Anaphylaxis to avocado, independent of latex sensitization, has been rarely reported in the literature. This case report describes a 15 year old male who experienced anaphylaxis within half an hour after eating avocado-containing food. Avocado consumption is common in both North America and South America. It is important to consider avocado as a cause of anaphylaxis, even in patients not sensitized to latex

A Diaz-Perales

Allan B Becker

C Blanco

Elissa M Abrams

P Lieberman

R Asero

R Sanchez-Monge

S Sowka

S Wagner

SH Sicherer

Thomas V Gerstner

English

PubMed

Crossref

Allergy Asthma & Clinical Immunology

Anaphylaxis related to avocado ingestion: a case and review

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CASE REPORT Open Access
Anaphylaxis related to avocado ingestion: a case
and review
Elissa M Abrams*, Allan B Becker and Thomas V Gerstner
Abstract
Anaphylaxis to avocado, independent of latex sensitization, has been rarely reported in the literature. This case
report describes a 15 year old male who experienced anaphylaxis within half an hour after eating avocado-
containing food. Avocado consumption is common in both North America and South America. It is important to
consider avocado as a cause of anaphylaxis, even in patients not sensitized to latex.
Keywords: anaphylaxis, food allergy, avocado
Background
Anaphylaxis is a life threatening reaction that occurs in
between 0.05 to 2% of the general population [1]. While
there have been efforts made to identify and clone the
major allergen of avocado [2], Prs a 1, the majority of
cases of anaphylaxis to avocado have been described in
the context of latex sensitization, otherwise termed
“latex-fruit syndrome” [3]. Isolated anaphylaxis to avo-
cado is rarely described in the literature. The following
case report describes an individual who developed ana-
phylaxis after eating guacamole without concurrent clin-
ical reactivity to latex.
Case presentation
The patient was a 15 year old male who was referred to
the allergy clinic for suspected anaphylaxis to avocado.
In the summer of 2010, the patient was eating guaca-
mole dip with chips and within a half an hour of eating
the guacamole, he developed coughing, wheezing, nasal
stuffiness, generalized urticaria and periorbital edema.
He did not experience any nausea, vomiting, diarrhea,
syncope or loss of consciousness. The patient had eaten
the same brand of chips multiple times in the past, but
did not remember if he had consumed avocado before.
A family member provided the patient with an antihis-
tamine but the symptoms didn’t improve so he went to
the emergency department. At the emergency
department, intravenous antihistamine and steroid were
administered. Within a few hours, the symptoms
resolved and the patient was discharged with a script for
oral steroid as well as an EpiPen®.
The diet of the patient was unrestricted. He had been
exposed to latex in the form of balloons multiple times
in the past without a reaction. In addition, his diet
included other foods that are often included in latex-
fruit syndrome (kiwi, banana, potato) [4]. It was unclear
if he had previously ingested chestnut.
The patient’s past medical history revealed resolved
“eczema” to the neck, posterior popliteal and antecubital
fossae. There was no history of asthma or allergic rhini-
tis. The patient reported a history of cold induced hives.
The family history included a mother with asthma, an
older brother with “environmental allergies” and asthma,
and a sister with “environmental allergies” and asthma.
A complete physical examination was unremarkable.
The patient underwent epicutaneous testing via prick
technique for fresh avocado, commercial avocado
extract, fresh and commercial chestnut, and guacamole
dip. In addition, an ice cube test was done. Skin testing
was positive to fresh avocado (10 mm) and commercial
extract (5 mm) and borderline to the guacamole mix (3
mm). Testing to fresh and commercial chestnut was
positive to fresh chestnut (10 mm) and commercial
chestnut (6 mm). Histamine was 5 mm, and saline con-
trol was 2 mm. The ice cube test revealed faint, transi-
ent localized urticaria. A latex use test (both finger and
full glove) was negative. ImmunoCAP to avocado was
positive at 0.9 KUA/L.
* Correspondence: elissa.abrams@gmail.com
Section of Allergy and Clinical Immunology, Department of Paediatrics and
Child Health, University of Manitoba, (685 William Avenue), Winnipeg, (R3A
1S1), Canada
Abrams et al. Allergy, Asthma & Clinical Immunology 2011, 7:12
http://www.aacijournal.com/content/7/1/12 ALLERGY, ASTHMA & CLINICAL 
IMMUNOLOGY
© 2011 Abrams et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
An oral challenge to chestnut will be considered,
