollen was the chief allergen of the district and contributed over 18% of the total air-borne pollen in a year. IgE antibody determination with Ambrosia allergen extracts showed a prevalence of 67.7% in 624 pollen-allergic individuals (102).

Ragweed pollinosis is also prominent in Taiwan (103). Of 3,550 asthmatic patients who visited the Taipei Municipal Chung-shing Hospital, 52.3% were shown to be sensitised to Ragweed (104). A high prevalence of sensitisation to Ragweed pollen has been reported in a further study (105).

Ragweed pollinosis has also been documented in Korea (58,106) and Japan (107-108). In 226 children visiting a paediatric allergy clinic in Kyoto, Japan, 17.1% were shown to be sensitised to Ambrosia artemisiifolia (109).

Few studies have examined the prevalence of Ragweed sensitisation in South America. In Cartagena, Columbia, in 99 subjects with acute asthma and 100 controls, the prevalence of specific IgE to Short ragweed was shown to be 23% and 12% respectively (110).

Ragweed allergy has also been reported in northern New South Wales, Australia, where 70 of 153 atopic patients were sensitised to Ragweed, as shown by allergen-specific IgE determination (111).

Although Ragweed is not present in most of Africa, it has been shown to be the third most prominent allergen for asthmatics in Egypt (112).

Other reactions
The food supplement bee pollen has been previously found to cause anaphylactic reactions. It has been advertised as useful for ”everything from bronchitis to haemorrhoids.” This study describes an atopic patient who experienced a non-life-threatening anaphylactic reaction upon her initial ingestion of bee pollen. The preparation of bee pollen caused 52% inhibition of IgE binding to Short ragweed (113).

Compiled by Dr Harris Steinman, harris@zingsolutions.com.

References

  1. Taramarcaz P. The Ragweed Invasion. Allergy Clin Immunol Int: J World Allergy Org 2006;19(1):35-36
  2. Lowenstein H, Marsh DG. Antigens of Ambrosia elatior (short ragweed) pollen. III. Crossed radioimmunoelectrophoresis of ragweed-allergic patients’ sera with special attention to quantification of IgE responses.
    J Immunol 1983;130(2):727-31
  3. Rogers BL, Morgenstern JP, Griffith IJ, Yu XB, Counsell CM, Brauer AW, King TP, Garman RD, Kuo MC. Complete sequence of the allergen Amb alpha II. Recombinant expression and reactivity with T cells from ragweed allergic patients. J Immunol 1991;147(8):2547-52
  4. Olson JR, Klapper DG. Two major human allergenic sites on ragweed pollen allergen antigen E identified by using monoclonal antibodies. J Immunol 1986;136(6):2109-15
  5. Wopfner N, Bauer R, Thalhamer J, Ferreira F, Chapman M. Natural and Recombinant Amb a 1: Analysis of IgE and Monoclonal Antibody Epitopes. (Poster) 2nd Int Symp Molecular Allergol, Rome, Italy 2007;April 22-4
  6. Wopfner N, Bauer R, Thalhamer J, Ferreira F,
    Chapman M. Immunologic analysis of monoclonal and immunoglobulin E antibody epitopes on natural and recombinant Amb a 1. Clin Exp Allergy 2008 Jan;38(1):219-26
  7. International Union of Immunological Societies Allergen Nomenclature: IUIS official list http://www.allergen.org/List.htm 2007
  8. Oberhuber C, Ma Y, Wopfner N, Gadermaier G,
    Dedic A, Niggemann B, Maderegger B, Gruber P, Ferreira F, Scheiner O, Hoffmann-Sommergruber K. Prevalence of IgE-binding to Art v 1, Art v 4 and Amb a 1 in mugwort-allergic patients. Int Arch Allergy Immunol 2008;145(2):94-101
  9. Pilyavskaya A, Wieczorek M, Jones SW, Gross K.
    Isolation and characterization of a new basic antigen from short ragweed pollen (Ambrosia artemisiifolia).
