Allergic Reactions to Fresh Fruits: Beyond Oral Symptoms

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RATIONALE: Fruit allergy is frequently considered to be associated with mild oral symptoms in the context of the pollen-food allergy syndrome, while few studies have focused on fruits as a cause of severe allergic reactions.

METHODS:Three hundred forty-six allergic reactions to fruits were diagnosed in 194 patients (135 female), aged from 14 to 72 yrs. (median=27 yrs). The diagnostic procedure followed the guidelines for the evaluation of the adverse reactions to foods from the EAACI, including a clinical questionnaire, skin testing, fruit-specific serum IgE (CAP-FEIA) and open challenges, followed if positive by DBPCFC, unless a convincing history of severe anaphylaxis.

RESULTS: One hundred-eighty (52%) reactions consisted exclusively of isolated oral symptoms. The most frequent offenders were: melon, 42(23%); kiwi, 28(15.5%) and avocado, 24 (13%). One hundred twenty-eight (37%) systemic reactions were accompanied with oral symptoms. The most frequent foods were peach, 29 (23%); kiwi, 21 (16%), and melon, 18 (14%). Thirty-eight (11%) systemic reactions did not show any oral symptoms. Peach, 10 reactions (26%); banana, 8 (21%); and kiwi, 4(10.5%), were the most frequent causal foods. Grades of severity were: mild, 15 reactions; moderate, 5 reactions; severe, 13 reactions; life-threatening, 5 reactions. Three patients reported having isolated oral symptoms months before their systemic reactions took place (2 peach, 1 banana).

CONCLUSIONS: Half of the fresh-fruit allergic reactions consist of isolated oral symptoms, with melon being the most frequent culprit. However, systemic reactions are relevant, being peach the most frequent causative agent in our area.