Type:
Whole Allergen
Whole Allergen
Whole Allergen
Cheese, mold type
Ingestion
Cheese is a milk-derived food product, obtained from raw or pasteurized, whole or semi-skimmed, milk from various species, following a variety of industrial or artisanal physico-chemical and microbiological procedures. Milk proteolysis takes place during cheese production. Mold-type cheese involves different fungal species during the cheese ripening process. A great diversity of molds and yeasts is present at the surface and in some cases inside the mold-type cheeses. Food-related and occupational IgE sensitization to mold-type cheese has been reported.
A mixture of cheeses from cow’s milk (Camembert, brie, Gorgonzola) and ewe’s milk (Roquefort).
During cheese manufacture, the curdling (coagulation) step results in the separation of milk caseins (curd, approximately 80% of milk proteins) and milk whey (soluble) proteins [1]. The curds are used for the next steps of cheese making, which include proteolysis with breakdown of proteins into peptides [2, 3]. Various species of Penicillium are used for manufacturing mold-type cheeses, such as Penicillium camemberti (Camembert and brie cheese), Penicillium candidum (Camembert, brie and Gorgonzola cheese), or Penicillium roqueforti (Roquefort cheese). Mold-type cheese contains a genuine microbiota, both inside and at the surface of the cheese (edible rind), with a great diversity of bacteria and yeasts reported in the literature [2, 4]. Blue or green marbling of mold-type cheeses, as seen in Roquefort or Gorgonzola, denotes the growth of mold spores into hyphae. Yeast species which have been reported from mold-type cheeses include Candida spp (C. catenulate, C. famate, C. intermedia, C. kefyr, C. lipolytica among others), Rhodotorula mucilaginosa, Rhodotorula minuta, Rhodotorula glutinis, Debaryomyces hansenii, Saccharomyces cerevisiae, Saccharomyces kluyveri, Cryptococcus albidus, Geotrichum spp, Trichosporon spp, Torulaspora spp [5, 6].
Milk (raw or heated, processed), microbial and/or enzymatic components necessary for cheese production (such as pepsin and chymosin for mold-type cheese) [2].
Milk allergy is a risk factor for cheese allergy, due to shared allergenic components [1]. Atopy is a risk factor for occupational allergy to cheese [7].
It is estimated that a third of the global cow’s milk production, and the major part of ewe’s and goat’s milk production, are used for making cheese [2].
The main route of exposure to cheese is ingestion.
Occupational exposure in cheesemakers is an alternative route exposure.
Depending on the route of exposure, allergy to cheese may present as food or respiratory allergy.
Proteolysis of milk allergens retained following cheese coagulation, i.e. mainly casein, results in cheese displaying lower allergenicity than milk, albeit higher than baked milk [2, 8, 9]. The corresponding categorization of milk-allergic patients in three groups is relevant for better diagnostic and management stratification of milk allergic patients [8].
Molds used for cheese manufacture are saprophytic and usually not associated with human disease except in occupational settings. Hypersensitivity pneumonitis or extrinsic allergic alveolitis have been reported in patients occupationally exposed to Penicillium spp used during cheese manufacturing, such as P. roqueforti [10] or P. verrucosum [11]. Exceptionally, they may however cause infections, as reported in an immunocompetent 40-year old female who developed a typical fungus ball with Penicillium roqueforti [12].
Occupational rhinitis and asthma may be caused by ingredients added during cheese manufacture such as enzymes (e.g. calf chymosin) from natural or artificial rennet [7].
Food allergy to dyes used for cheese (e.g. annatto) has been reported as anaphylaxis in a 58-year old atopic patient [13].
Caseins are the main milk allergens retained in cheese. Caseins undergoes physico-chemical and enzymatic processing resulting in lower allergenicity as compared to milk, but greater than allergenicity of heat-denatured casein from baked milk [8].
Caseins from cow’s milk, but not from ewe’s milk or goat milk, are included in the IUIS/WHO Nomenclature as of June 20, 2022 [14].
Name |
Biochemical activity |
Molecular weight (kDa) |
Glycosylation |
Major/minor allergen |
Marker allergen |
IUIS |
Reference |
---|---|---|---|---|---|---|---|
Bos d 8 |
caseins (casein family) |
20-30 |
(variable) |
Major |
Yes |
Yes |
[1, 14] |
Bos d 9 |
alphaS1-casein |
23.6 |
No |
Major |
Yes |
Yes |
[1, 14] |
Bos d 10 |
alphaS2-casein |
25.2 |
No |
Major |
Yes |
Yes |
[1, 14] |
Bos d 11 |
beta-casein |
24 |
No |
Major |
Yes |
Yes |
[1, 14] |
Bos d 12 |
kappa-casein |
19 |
Yes |
Major |
Yes |
Yes |
[1, 14] |
Name |
Biochemical activity |
Molecular weight (kDa) |
Glycosylation |
Major/minor allergen |
Marker allergen |
IUIS |
Reference |
---|
Severe clinical reactions to ewe’s milk cheese and goat’s milk cheese may occur upon consumption by patients otherwise tolerant to cow’s milk products [15].
Reports of allergenic cross-reactivity involving fungal species used for cheese manufacturing are scarce. However, a variety of allergenic fungal species may grow on cheese as a result of food spoilage, including Aspergillus flavus, Aspergillus niger, and various Penicillium spp [6].
IgE sensitization to molds and yeasts resulting in clinical reactions to wine, cider, and some beers together with skin reactivity to blue cheese, was reported in a 19-year old atopic patient [16].
Author: Joana Vitte
Reviewer: Dr. Christian Fischer
Last reviewed: June 2022.