Bartolomé, B

Carrapatoso, I

Chieira

Geraldes, L

Ribeiro, F

English

Repositório Institucional dos Hospitais da Universidade de Coimbra

recently, lip pruritus has also occurredimmediately after almond and hazelnutingestion. Despite these episodes, thepatient hasn’t completely avoided thesefruits. Two years ago, facial redness andoedema occurred minutes after eating rawpomegranate, a fruit she previously toler-ated. Currently, she tolerates peeled appleand the other Rosaceae family fruits. Skinprick tests (SPT) were positive to parietariaand grass pollens, peach and cherry com-mercial extracts as well as fresh pear, appleand pomegranate. In vitro tests for serumspecific IgE (sIgE) determination yieldedpositive results to Parietaria (Par j 2) andgrass pollens (Phl p 1 and Cyn d 1). Apositive result to peach Pru p 3 was alsoobtained. We weren’t able to demonstratein vitro sIgE to pomegranate. An oral foodchallenge (OFC) with this fruit elicitedimmediate lip oedema and pruritus aftereating a quarter of a raw pomegranate.Conclusion: This is a description of pome-granate allergy, associated with Rosaceaefruits hypersensitivity. Similarly, mostpomegranate allergy published cases arereported from Southern Europe andpatients show Rosaceae fruits allergy, espe-cially to peach. Although we weren’t ableto identify the pomegranate allergensinvolved, an IgE-mediated reaction wasconfirmed by the SPT result. Despite themild symptoms mentioned by our patient,there are risk factors for severe reactions:the patient is from a Mediterranean coun-try, is allergic to peach and has positiveSPT to commercial fruit extracts, includingpeach pulp. Lastly, the in vitro results con-firmed LTP involvement. Therefore, therecommendations for allergen avoidancecan raise difficulties and be controversial:some recommend avoiding only the fruitsto which the patient reacted; others suggesta more restrict diet, with other fruits andvegetables, including those from taxonomi-cally different species, especially those towhich the patient has positive SPT. Nega-tive OFC can be insufficient for dietary lib-eralization as asymptomatic sensitizationscan become clinically relevant in thefuture.1050Atypical fruit allergy in a pollen allergicpatientSousa, N; Almeida, E; Carrapatoso, I; Ribeiro, F;Faria, E; Chieira, CImmunoallergology Department, Coimbra UniversityHospitals, Coimbra, PortugalBackground: Allergy to fruits and vegeta-bles in patients with pollinosis is attributedto the existence of ubiquitous panallergensin plants, with subsequent cross-reactivity.In patients with reactions to multiplefoods, the use of ImmunoCAP ISACR andimmunoblotting assays represent comple-mentary in vitro methods to characterizethe molecules involved.Patients and Methods: We describe thecase of a 38 years old female patient, witha history of persistent allergic rhinitis andasthma since childhood, with symptoms oforal allergy syndrome and wheezing imme-diately after the ingestion of hazelnut,peach and apple. Skin prick tests (SPT)were performed to aeroallergens and plantfood allergens. Specific IgE, immunoblot-ting assays and ImmunoCAP ISACR werealso carried out to characterize the mole-cules involved.Results: SPTs and Specific IgE were posi-tive to Betulla verrucosa, peach, apple andcherry. Immunoblotting assays showed a16.48 kDa IgE binding band in Betulaverrucosa, 19.33 kDa band in peach andno bands in apple. ImmunoCAP ISACRwas positive to Bet v1, Aln g1, Mal d1,Cor a1, Api g1 and negative to Pru p3.Discussion and Conclusion: The severe clin-ical presentation with bronchospasm sug-gested the involvement of an LTP, typicalof Mediterranean countries. ImmunoCAP,ISACR and the immunoblotting assaysconfirmed instead a PR-10 analogues crossreactivity (Bet v1/Mal d1). We emphasizethat this pattern is rare in Portugal and isalso not usually associated with severesymptoms, as