    Molecular Immunol 1995;32(7):523-9
  10. Kuo MC, Zhu XJ, Koury R, Griffith IJ, Klapper DG,
    Bond JF, Rogers BL. Purification and immuno-chemical characterization of recombinant and native ragweed allergen Amb a II.
    Mol Immunol 1993;30(12):1077-87
  11. Griffith IJ, Pollock J, Klapper DG, Rogers BL, Nault AK. Sequence polymorphism of Amb a I and Amb a II, the major allergens in Ambrosia artemisiifolia (short ragweed). Int Arch Allergy Appl Immunol 1991;96(4):296-304
  12. Rafnar T, Griffith IJ, Kuo MC, Bond JF, Rogers BL, Klapper DG. Cloning of Amb a I (Antigen E), the major allergen family of short ragweed pollen.
    J Biol Chem 1991;266(2):1229-36
  13. Bond JF, Garman RD, Keating KM, Briner TJ, Rafnar T, et al. Multiple Amb a I allergens demonstrate specific reactivity with IgE and T cells from ragweed-allergic patients. J Immunol 1991;146(10):3380-5
  14. King TP, Alagón A, Kochoumian L, Kuan J,
    Sobotka A, Lichtenstein LM. Limited proteolysis of antigens E and K from ragweed pollen.
    Arch Biochem Biophys 1981;212(1):127-35
  15. Gadermaier G, Dedic A, Obermeyer G, Frank S,
    Himly M, Ferreira F. Biology of weed pollen allergens.
    Curr Allergy Asthma Rep 2004;4(5):391-400
  16. Shen HD, Chang LY, Su SN, Han SH. Characteristics of five monoclonal antibodies to major allergens of the short ragweed pollen. Int Arch Allergy Appl Immunol 1988;85(2):167-73
  17. Shen HD, Lin WL, Han SH. Analysis of ragweed allergens recognized by monoclonal antibody 8-5 using two-dimensional gel electrophoresis and immunoblotting.
    Proc Natl Sci Counc Repub China B 1992;16(4):177-83
  18. Atassi H, Atassi MZ. Antibody recognition of ragweed allergen Ra3: localization of the full profile of the continuous antigenic sites by synthetic overlapping peptides representing the entire protein chain.
    Eur J Immunol 1986;16(3):229-35
  19. Atassi H, Atassi MZ. Localization of the continuous allergenic sites of ragweed allergen Ra3 by a comprehensive synthetic strategy. FEBS Lett 1985;188(1):96-100
  20. Platts-Mills TA, Chapman MD, Marsh DG.
    Human immunoglobulin E and immuno-globulin G antibody responses to the ”minor” ragweed allergen Ra3: correlation with skin tests and comparison with other allergens.
    J Allergy Clin Immunol 1981;67(2):129-34
  21. Løwenstein H, King TP, Goodfriend L, Hussain R, Roebber M, Marsh DG. Antigens of Ambrosia elatior (short ragweed) pollen. II. Immunochemical identification of known antigens by quantitative immunoelectrophoresis.
    J Immunol 1981;127(2):637-42
  22. Klapper DG, Goodfriend L, Capra JD. Amino acid sequence of ragweed allergen Ra3.
    Biochemistry 1980;19(25):5729-34
  23. Mole LE, Goodfriend L, Lapkoff CB, Kehoe JM,
    Capra JD. The amino acid sequence of ragweed pollen allergen Ra5.
    Biochemistry 1975;14(6):1216-20
  24. Roebber M, Klapper DG, Marsh DG. Two isoallergens of short ragweed component Ra5.
    J Immunol 1982;129(1):120-5
  25. Ghosh, B., M.P. Perry, T. Rafnar, D.G. Marsh. Cloning and expression of immunologically active recombinant Amb a V allergen of short ragweed (Ambrosia artemisiifolia) pollen.
    J Immunol 1993;150:5391-9
  26. Ghosh B, Rafnar T, Perry MP, Bassolino-Klimas D, Metzler WJ, Klapper DG, Marsh DG. Immunologic and molecular characterization of Amb p V allergens from Ambrosia psilostachya (western Ragweed) pollen.
