Plantain (English)/ Ribwort

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Code: w9
Latin name: Plantago lanceolata
Source material: Pollen
Family: Plantaginaceae
Common names: English Plantain, Ribwort Plantain, Ribwort

Allergen Exposure

Plants in the genus Plantago, commonly known as Plantains, generally have a rosette of basal leaves and flowers on a dense, terminal spike. These green weedy plants are native to Europe and Asia, but now grow practically anywhere in the world. English Plantain is common in most temperate regions, and is considered a troublesome pollen weed in such diverse areas as New Zealand, Mauritania, Italy, Canada, Ecuador, Belgium, Germany, France and the USA.

English Plantain is an erect perennial growing 0.3m to 0.5m in height. The leaves are found at the base of the stalk, and are dark green, 5 to 40cm long, 8 to 25mm wide, and 3-ribbed, with a smooth, wavy texture. The margins are slightly toothed. The leaves are oblong or lance-shaped, tapering at the base into a slender stalk. The leaf axils are often filled with long brownish cottony hairs.

The plant flowers from April to August. The spike is 2 to 7.5cm long at the tip of the flower stalks, and each crowded flower has 4 parchment-like petals 3mm long; 4 stamens on hair-like stalks ending in large, cream-coloured anthers; and bracts present under flowers. The flowers are hermaphrodite (have both male and female organs) and are pollinated by wind and insects. The plant is also self-fertilising. English Plantain produces more pollen than the other Plantains. Rugel Plantain has the potential to cause hay fever, but the pollen is produced in such small quantities that it is considered of less importance as an allergen. The seeds ripen from June to September. The 3mm-long seedpods are globe-shaped, dry and papery, and contain 2 seeds. They open by the upper half falling off as a lid. The seeds are boat-shaped, the surface usually shiny, and greenish brown to dark brown.

Plantain is found on grasslands, roadsides, and cultivated ground. The English Plantain is a troublesome weed; it often invades lawns and gardens.

The leaves and stems are used in salads or for herbal therapies.

Allergen Exposure

Initially at least 16 different antigens were detected in Plantain pollen, and at least 6 of these antigens may be allergenic. (1) Subsequent studies isolated 3 specific allergens of 17, 19, and 40 kDa. (2)

The following allergens have been characterised:

Pla l 1, a 17-20 kDa protein with an unknown biological function, a major allergen. (3, 4, 5, 6, 7, 8, 9, 10, 11, 12)

Pla l Cytochrome C, a cytochrome c protein. (13)

Pla l CBP, a calcium binding protein. (14)

Pla I 1, occurs as 16 to 20 kDa isoforms. Pla I 1 shares a partial sequence identity with Ole e 1. The prevalence of specific IgE to purified Pla l 1 in Plantain-allergic patients was demonstrated to be 86%, and this represents about 80% of the total allergen-specific IgE-binding capacity of the Plantain extract. (4) However, although Pla l 1 is an Ole e 1-related protein (olive tree pollen) this similarity appears to have little clinical relevance. (15)

In a Spanish study of 179 pollen-sensitized patients who underwent skin prick testing with pollen extract and allergen-specific IgE determination against different allergens, 94 (53%) were sensitised to P. lanceolata and 8 (5%) to Pla l 1. (10)

Potential Cross-Reactivity

An extensive cross-reactivity among the different individual species of the genus could be expected, as well as to a certain degree among members of the family Plantaginaceae. (16) However, contrary to the taxonomical inferences, the results of two studies showed that there was little cross-allergenicity between English Plantain pollen and Psyllium (P. ovata), closely related members of the same genus. (17, 18) These studies are contrary to an earlier study which suggested that English Plantain may cross-react to Psyllium. (19) Thus indicating the presence of both common and species specific allergens.

Cross-reactivity between grass and Plantain pollen is mainly caused by a 30-kDa protein in Plantain pollen. A Group 5 grass pollen allergen is probably responsible for most grass/Plantain cross-reactivity. (2)

Pla I 1 and Ole e 1 from Olive tree pollen share 38.7% of their amino acid sequences. ( 5, 6, 8) The Ole e 1-like family of proteins comprises allergenic members (Fra e 1, Lig v 1, Syr v 1 from Oleaceae species; Pla l 1 from P. lanceolata; Che a 1 from Chenopodium album; Lol p 11 from Lolium perenne; and Phl p 11 from Phleum pratense). (20)

A 2 EF-hand calcium-binding allergen from Timothy grass pollen, Phl p 7, has been shown to contain the majority of relevant IgE epitopes among calcium-binding allergens occurring in pollen species of different plants, including ribwort (English Plantain). (14)

Immunoblotting inhibition experiments, performed with extracts of Melon, P. lanceolata pollen and Dactylis glomerata pollen, showed that all allergens of Melon blotting were almost completely inhibited by grass and Plantago pollen extracts. The results support the presence of structurally similar allergens in Melon, Plantago and grass pollens, and that all allergenic epitopes of Melon are present in these pollens. (21, 22)

