Table of Contents

Whole Allergen

t222 Arizona cypress pollen

t222 Arizona cypress pollen Scientific Information

Type:

Whole Allergen

Display Name:

Arizona cypress pollen

Allergen code:

t222

Family:

Cupressaceae

Species:

Hesperocyparis arizonica (formerly: Cupressus arizonica)

Route of Exposure:

inhalation

Source Material:

Pollen

Latin Name:

Hesperocyparis arizonica

Other Names:

Cypress, Arizona rough cypress, Cedro blanco, C. glabra, C. arizonica var. glabra

WHO/ICD-11 code:

XM5TH6

(ICD-11 is currently under implementation by WHO and the ICD-11 codes displayed in the encyclopedia may not yet be available in all countries)

Summary

Arizona cypress, indigenous to North America, has been extensively planted in the Mediterranean area, the Middle East, and Australia. It bears considerable resemblance with other members of the Cupressaceae family regarding pollen characteristics (small and anemophilous), pollination season (winter), symptoms (rhinitis and rhinoconjunctivitis with virtually no asthma), diagnosis (interchangeable whole allergens and molecular allergens), treatment, and prevention.

Allergen

Nature

Arizona cypress (Hesperocyparis arizonica, formerly known as Cupressus arizonica) is typically used as a windbreak, privacy screen, ornamental tree, or for soil erosion prevention. Arizona cypress is a steeple-shaped, coniferous evergreen that can grow over 25 m tall. Its leaves are pale green to grey-blue. The small, inconspicuous yellow flowers are monoecious (individual flowers are either male or female, but both sexes can be found on the same plant) and are pollinated by wind (anemophilous pollen) (1).

Taxonomy

The Cupressaceae family contains five genera: Cupressus, Hesperocyparis, Juniperus, Cryptomeria, and Chamaecyparis. Arizona cypress, currently classified as Hesperocyparis arizonica, was formerly known as Cupressus arizonica (1-4).

Taxonomic tree of Arizona cypress
Kingdom	Plantae
Clade	Tracheophytes
Division	Pinophyta
Class	Pinopsida
Subclass	Pinidae
Clade	Conifers II
Family	Cupressaceae
Genus	Hesperocyparis
Species	H. arizonica

Tissue

Pollen grains from Arizona cypress are spherical, with a diameter of 24 µm (5). Due to morphological resemblance and extensive cross-reactivity (6), pollens of the Cupressaceae family are counted together. They make up an important part of global airborne pollen counts, e.g. 25% to 40% in Mediterranean areas, 30% in Mexico, up to 10% on the Eastern coast of the US, 19% in Yunnan, China, and up to 60% in Japan (1). Cupressaceae pollen is anemophilous, meaning that it becomes airborne; its small size favors its dispersion over long distances, outside the actual region where the trees grow (1). Arizona cypress pollinates in January and February and partially overlaps with C. sempervirens, which pollinates from February to the end of March (7). Cupressaceae pollens can persist during all seasons and their allergenicity may be accentuated by air pollution (1,5).

Epidemiology

Worldwide distribution

Pollen grains from Arizona cypress contain allergenic molecules able to induce sensitization and allergic diseases. The allergenicity of Arizona cypress pollen was reported to be higher than that of C. sempervirens (8,9). Arizona cypress pollinosis occurs mainly in Central and North America, where the tree is indigenous, and in the Mediterranean area, Iran, South Africa, and Australia (1).

Risk factors

The individual risk factors for being diagnosed with Cupressaceae allergy were addressed in 110 Cupressaceae-allergic consecutive outpatients from Southern France, as compared with grass pollen allergic patients from the same clinic (10). Significantly different features between the two patient groups were: equal gender distribution (vs a male/female ratio of 2 for grass pollinosis, p = 0.001), later age of symptom onset (32 vs 18, p = 0.0002), and relatively high prevalence of dry cough (16.5% vs 0%, p = 0.008) for Cupressaceae pollinosis. The later age of onset of Cupressaceae pollinosis, especially in monosensitized patients, is consistently retrieved in other studies (11-13).

Environmental Characteristics

Living environment

Arizona cypress shares with other trees from the Cupressaceae family the ability to grow in arid and hot areas, explaining their widespread use as ornamental trees in the 20^th century (1,4,5).

Worldwide distribution (of the species)

Arizona cypress is the only cypress species native to the south-west of North America. It can be found in coniferous woodlands on rough, very dry and very rocky soils. It has been widely exported, especially to Europe, where it is now the second most common cypress species following the Italian (funeral) cypress (Cupressus sempervirens), but also to Australia and the Middle East (1-4). The wide use of Arizona cypress for reforestation, wind and noise barriers, and ornamentally in gardens and parks, especially in the Mediterranean area and in North America, led to an increase in annual pollen counts (14-17).

Route of Exposure

Main

The main route of exposure to Arizona cypress allergens is inhalation of allergenic pollen, which occurs mainly during the pollination season in January and February.