    J Immunol 1994;152(6):2882-9
  27. Kim KE, Rosenberg A, Roberts S, Blumenthal MN. The affinity of allergen specific IgE and the competition between IgE and IgG for the allergen in Amb a V sensitive individuals.
    Mol Immunol 1996;33(10):873-80
  28. Kim KE, Rosenberg A, Lemke T, Calderon J, Rich S, Blumenthal MN. B-cell epitopes recognized by IgE from patients sensitive to Amb a 5.
    Clin Exp Allergy 1997;27(10):1193-202
  29. Zhu X, Greenstein JL, Rogers BL, Kuo MC. T cell epitope mapping of ragweed pollen allergen Ambrosia artemisiifolia (Amb a 5) and Ambrosia trifida (Amb t 5) and the role of free sulfhydryl groups in T cell recognition.
    J Immunol 1995;155(10):5064-73
  30. Roebber M, Hussain R, Klapper DG, Marsh DG.
    Isolation and properties of a new short ragweed pollen allergen, Ra6.
    J Immunol 1983;131:706-11
  31. Marsh DG, Freidhoff LR, Ehrlich-Kautzky E, Bias WB, Roebber M. Immune responsiveness to Ambrosia artemisiifolia (short ragweed) pollen allergen Amb a VI (Ra6) is associated with HLA-DR5 in allergic humans. Immunogenetics 1987;26(4-5):230-6
  32. Hiller, Lubahn, Klapper Cloning and expression of ragweed allergen Amb a 6. Scand J Immunol 1998;48(1):26
  33. Lubahn B, Klapper DG. Cloning and characterization of ragweed allergen Amb a VI (abst). J Allergy Clin Immunol 1993;91:338
  34. Roebber M, Marsh DG. Isolation and characterization of allergen Amb a VII from short ragweed pollen.
    J Allergy Clin Immunol 1991;87:324
  35. Vallier P, Dechamp C, Vial O, Deviller P. Purification and characterization of an allergen from celery immunochemically related to an allergen present in several other plant species. Identification as a profilin.
    Clin Allergy 1992;22:774-82
  36. Hirschwehr R, Heppner C, Spitzauer S,
    Sperr WR, Valent P, Berger U, Horak F, Jäger S, Kraft D, Valenta R. Identification of common allergenic structures in mugwort and ragweed pollen. J Allergy Clin Immunol 1998;101(2 Pt 1):196-206
  37. Tao AL, He SH. Cloning, expression, and characterization of pollen allergens from Humulus scandens (Lour) Merr and Ambrosia artemisiifolia L.
    Acta Pharmacol Sin 2005;26(10):1225-32
  38. Asero R, Wopfner N, Gruber P, Gadermaier G,
    Ferreira F. Artemisia and Ambrosia hypersensitivity: co-sensitization or co-recognition?
    Clin Exp Allergy 2006;36(5):658-65
  39. Liebers V, Sander I, Van Kampen V, Raulf-Heimsoth M, Rozynek P, Baur X. Overview on denominated allergens.
    Clin Exp Allergy 1996;26(5):494-516
  40. Weber RW. Cross-reactivity of pollen allergens: impact on allergen immunotherapy. Ann Allergy Asthma Immunol 2007;99(3):203-11
  41. Rogers BL, Pollock J, Klapper DG, Griffith IJ.
    Sequence of the proteinase-inhibitor cystatin homologue from the pollen of Ambrosia artemisiifolia (short ragweed).
    Gene 1993;133(2):219-21
  42. Leiferman KM, Gleich GJ, Jones RT. The cross-reactivity of IgE antibodies with pollen allergens. II. Analyses of various species of ragweed and other fall weed pollens. J Allergy Clin Immunol 1976;58(1 PT. 2):140-8
  43. Subiza J, Subiza JL, Hinojosa M, Garcia R, Jerez M, Valdivieso R, Subiza E. Anaphylactic reaction after the ingestion of chamomile tea: a study of cross-reactivity with other composite pollens.