Sera from subjects diagnosed as 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 might not necessarily be a true reflection of sensitising pollen species. (23)

Preliminary evidence for cross-reactivity between English Plantain and Paterson's Curse (Echium plantagineum) was demonstrated by RAST inhibition studies. (13)

A French study reported that Plantain is frequently associated with sensitisation to Latex, but no common allergen was detected. (24)

Clinical Experience

IgE mediated reactions

English Plantain pollen is an important cause of asthma, allergic rhinitis and allergic conjunctivitis, particularly in the temperate regions of North America, Australia and Europe. (11, 12, 25, 26, 27, 28, 29)

Plantain pollen has been shown to be present in relatively large amounts in Montpellier, in southern France, and was the second most important cause of allergy, after grass pollen allergy, in pollen-allergic patients. (30)

Plantago pollen has been found in aerobiological studies of the air of Badajoz (31) and Estepona in the "Costa del Sol" (32) in southwest Spain. Allergen-specific IgE to this pollen was demonstrated in Madrid in allergic individuals with Cupressaceae pollinosis. (33) In Salamanca, in a study to evaluate allergy to plant-derived fresh foods among pollen-allergic patients from a Birch- and Ragweed-free area, in 95 pollen-allergic patients, the largest number were sensitised to grass (Lolium and Phleum; 97.9%), followed by tree (Olea; 82.1%) and Plantago (64.2%). (34) The flowering of grasses, along with Plantago, occurs earlier and lasts longer in the south than the north of Spain.  (35) Asthma-related hospital emergencies in Madrid was associated with a lag of 1 day for Urticaceae, a lag of 2 days for Plantago, and a day lag of 3 days for Poaceae. (36)

Plantago pollen is also a prominent aeroallergen in Italy, depending on geographical location, as documented in a study involving 80 data-gathering stations and 40 clinical centres nationwide. (37)

Several countries in Europe have documented the importance of Plantago pollen as an allergen. Plantago pollen has been shown to be a prominent allergen in aerobiological surveys in Cordoba, Salamanca and Seville, in Spain, (38, 39, 40) In the north of France, this plant’s pollen was the third most prevalent cause of pollinosis in children, (41) and it was one of the most important pollens in Zurich, Switzerland. (26, 42, 43)

In a Polish study involving 22 patients between 13 and 53 years of age with seasonal allergic rhinitis, specific IgE determination demonstrated the importance of English Plantain as an aeroallergen. (44) In a second study from this country, in 2561 patients suffering from upper airway allergy symptoms, hypersensitivity to weed pollen allergens was found in 1069 patients with pollinosis. In patients sensitised to weeds, the most prevalent allergens were Wormwood (86.2%), Mugwort (82.9%), White Goosefoot (44.3%), and Narrowleaf Plantain (28.8%). (45)

Plantago pollen has also been found in aerobiological surveys in Athens, (46) in Balikesir (47) and Bitlis (48) in Turkey, and in the Canary Islands. (49) A study measuring specific IgE in patients with allergic rhinitis in south Hungary showed Plantago pollen to be an important allergen in sensitisation. (50)

In a study of Kibbutz Netzer Sereni, a rural community in Israel, air sampling demonstrated that English Plantain was one of the most prevalent allergenic pollens. (51)

English Plantain has also been shown to be a very prevalent allergen in England. In Surrey, 34% of sera from subjects with respiratory allergy had specific IgE to Plantain. (52)

In New South Wales, Australia, in 3 populations of schoolchildren aged 8 to 11 years and living in different climatic areas, 95 to 97% of all atopic children were sensitised to one of seven allergens, including English Plantain, House Dust, Dermatophagoides farinae, D. pteronyssinus, Cat dander, Plantain, Rye grass, and Alternaria tenuis. (53)

Few studies on English Plantain have emanated from the USA. In St. Louis, Missouri, English Plantain was found to be present but not a prominent problem. (54) Similarly, a study of the United States Gulf Coast stated that Plantago pollen was very infrequently sampled (less than 0.1% in the air) even though several species were common in the area. (55) Similarly, Plantago was detected in Alaska, but in low levels. (56, 57)

In children with wheezing bronchitis on the small Pacific island of Niue, skin testing and serologic results indicated that hypersensitivity to House Dust mite (Dermatophagoides pteronyssinus) and Plantain (P. lanceolata) antigens were associated with the wheezing bronchitis. (58)

An early study of atmospheric counts of aeroallergens in Tehran, Iran, documented the presence of English Plantain in the atmosphere. (59)

Immediate and delayed cutaneous hypersensitivity are believed to be implicated in the physiopathology of atopic dermatitis. A study to evaluate Type I and Type IV allergy to aeroallergens in children with atopic dermatitis reported that of 59 children presenting with this condition and tested with common environmental aeroallergens, 9.8% were sensitised to Plantain pollen. (60)

The measurement of allergen-specific IgE antibodies is one method of determining sensitisation to English Plantain. Various diagnostic tests may be required to confirm clinical sensitivity. (61)

Compiled by Dr Harris Steinman, harris@allergyadvisor.com

References

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