Tables of pollen cross-reactivities for formulating allergen immunotherapy*designated as a recommended representative for allergen immunotherapy (WeberRW, Guidelines for using pollen cross-reactivity in formulating allergen immunotherapy, JACI, July 2008)General Patterns of Allergenic Cross-ReactivityBotany taxonomic ranks: kingdom>phylum>class>order>family>subfamily>tribe>genus>speciesSame tribe or genusClosely-related compositions and protein structuresStrong cross-reactionsSame family or subfamilySimilar compositions with different/unique structuresModerate cross-reactionsDifferent subfamilies or familiesDistinct compositions/structures, minimal similaritiesLow/no cross-reactionsWeedsFamilyGenusCommon name and speciesNotesAsteraceaeArtemisiaMugwort (A. vulgaris)*Common/giant sagebrush (A. tridentata)*WormwoodCross-react within genusMay evaluate and treat with one member; use mugwortin Europe and eastern US, sagebrush in midwestern and western USAmbrosiaShort ragweed (A. artemisiifolia)*Giant ragweed (A. trifida)*False ragweed (A. acanthicarpa)*Western ragweed (A. psilostachya)*Cross-react within genus May treat with one member, but common to treat with both short and giant ragweeds due to possible unique major/minor allergensAmbrosia, Xanthium, and Ivain same family and may cross-react, some authors recommend using limited number of allergens from cross-reactive groupsSouthern ragweedSlender ragweedDo not cross-react well with other ragweeds, consider treating separatelyIvaBurweed marshelder (I. xanthifolia)*Rough marshelder (I. ciliata)Poverty weedCross-react within genus, choose one (usually burweed marshelder)XanthiumCocklebur (X. communis)*Consider treating separatelyAmaranthaceaeAtriplex(“saltbush”)Redroot pigweed (A. retroflexus)*PigweedAmaranthCross-react within genus, choose one (usually redroot pigweed)AmaranthusWingscale(A. canescens)*Cross-react within genus, choose one (usually wingscale)Chenopodioiddeae subfamily (formerly known as Chenopodiaceae family)SalsolaRussian thistle (S. pestifer= S. kali)*May possess unique allergens, treat separatelyKochiaBurning bush (K. scoparia)*May possess unique allergens, treat separatelyChenopodiumLamb’s quarters(C. album)Mexican teaCross-react within genusLamb’s quarter has strong cross-reactivity with Salsola(e.g. Russian thistle) and Kochia(e.g. burning bush) sppUrticaceaeUrticaNettle (U. dioica)*Nettle and pellitory with unique allergens, treat separatelyParietariaPellitory (P. judaica)*PlantaginaceaePlantagoEnglish plantain (P. lanceolota)Treat separatelyPolygonaceaeRumexSheep’s sorrel (R. acetosella)DockCross-react within genusGrassesFamilyCommon name and genus/speciesNotesPooideaeTimothy (Phleum pratense)*Sweet vernalMeadow fescueRyeJuneKentucky blueOrchardRed topVelvetCanaryCereal grains (e.g. wheat, rye, barley)Cross-react within familyTimothy and sweet vernal may have unique allergensTreat with one member (usually timothy) but consider addition of sweet vernal if neededChloridoideaeBermuda (Cynodon dactylis)*LovegrassPrairie grasses including salt, buffalo, gramaCross-react within family, choose one (usually bermuda)PanicoideaeJohnson (Sorghum halepense)*BahiaCornSugarcaneCross-react within familyEvaluate bahia and johnson separatelyMay treat with one member(usually johnson) but consider treating bahia and johnson separately
*designated as a recommended representative for allergen immunotherapy (WeberRW, Guidelines for using pollen cross-reactivity in formulating allergen immunotherapy, JACI, July 2008)ReferencesWeberRW, Guidelines for using pollen cross-reactivity in formulating allergen immunotherapy, JACI, 7/2008Cox et al, Allergen immunotherapy: A practice parameter thirdupdate, JACI, 1/2011WeberRW, Patterns of pollen cross-allergenicity, JACI, 8/2003WeberRW, Cross-reactivity of Plant and Animal Allergens, Clin Rev in All and Imm, 2001Esch RE, Portnoy J, Allergen Immunotherapy, Curr All Asthma Reports, 2001TreesFamily and subfamilyCommon name and genus/speciesNotesCupressaceaeMountain cedar (Juniperus ashe)*Other juniper, cedar treesCypressCross-react within family(except Taxodioideae)May evaluate and treat with one member, usually mountaincedarTaxodioideaeJapanese red cedar (Cryptomeria japonica)*Not a truecedar; evaluate and treat separatelyfrom other CupressaceaeJapanese red cedar is the only species in this genusPinaceaeWhite pine (Pinus strobus)*Other pine treesSpruceCross-react within family, choose one (usually white pine)FabaceaeMimosaLocustMesquiteCross-react within familyBetulaceaeSilver birch (Betula verrucosa)*European alder (Alnus glutinosa)*HazelnutHornbeamCross-react within family, and between Betulaceae/Fagaceae familiesThe use of one locally prevalent member adequate (usually birch, alder, or oak)FagaceaeWhite oak (Quercus alba)*Red oakBeechChestnutJuglandaceaeCaryaPecan (C. illinoensis)HickoryCross-react within familyJuglansBlack walnut (J. nigra)OleaceaeAsh (Fraxinus excelsior)*European olive (Olea europaea)*PrivetLilacCross-react within family, choose one locally prevalent member (usually ash in N. America)SalicaceaePopulusEastern cottonwoodPoplarAspenCross-react within genusand family, cottonwoodand willowin particularSalixWillowSapindaceaeAcerRed maple (A. rubrum)*Cross-react within genus but box elder may have unique allergens, evaluate and treat box elder separatelyBox elder (A. negundo)*UlmaceaeUlmusAmerican elm Chinese elm Siberian elm Cross-react within genusMoraceaeWhite mulberry(Morus alba)Paper mulberry(Morus papyrifera)Cross-react within genusPlatanaceaeAmerican sycamore(Platanus occidentalis)Cross-react within genusAltingiaceaeAmerican sweetgum(Liquidambar styraciflua)Cross-react within genusArthropodsGenusCommon name and speciesNotesDermatophagoidesDust mite (D. pteronyssinus, D. farinae)Cross-react but also have significant unique allergens, if treating with both decrease dose of eachBlatellaGerman cockroach(B. germanica)Unique allergens, treat with both at full doseAlthough, German cockroaches are most likely to occur in American homes, an equal mixture of German and American is appropriatePeriplaneta American cockroach(P. americana)AedesMosquito (A. aegyptii)Treat separately