    J Allergy Clin Immunol 1989;84(3):353-8
  44. Perrick D, Stafford CT, Armstrong E, DuRant RH. Modification of the fluorescent allergosorbent test as an inhibition assay for determination of cross-reactivity among aeroallergens. J Allergy Clin Immunol 1991;87(1 Pt 1):98-103
  45. Su SN, Harris J, Lau GX, Han SH. Aqueous-organic solvent extraction of water-insoluble protein from ragweed pollen. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi 1987;20(2):104-12
  46. Asero R, Weber B, Mistrello G, Amato S, Madonini E, Cromwell O. Giant ragweed specific immunotherapy is not effective in a proportion of patients sensitized to short ragweed: analysis of the allergenic differences between short and giant ragweed. J Allergy Clin Immunol 2005;116(5):5-1041
  47. Sanger Institute Family: Pec_lyase_C (PF00544) http://pfam.sanger.ac.uk/family?acc=PF00544. Accessed: March 2008
  48. Fuchs T, Spitzauer S, Vente C, Hevler J, Kapiotis S, Rumpold H, Kraft D, Valenta R. Natural latex, grass pollen, and weed pollen share IgE epitopes.
    J Allergy Clin Immunol 1997;100(3):356-64
  49. Caballero T, Martin-Esteban M. Association between pollen hypersensitivity and edible vegetable allergy: a review. J Investig Allergol Clin Immunol 1998;8(1):6-16
  50. Enberg RN, Leickly FE, McCullough J, Bailey J,
    Ownby DR. Watermelon and ragweed share allergens.
    J Allergy Clin Immunol 1987;79(6):867-75
  51. de la Torre Morin F, Sanchez Machin I, Garcia Robaina JC, Fernandez-Caldas E, Sanchez Trivino M. Clinical cross-reactivity between Artemisia vulgaris and Matricaria chamomilla (chamomile). J Investig Allergol Clin Immunol 2001;11(2):118-22
  52. Fernandez C, Martin-Esteban M, Fiandor A,
    Pascual C, Lopez Serrano C, Martinez Alzamora F, Diaz Pena JM, Ojeda Casas JA.
    Analysis of cross-reactivity between sunflower pollen and other pollens of the Compositae family.
    J Allergy Clin Immunol 1993;92(5):660-7
  53. Bonnin JP, Grezard P, Colin L, Perrot H. A very significant case of allergy to celery cross-reacting with ragweed. [French] Allerg Immunol (Paris) 1995;27(3):91-3
  54. Dechamp C, Deviller P. Rules concerning allergy to celery (and other Umbellifera). [French] Allerg Immunol (Paris) 1987;19(3):112-4, 116
  55. Yun YY, Ko SH, Park JW, Hong CS. IgE immune response to Ginkgo biloba pollen.
    Ann Allergy Asthma Immunol 2000;85(4):298-302
  56. Pham NH, Baldo BA. Allergenic relationship between taxonomically diverse pollens.
    Clin Exp Allergy 1995;25(7):599-606
  57. Suzuki M, Komiyama N, Itoh M, Itoh H,
    Sone T, Kino K, Takagi I, Ohta N. Purification, characterization and molecular cloning of
    Cha o 1, a major allergen of Chamaecyparis obtusa (Japanese cypress) pollen.
    Mol Immunol 1996;33(4-5):451-60
  58. Paschke A, Kinder H, Zunker K, Wigotzki M,
    Steinhart H, Wessbecher R, Vieluf I. Characterization of cross-reacting allergens in mango fruit. Allergy 2001;56(3):237-42
  59. Leng X, Ye ST. An investigation on in vivo allergenicity of Artemisia annua leaves and stems. Asian Pac J Allergy Immunol 1987;5(2):125-8
  60. Shen HD, Chang LY, Gong YJ, Chang HN,
    Han SH. A monoclonal antibody against ragweed pollen cross-reacting with yellow dock pollen. [Chinese] Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi 1985;18(4):232-9
  61. Politi C, Costigliola A, Casaretti B, Zamparelli P,
    Scala A, Quattrin S. Respiratory allergies in the Flegrean region. [Italian] Arch Monaldi Mal Torace 1992;47(1-6):11-5
  62. Kadocsa E, Bittera I, Juhasz M. Results of skin tests, based on pollen count, in patients allergic to summertime seasonal rhinitis. [Hungarian] Orv Hetil 1991;132(29):1589-91
  63. Pollart SM, Chapman MD, Fiocco GP, Rose G, Platts-Mills TA. Epidemiology of acute asthma: IgE antibodies to common inhalant allergens as a risk factor for emergency room visits.