should the family be willing, at a later date, to confirm
whether a clinical allergy to chestnut exists.
Conclusions
Avocado is the fruit of the tree Persea americana [5].
IgE-mediated reactions to avocado are well described in
the literature, although almost exclusively in the context
of latex sensitization. Anaphylaxis to avocado alone is
rare. A possible case of isolated anaphylaxis to avocado
was described in one multi-center Italian study [6],
which examined the frequency of anaphylaxis among
food allergic adults. Of 1110 adults with food allergy, 58
had at least one episode of anaphylaxis. Only one of
these patients had anaphylaxis to avocado, although it is
unclear if they were sensitized to latex.
Sensitization to both avocado and chestnut have also
been described, but also almost exclusively in the con-
text of a latex allergy. In 1998 the relevant allergens in
chestnut and avocado were described by Diaz-Perales et
al [7]. Of the four patients with immediate hypersensi-
tivity to chestnut and avocado, all four also showed
associated hypersensitivity to latex.
The prevalence of isolated avocado hypersensitivity, as
well as the long-term outcome, is currently unknown.
In a recent study of chestnut allergy, Sanchez-Monge
et al examined the difference in allergen sensitization
patterns in those who were allergic to chestnut alone, or
chestnut with associated latex hypersensitivity [8]. In
that study, different patterns of allergen sensitization
were present in patients with chestnut allergy with and
without latex hypersensitivity (lipid transfer proteins and
class I chitinases). One could hypothesize that similar to
chestnut, there would be different patterns of allergen
sensitization in those patients with avocado allergy, with
and without latex hypersensitivity.
Consent
Written informed consent was obtained from the patient
for publication of this case report and any accompany-
ing images. A copy of the written consent is available
for review by the Editor-in-Chief of this journal.
Authors’ contributions
EA and TG diagnosed the case and planned the treatment and medical
follow up. EA gathered the patient’s history and drafted the manuscript and
the subsequent revisions. TG and AB participated in manuscript revision. All
authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 16 January 2011 Accepted: 10 June 2011
Published: 10 June 2011
References
1. Lieberman P, Camargo CA Jr, Bohlke K, Jick H, Miller RL, Sheikh A,
Simons FE: Epidemiology of anaphylaxis: findings of the American
College of Allergy, Asthma and Immunology Epidemiology of
Anaphylaxis Working Group. Ann Allergy Asthma Immunol 2006,
97(5):596-602.
2. Sowka S, Hsieh LS, Krebitz M, Akasawa A, Martin BM, Starrett D,
Peterbauer CK, Scheiner O, Breiteneder H: Identification and cloning of prs
a 1, a 32-kDa endochitinase and major allergen of avocado, and its
expression in the yeast Pichia pastoris. J Biol Chem 1998, 273(43):28091-7.
3. Wagner S, Breiteneder H: The latex-fruit syndrome. Biochem Soc Trans
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4. Sicherer SH: Clinical implications of cross-reactive food allergens. J Allergy
Clin Immunol 2001, 108(6):881-90.
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doi:10.1186/1710-1492-7-12
Cite this article as: Abrams et al.: Anaphylaxis related to avocado
ingestion: a case and review. Allergy, Asthma & Clinical Immunology 2011
7:12.
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Page 2 of 2


Abstract Anaphylaxis to avocado, independent of latex sensitization, has been rarely reported in the literature. This case report describes a 15 year old male who experienced anaphylaxis within half an hour after eating avocado-containing food. Avocado consumption is common in both North America and South America. It is important to consider avocado as a cause of anaphylaxis, even in patients not sensitized to latex.</p

Abrams Elissa M

Becker Allan B

Gerstner Thomas V

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Breiteneder H: The latex-fruit syndrome. Biochem Soc Trans

Class I chitinases with hevein-like domain, but not class II enzymes, are relevant chestnut and avocado allergens.

Clinical implications of cross-reactive food allergens.

Identification and cloning of prs a 1, a 32-kDa endochitinase and major allergen of avocado, and its expression in the yeast Pichia pastoris.

Senna GE: Causes of food-induced anaphylaxis in Italian adults: a multicentre study. Int Arch Allergy Immunol

Simons FE: Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol

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Anaphylaxis related to avocado ingestion: a case and review

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