• allergy;
  • asthma;
  • Cupressaceae;
  • epidemiology;
  • pollinosis

Winter rhinoconjunctivitis caused by cypress allergy represents an emerging cause of morbidity in young adults living in the Mediterranean area, where ornamental use of both Cupressus arizonica and C. sempervirens has spread in recent years (1,2).

Despite emphasis in describing this pollinosis as an emerging one, population-based studies on cypress allergy and sensitization are lacking. Our epidemiological survey was designed to assess the prevalence of symptomatic oculorhinitis and asymptomatic cypress sensitization in a cohort of 3434 subjects living in central Italy (Perugia county, Umbria region). Data were collected using a modified questionnaire of the European Community Respiratory Health Survey (3). Subjects had skin prick tests (SPT) with Dermatophagoides, Alternaria tenuis, Parietaria officinalis, Graminaceae mix, Olea europaea, Cupressus arizonica and C. sempervirens extracts (ALK-Abellò and Lofarma, Milan, Italy), by a standard procedure. Specific IgE levels were determined with commercially available reagents.

To categorize enrolled subjects (4), we applied a clinical score for absence (0points) or presence (3 points) of symptoms, and a laboratory score from 0 to 3 points for cutaneous wheal and flare reactions plus 0–3 points for IgE antibody levels (RAST class from I to IV) to cypress extracts.

Table 1 summarizes the distribution of cypress allergy and sensitization in our study population. Among group A subjects, 103 (84.4%) were mono-sensitive to cypress pollen, whereas the remaining 19 (15.6%) were also sensitive to perennial and/or seasonal allergens. The frequency of self-reported asthmatic symptoms was less than 1% (one subject). Group A patients had fewer atopic members in their first-degree relatives, compared to other groups.

Table 1.  Distribution of cypress allergy or sensitization in a population of 3434 young adults of central Italy
 NumberPrevalence (%)Features of cypress sensitivityFamilial atopy
  • Allergic subjects (group A) reached a total score = 7, by adding the 3 clinical symptom points to the sum of the laboratory score. Group B consisted of atopic subjects (0 point clinical score), identified as cypress-sensitized on the basis of the laboratory score only. Control groups were atopic subjects (group C) suffering from seasonal or perennial rhinitis due to other inhalant allergens; group D nonatopic healthy subjects. Statistical evaluation was performed by two dimensional contingency tables and Pearson's chi-squared tests with spss software.

  • *

    P < 0.001 vs. groups B and C.

Group A 122 3.6Oculo-rhinitis, positive SPT  and detectable IgE antibody19.5%*
Group B 167 4.9Positive SPT and detectable  IgE antibody40.3%
Group C 53915.7None38.9%
Group D260675.8NoneNo

SPT and/or RAST give information merely on sensitivity to individual allergens (5); 4.9% of our subjects were clinically asymptomatic but, nonetheless, had positive SPT and/or measurable IgE antibody levels. Therefore, assuming sensitization to cypress pollen as study end-point, would lead to a disease prevalence over-estimation (up to 8% of the total study population), similar to that previously published (1,2).

The virtual absence of asthma has been noted for other Cupressaceae species, such as the respiratory allergy to Juniperus sabinoides, and recently confirmed in a survey on asthmatic children living in the south-east of France (6,7).

In conclusion, in areas (such as central Italy) in which cypress trees have been a common feature for centuries, cypress hypersensitivity is relatively low. Nonetheless, the widespread use of such trees justifies the major attention we now pose in diagnosing this particular winter allergy.

Accepted for publication 23 May 2002 Copyright © Blackwell Munksgaard 2002 ISSN 0105-4538


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