    J Allergy Clin Immunol 1989;83(5):875-82
  64. Rosenberg GL, Rosenthal RR, Norman PS. Inhalation challenge with ragweed pollen in ragweed-sensitive asthmatics.
    J Allergy Clin Immunol 1983;71(3):302-10
  65. Popa VT. Respiratory allergy to ragweed: correlation of bronchial responses to allergen with bronchial responses to histamine and circulating immunoglobulin E.
    J Allergy Clin Immunol 1980;65(5):389-97
  66. Bruce CA, Norman PS, Rosenthal RR, Lichtenstein LM. The role of ragweed pollen in autumnal asthma.
    J Allergy Clin Immunol 1977;59(6):449-59
  67. Osur SL, Volovitz B, Dickson S, Enck DC, Bernstein JM. Eustachian tube dysfunction in children with ragweed hayfever during natural  pollen exposure.
    Allergy Proc 1989;10(2):133-9
  68. Fisher AA. Esoteric contact dermatitis. Part III: Ragweed dermatitis.
    Cutis 1996;57(4):199-200
  69. Bagarozzi DA Jr, Potempa J, Travis J. Purification and characterization of an arginine-specific peptidase from ragweed (Ambrosia artemisiifolia) pollen.
    Am J Respir Cell Mol Biol 1998;18(3):363-9
  70. Hidvegi T, Schmidt B, Varga L, Dervaderics M,
    Lantos A, Gonczi Z, Barok J, Otos M, Kirschfink M, Spath P, et al. In vitro complement activation by ragweed allergen extract in the sera of ragweed allergic and non-allergic persons.
    Immunol Lett 1995;48(1):65-71
  71. Gonczi Z, Varga L, Hidvegi T, Schmidt B, Panya A, Kokai M, Fust G. The severity of clinical symptoms in ragweed-allergic patients is related to the extent of ragweed-induced complement activation in their sera.
    Allergy 1997;52(11):1110-4
  72. Huang SK, Marsh DG. Human T-cell responses to ragweed allergens: Amb V homologues. Immunology 1991;73(3):363-5
  73. Kato S, Nakai Y, Ohashi Y, Kato M. RAST in diagnosis and therapy of allergic rhinitis.
    Acta Otolaryngol Suppl 1991;486:209-16
  74. Tang RB, Wu KK. Total serum IgE, allergy skin testing, and the radioallergosorbent test for the diagnosis of allergy in asthmatic children. Ann Allergy 1989;62(5):432-5
  75. Williams PB, Siegel C, Portnoy J. Efficacy of a single diagnostic test for sensitization to common inhalant allergens. Ann Allergy Asthma Immunol 2001;86(2):196-202
  76. Perera MG, Bernstein IL, Michael JG, Johansson SG. Predictability of the radioallergosorbent test (RAST) in ragweed pollenosis.
    Am Rev Respir Dis 1975;111(5):605-10
  77. Gergen PJ, Turkeltaub PC, Kovar MG. The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey.
    J Allergy Clin Immunol 1987;80(5):669-79
  78. Kosisky SE, Carpenter GB. Predominant tree aeroallergens of the Washington, DC area: a six year survey (1989-1994). Ann Allergy Asthma Immunol 1997;78(4):381-92
  79. Sneller MR, Hayes HD, Pinnas JL. Pollen changes during five decades of urbanization in Tucson, Arizona.
    Ann Allergy 1993;71(6):519-24
  80. Buck P, Levetin E. Weather patterns and ragweed pollen production in Tulsa, Oklahoma. Ann Allergy 1982;49(5):272-5
  81. Taksey J, Craig TJ. Allergy test results of a rural and small-city population compared with those of an urban population. J Am Osteopath Assoc 2001;101(5 Suppl):S4-7
  82. Lewis SA, Weiss ST, Platts-Mills TA, Syring M,
    Gold DR. Association of specific allergen sensitization with socioeconomic factors and allergic disease in a population of Boston women.