Secondary

Direct skin contact with Cupressaceae pollen or resin may result in contact dermatitis (18).

Clinical Relevance

Cupressaceae pollinosis, including Arizona cypress, manifests during wintertime, mainly as rhinitis or rhinoconjunctivitis, less often as asthma or cutaneous symptoms, and exceptionally as bronchitis (1,19,20). Its prevalence increases with exposure to Cupressaceae pollens, which has plummeted during the second half of last century, due to the extended use of Cupressaceae as ornamental trees next to housing units (1,9). In fact, Cupressaceae pollinosis was underestimated until the end of the 20^th century, because of the lack of physician and patient awareness and lack of performant Cupressaceae pollen extracts for diagnostic testing (7,11,12). Due to the similar morphology of Cupressaceae pollens, to their allergenic cross-reactivity and to the interchangeable use of pollen extracts for diagnosis, such as Juniperus ashei, Arizona cypress, C. sempervirens, and more recently the molecular allergen Cup a 1 (21,22), Arizona cypress pollinosis is not distinguished from pollinosis induced by other Cupressaceae genera or species (1,10).

For further details on the clinical relevance of Cupressaceae pollinosis, the reader is referred to the Cupressus sempervirens (t23) section.

Diagnostics Sensitization

Arizona cypress extracts have been consistently found more potent than C. sempervirens for the diagnosis of Cupressaceae sensitization and allergy with skin prick tests and in vitro assays (6,9,23). Following the characterization of the major allergen Cup a 1 and the demonstration of its sequence identity and cross-reactivity with other Cupressaceae pectate lyases Cup s 1 (C. sempervirens), Jun a 1 (Juniperus ashei), Cry j 1 (Cryptomeria japonica), and Cha o 1 (Chamaecyparis obtusa) (9,24-26), this allergen has become widely used as a marker of genuine sensitization to Cupressaceae pollen (26).

Prevention and Therapy

Allergen immunotherapy

Allergen immunotherapy for Cupressaceae pollinosis proved efficient in several studies using Arizona cypress or other Cupressaceae extracts, but the number of patients included in each of these studies was low (reviewed in ref 1).

Prevention strategies

Avoidance

During the pollination season, exposure to Cupressaceae pollen can be reduced by using a few precautionary measures, such as avoiding outdoor exercise, keeping doors and windows closed, washing hair before sleeping, using protective sunglasses and a mask for outdoor activities, and avoiding drying of linen clothes outside (1). If the patient’s health condition deteriorates, moving to an area with lower pollen counts may be advised (27).

Molecular Aspects

Allergenic molecules

Cup a 1 is the only allergen from Arizona cypress included in the IUIS database as of July 2021. Cup a 1, used either a recombinant or a a purified molecule, is widely used as a marker of genuine sensitization to Cupressaceae (26). Further allergens from Arizona cypress pollen have been reported and characterized in the literature.

Name	Biochemical activity	Molecular weight (kDa)	Glycosylation	Major/minor allergen	Marker allergen	IUIS	Reference
Cup a 1	Pectate lyase	43	Yes	Major	Yes	Yes	24
Cup a 2	Polygalacturonase	41 (fragment)	Yes	Major	No	No	1
Cup a 3	Thaumatin-like protein	21	No	Major	No	No	28
Cup a 4	Polcalcin	18	No	Minor	No	No	29

Although currently not characterized, an allergenic gibberellin-regulated protein is presumably expressed in Arizona cypress pollen, similarly to C. sempervirens (Cup s 7), J. ashei (Jun a 7), and Cryptomeria japonica (Cry j 7) (30,31).

Biomarkers of severity

Cup a 1 is the marker allergen for sensitization to Cupressaceae family including Arizona cypress and C. sempervirens (22,25,26). Polcalcin sensitization can be assayed using Phl p 7 or Bet v 4 as surrogates. In patients with suspected pollen – food cross-reactivity due to gibberellin-regulated proteins, Pru p 7 is the currently available marker (32).

Cross-reactivity

There is extensive cross-reactivity between Arizona cypress pollen and other members of the Cupressaceae family, due to high sequence identity and similarity between molecular allergens. Cross-reactivity with pollens outside the family is possible, mainly through polcalcin sensitization, but relatively infrequent for this minor allergen (9.6% Cup a 4 sensitization in cypress-allergic patients, ref 29). The carbohydrate moieties present on pectate lyase Cup a 1 and other major allergens of Cupressaceae family contribute to IgE binding, but their pathogenic role is not established. Pollen-food syndrome due to Cupressaceae primary sensitization has been suspected for a long time. Although multiple allergens could be involved, e.g. polygalacturonase, thaumatin-like protein, and gibberellin-regulated protein, formal demonstration has only been provided for the latter (31,32).

Compiled By

Author:Joana Vitte

Reviewer: Dr. Christian Fischer

Last reviewed: March 2022

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