in this patient.1051Oral allergy syndrome due to strawberryArochena, L; Fernandez-Nieto, M; Sastre, JAllergy Department, Fundación Jiménez Dı́az, Madrid,SpainBackground: Fruits from the Rosaceaefamily have been increasingly reported ascauses of allergic reactions. Patients fre-quently have positive skin test results formultiple members of this botanical family.Despite the increasing use of strawberriesin culinary recipes, allergy to this fruit hasrarely been described.Methods: A 32 years old woman, residentin Madrid, was seen in our clinic with rhin-orrhea, tearing, and serial sneezing that shepresented in spring since 10 years ago; noasthma symptoms were referred. Besides,she described oropharyngeal tingling, ton-gue swelling feeling (not real) and pharyn-geal pruritus every time she ate strawberry,although this didn’t happen with otherfruits or nuts. The study was based on skintest [prick-test (SPT) and prick-prick test]with standard pollen battery for Madrid,various fruits and nuts, and analyticaldetermination of specific IgE serum anti-bodies to these foods.Results: SPT with standard battery ofinhalants allergens: positive Cupressus,Platanus, Olea, Lolium, Secalle, Plantago,Artemisia, Phragmites and Salsola. Nega-tive to LTP and profilin. SPT with com-mercial fruit extracts were negative. Prick-prick test with Peach, Apple, Pear, Orange,Banana, Pineapple, Grape, Plum, Tomato,Walnut, Almond, Peanut, Cashew, Hazel-nut and Latex were also negative. Positiveonly with Strawberry. Specific IgE serumantibodies were negative for all fruits.Double-blind placebo-controlled food chal-lenge was performed, and the patient pre-sented oropharyngeal pruritus with novisible skin lesions.Conclusions: We report a case of oralallergy syndrome to strawberry, with nosensitization to other Rosaceae fruits.1052Mugwort-celery-carrot-curry syndrome: acase reportCarrapatoso, I1; Bartolome, B2; Ribeiro, F1; Geraldes, L1;Chieira, C11Immunoallergology Department, Coimbra UniversityHospital, Coimbra, Portugal; 2Bial-Aristegui, R&DDepartment, Bilbao, SpainBackground: We report the case of a 22-year-old man that started suffering fromrecurrent episodes of anaphylaxis, follow-ing the ingestion of meals containing mixedfoods. The patient had no history ofasthma or rhinitis related to airborne aller-gens. When he was 20 years old the firstepisode of generalized urticaria and angioe-dema, hypotension and blurred visionoccurred after ingestion of pizza. Sixmonths later another episode occurredafter ingestion of meatballs and spaghetti.At 21, the same symptoms occurred afteringestion of spicy food. Interestingly, allthe systemic episodes developed 30–60 minafter exercise. The possibility of a cross-reactive celery-carrot-spicy syndrome wassuspected as all meals contained theseplant foods. Self-administered adrenalinewas prescribed and the patient was advisednot to exercise at least 2 h after eating. Nomore anaphylactic episodes occurred sincethen.Methods: Skin prick tests (SPT) to com-mercial extracts of aeroallergens and foodsallergens were carried out. Prick-to-pricktests (PP) and serum specific IgE determi-nations (sIgE) to some plant foods werealso performed, according to case history.The molecular mass of the IgE bindingbands was calculated by means of SDSPAGE immunoblotting. In order to studythe presence of cross reacting specific IgEwe carried out a SDS-PAGE immunoblot-ting-inhibition assay using the celery rootextract as solid phase and the extracts fromPoster Group 2 – Food allergy: surveys and new causesÓ 2010 The Authors396 Journal Compilation Ó 2010 Blackwell Publishing Ltd Allergy 65 (Suppl. 92): 209–682

Mugwort-celery-carrot-curry syndrome: a case report

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Mugwort-celery-carrot-curry syndrome: a case report

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