    J Allergy Clin Immunol 2001;107(4):615-22
  83. Bucholtz GA, Lockey RF, Wunderlin RP, Binford LR, Stablein JJ, Serbousek D, Fernandez-Caldas E. A three-year aerobiologic pollen survey of the Tampa Bay area, Florida. Ann Allergy 1991;67(5):534-40
  84. Kang BC, Johnson J, Veres-Thorner C. Atopic profile of inner-city asthma with a comparative analysis on the cockroach-sensitive and ragweed-sensitive subgroups. J Allergy Clin Immunol 1993;92(6):802-11
  85. Wedner HJ, Wilson P, Lewis WH. Allergic reactivity to Parthenium hysterophorus pollen: an ELISA study of 582 sera from the United States Gulf Coast.
    J Allergy Clin Immunol 1989;84(2):263-71
  86. Wedner HJ, Zenger VE, Lewis WH. Allergic reactivity of Parthenium hysterophorus (Santa Maria feverfew) pollen: an unrecognized allergen. Int Arch Allergy Appl Immunol 1987;84(2):116-22
  87. Sriramarao P, Rao PV. Allergenic cross-reactivity between Parthenium and ragweed pollen allergens.
    Int Arch Allergy Immunol 1993;100(1):79-85
  88. Boulet LP, Turcotte H, Laprise C, Lavertu C, Bedard PM, Lavoie A, Hebert J. Comparative degree and type of sensitization to common indoor and outdoor allergens in subjects with allergic rhinitis and/or asthma.
    Clin Exp Allergy 1997;27(1):52-9
  89. Banken R, Comtois P. Concentration of ragweed pollen and prevalence of allergic rhinitis in 2 municipalities in the Laurentides. [French] Allerg Immunol (Paris) 1992;24(3):91-4
  90. D’Amato G, Spieksma FT, Liccardi G, Jager S,
    Russo M, Kontou-Fili K, Nikkels H, Wuthrich B, Bonini S. Pollen-related allergy in Europe. Allergy 1998;53(6):567-78
  91. Corsico R, Falagiani P, Ariano R, Berra D, Biale C, Bonifazi F, Campi P, Feliziani V, Frenguelli G, Galimberti M, Gallesio MT, Liccardi G, Loreti A, An epidemiological survey on the allergological importance of some emerging pollens in Italy. J Investig Allergol Clin Immunol 2000;10(3):155-61
  92. Verini M, Rossi N, Verrotti A, Pelaccia G, Nicodemo A, Chiarelli F. Sensitization to environmental antigens in asthmatic children from a central Italian area.
    Sci Total Environ 2001;270(1-3):63-9
  93. Thibaudon M. Ragweed in France; some air pollen data for the years 1987-1990. [French] Allerg Immunol (Paris) 1992;24(1):9-16
  94. Comtois P, Sherknies D. Ragweed pollen (Ambrosia artemisiifolia L.): prediction and prevention. [French] Allerg Immunol (Paris) 1992;24(1):22-6
  95. Dechamp C, Dechamp J. Ragweed pollen counts (P. Cour collection apparatus) from Lyon-Bron from 1982 to 1989: results, informing the public. [French] Allerg Immunol (Paris) 1992;24(1):17-21
  96. Harf R, Contassot JC, Dechamp C, Despres B,
    Deviller P, Diter P, Garcier Y, Liard R, Neukirch F, Quelin P, et al. Biological and clinical prevalence of pollinosis caused by ragweeds of the upper valley of the Rhone corridor. [French] Allerg Immunol (Paris) 1992;24(3):95-7
  97. Couturier P. Dispersion of ragweed in the Drome-Ardeche region. [French] Allerg Immunol (Paris) 1992;24(1):27-31
  98. Ramos Morin CJ, Canseco Gonzalez C. Hypersensitivity to airborne allergens common in the central region of Coahuila. [Spanish] Rev Alerg Mex 1994;41(3):84-7
