Santos N, Gaspar A, Pires G, Morais-Almeida M. Why did they have anaphylaxis to apple? Allergy 2012;67(Suppl.96):381-382.

1.
We
confirmed
sensi-za-on
to
nsLTP,
thermally
stable
and
resistant
to
pep-c
diges-on
panallergens
present
in
apple
and
peach
peel.
Although
peach
is
the
most
frequently
implicated
fruit
in
Rosaceae
anaphylaxis,
both
pa-ents
had
a
more
severe
reac-on
to
apple.
We
hypothesize
this
may
be
due
to
an
increased
content
of
Mal
d
3
in
both
apple
species
consumed,
or
by
cofactors
that
might
amplify
an
anaphylac-c
episode
as
fas-ng
and
exercise.
Natacha
Santos,
Ângela
Gaspar,
Graça
Pires,
Mário
Morais-­‐Almeida
Immunoallergy
Department,
CUF
Descobertas
Hospital,
Lisbon,
Portugal
Rosaceae
fruits
are
an
important
cause
of
food
allergy
in
the
Southern
Europe.
Peach
is
the
most
implied
Rosaceae
in
anaphylaxis
reports.
We
describe
2
less
usual
case
reports
of
anaphylaxis
to
apple:
§ 29
year-­‐old
woman
§ Allergic
rhinoconjunc-vi-s
and
asthma,
sensi-zed
to
grass
and
parietaria
pollen,
mites
and
cat
§ Immediate
anaphylac(c
reac(on
(generalized
ur-caria
and
shortness
of
breath)
aTer
ea-ng
an
unpeeled
Granny
smith
apple,
and
aTer
a
fas(ng
period.
Treated
with
oral
an--­‐histamine
and
cor-costeroid
and
inhaled
bronchodilator,
the
reac-on
was
surpassed
in
one
hour.
§ ATerward,
she
reported
two
episodes
of
labial
angioedema
aTer
inges-on
of
peach
fruit
and
juice.
§ 18
year-­‐old
male
§ Allergic
rhini-s
and
asthma,
sensi-zed
to
grass
and
cypress
pollen
and
to
mites
§ Immediate
anaphylac(c
reac(on
(generalized
pruritus,
lips,
hands
and
feet
angioedema
and
shortness
of
breath)
aTer
ea-ng
an
unpeeled
Golden
delicious
apple
during
a
football
game.
Treated
in
the
emergency
with
i.m.
an--­‐histamine,
i.v.
cor-costeroid,
inhaled
bronchodilator
and
oxygen
therapy,
with
full
recovery
in
three
hours.
§ He
referred
one
previous
episode
of
facial
angioedema
aTer
drinking
peach
juice.
Fig.
1
–
Results
of
the
prick
tests
with
Bial-­‐Aristegui®
extracts
(PT),
prick
to
prick
with
the
fresh
food
(PPT)
and
specific
IgE
(sIgE)
Fig.
2
–
Results
of
the
ImmunoCAP
ISAC®
(Phadia)
for
non
specific
Lipid
Transfer
Proteins
(nsLTP)
PT
(mm)
PPT
(mm)
sIgE
(kU/L)
apple
(peel)
3x3
7x6
0.48
(pulp)
-­‐
-­‐
peach
(peel)
5x4
14x6
0.51
(pulp)
-­‐
-­‐
plum
(peel)
-­‐
-­‐
-­‐
(pulp)
pear
(peel)
-­‐
-­‐
-­‐
(pulp)
chery
(peel)
-­‐
-­‐
-­‐
(pulp)
almond
-­‐
n.t.
-­‐
strawberry
-­‐
-­‐
-­‐
rPru
p
3
0.69
PT
(mm)
PPT
(mm)
sIgE
(kU/L)
apple
(peel)
3x3
4x3
10.3
(pulp)
-­‐
-­‐
peach
(peel)
11x7
n.t
13.2
(pulp)
4x3
plum
(peel)
3x3
n.t
8.36
(pulp)
pear
(peel)
-­‐
5x3
5.33
(pulp)
-­‐
chery
(peel)
3x3
n.t
8.0
(pulp)
almond
3x3
n.t.
0.66
strawberry
-­‐
10x4
1.18
rPru
p
3
8.3
In
rela-on
to
this
presenta-on,
I
declare
that
there
are
no
conflicts
of
interest.
n.t.
–
not
tested
Peach
Parietaria
Peach
Hazelnut