  99. Gilardi S, Torricelli R, Peeters AG, Wuthrich B.
    Pollinosis in Canton Ticino. A prospective study in Locarno. [German] Schweiz Med Wochenschr 1994;124(42):1841-7
  100. Kadocsa E, Juhasz M. Lawn grass (Poaceae) causing hayfever in the South Plain of Hungary. Results of aeropalinologic and allergologic studies 1989-95. [Hungarian] Orv Hetil 1997;138(14):851-4
  101. Mezei G, Jaraine KM, Medzihradszky Z, Cserhati E. Seasonal allergic rhinitis and pollen count (a 5-year survey in Budapest) [Hungarian] Orv Hetil 1995;136(32):1721-4
  102. Lu DW. Investigations on ragweed pollens in the air in Qingdao District and its allergenicity. [Chinese] Zhonghua Yu Fang Yi Xue Za Zhi 1992;26(4):216-8
  103. Yang Y. Allergic asthma caused by ragweed pollen. [Chinese] Zhonghua Yi Xue Za Zhi 1983;63(12):740-2
  104. Chen CD, Chang DW, Wu CC. Skin tests in asthmatic patients in Taiwan. [Chinese] Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi 1984;17(2):98-104
  105. Wang JY, Chen WY. Inhalant allergens in asthmatic children in Taiwan: comparison evaluation of skin testing, radioallergosorbent test and multiple allergosorbent chemiluminescent assay for specific IgE.
    J Formos Med Assoc 1992;91(12):1127-32
  106. Park HS, Jung KS, Jee SY, Hong SH, Kim HY,
    Nahm DH. Are there any links between Hop Japanese pollen and other weed pollens or food allergens on skin prick tests?
    Allergy Asthma Proc 2001;22(1):43-6
  107. Yamaguchi H. Evaluation of immediate hypersensitivity and environmental factors by intracutaneous skin tests and specific IgE antibodies in allergic children. Part 1. The annual change of immediate hypersensitivity measured by intracutaneous skin tests and radioallergosorbent test. [Japanese] Arerugi 1993;42(4):571-81
  108. Shimada T. Four years study on Japanese cedar, orchard grass and ragweed pollinosis in Yotsukaido City – radioallergosorbent test (RAST) results of 361 patients [Japanese] Nippon Jibiinkoka Gakkai Kaiho 1986;89(7):864-71
  109. Kusunoki T, Korematsu S, Harazaki M, Ito M,
    Hosoi S. Recent pollen sensitization and its possible involvement in allergic diseases among children in a pediatric allergy clinic. [Japanese] Arerugi 1999;48(10):1166-71
  110. Caraballo L, Puerta L, Fernandez-Caldas E, Lockey RF, Martinez B. Sensitization to mite allergens and acute asthma in a tropical environment. J Investig Allergol Clin Immunol 1998;8(5):281-4
  111. Bass DJ, Delpech V, Beard J, Bass P, Walls RS.
    Late summer and fall (March-May) pollen allergy and respiratory disease in Northern New South Wales, Australia. Ann Allergy Asthma Immunol 2000;85(5):374-81
  112. Alshishtawy MM, Abdella AM, Gelber LE, Chapman MD. Asthma in Tanta, Egypt: serologic analysis of total and specific IgE antibody levels and their relationship to parasite infection. Int Arch Allergy Appl Immunol 1991;96(4):348-54
  113. Greenberger PA, Flais MJ. Bee pollen-induced anaphylactic reaction in an unknowingly sensitized subject. Ann Allergy Asthma Immunol 2001;86(2):239-42

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.