Immediate hypersensitivity reaction with mango

Ashok Shah, Kamal Gera

Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

 

 

Immediate hypersensitivity reaction with mango

Natychmiastowa reakcja nadwrażliwości na mango

The authors declare no financial disclosure

 

 

ABSTRACT

Hypersensitivity to the fruit mango is extremely rare and can exhibit either as immediate or delayed reactions. Since 1939, only 22 patients (10 with immediate type I reactions and 12 with delayed) have been documented with allergy to mango. History of atopy and geographical region may influence the type of reaction. Immediate reactions occured most often in patients with history of atopy, while delayed reactions developed in non-atopic individuals. Clustering of delayed hypersensitivity reports from Australia and immediate reactions from Europe has been documented. We report a 50-year-old man with immediate type I hypersensitivity to mango, who developed cough, wheezing dyspnoea, generalised itching and abdominal discomfort after ingestion of mango. Life threatening event can also happen making it imperative to diagnose on time, so as to prevent significant morbidity and potential mortality.

 

Key words: allergy, anaphylaxis, bronchial asthma, contact dermatitis, mango, urticaria

Pneumonol. Alergol. Pol. 2014; 82: 445–453

 

STRESZCZENIE

Nadwrażliwość na owoce mango jest bardzo rzadkim zjawiskiem i może przebiegać zarówno jako reakcja natychmiastowa, jak i opóźniona. Od 1939 roku udokumentowano alergię na mango tylko u 22 pacjentów (u 10 z reakcjami typu natychmiastowego i u 12 z reakcją opóźnioną). Wydaje się, że wywiad atopowy oraz region geograficzny mogą wpływać na rodzaj reakcji. Natychmiastowe reakcje obserwowano najczęściej u pacjentów z wywiadem atopii, natomiast reakcje opóźnione byłych częstsze u pacjentów bez takiego wywiadu. Dane epidemiologiczne wskazują, że na terenie Australii dominuje nadwrażliwość z opóźnionym typem reakcji, w Europie zaś przeważają reakcje typu natychmiastowego.

W pracy przedstawiono przypadek 50-letniego mężczyzny z nadwrażliwością typu I natychmiastowego na alergeny owocu mango, u którego po spożyciu mango wystąpił kaszel, świszczący oddech i duszność, uogólniony świąd skóry i dolegliwości brzuszne.

Diagnostyka w takich sytuacjach powinna być przeprowadzona możliwie szybko, aby wdrożyć wtórną profilaktykę, uniknąć ekspozycji i zapobiegać stanom zagrażającym życiu w przebiegu nadwrażliwości.

 

Słowa kluczowe: allergy, anaphylaxis, bronchial asthma, contact dermatitis, mango, urticaria

Pneumonol. Alergol. Pol. 2014; 82: 445–453

 

 

Introduction

The fruit mango (Mangifera indica), often known as the ‘king of fruits’, belongs to the family Anacardiacae. During the summer months, India produces nearly half of the mangoes cultivated throughout the world and is the national fruit of the country. Despite being consumed in large quantities and in many forms in our country, hypersensitivity reactions to mango are extremely rare. Hypersensitivity to the fruit mango can manifest in two forms, immediate and delayed. To date, there are only 22 patients with documented hypersensitivity to mango. Of these 22 patients, 10 [1–9] exhibited immediate hypersensitivity while 12 [10–17] had delayed hypersensitivity reactions. Of the 10 patients with immediate hypersensitivity, two were reported from India [6, 9]. The mango allergen is known to cross react with Artemisia pollen, birch pollen, poison ivy, carrot, celery, pistachio nut, banana, tomato and papaya [8]. Paucity of the literature on the subject prompted this report of the 50-year-old man with immediate hypersensitivity reaction in the form of wheezing dyspnoea, generalised itching and abdominal discomfort after ingestion of fresh mango.

 

Case report

A 50-year-old male office worker, a never-smoker, was referred to our Institute for evaluation of hypersensitivity to the fruit mango. He had wheezing dyspnoea and cough for 10 years which initially were episodic but had recently become troublesome. These complaints were preceded by nasal symptoms which had commenced about 15 years ago in the form of paroxysmal sneezing, rhinorrhoea and nasal itching. Nasal blockage and post nasal drip too occurred off and on. All respiratory symptoms aggravated during change of season and whenever he ingested mango during the mango season. This also caused skin allergy which manifested as itching and rashes. Symptomatic treatment and avoidance of mangoes for past 10 years had partially controlled his symptoms.

Physical examination revealed a middle aged man in no acute distress.There was no pallor, icterus, clubbing, cyanosis or pedal oedema. Oxygen saturation at room air was 98%. Diaphragmatic excursion was equal on both sides. On auscultation, vesicular breath sounds along with bilateral polyphonic expiratory rhonchi were audible over all lung fields. Nasal mucosa was erythematous.

Complete blood counts revealed a total leucocyte count of 9900 cells per cubic millimeter with an eosinophil count of 10.8%. Absolute eosinophil count was 1000 cells per cubic millimeter. Serum total Ig E value was 358 kUA/L (reference range < 64.00). Specific IgE against mango was 1.38 kUA/L (Immunocap [100] system) suggesting presence of moderate levels of mango specific antibodies. Renal as well as hepatic functions were within normal limits. The chest radiograph revealed no abnormalities but a non-contrast CT scan of the paranasal sinuses showed bilateral maxillary, bilateral ethmoidal and left sphenoidal sinusitis. Pulmonary function testing showed a ratio of FEV1/FVC of 62% with a FVC of 3.99 L (126% of predicted), an FEV1 of 2.48 L (95% of predicted) but there was no significant increase in FEV1 after inhalation of 400 micrograms of salbutamol. This was suggestive of an obstructive pattern with mild airflow limitation. Neither was there any significant reversibility nor did the peak flow diary reveal any circadian variation.

Skin prick testing with the battery of standard aeroallergens demonstrated immediate hypersensitivity to weeds (Ageratum, Amaranthus spinosus, Argemone, Artemisia, Gynandropsis and Parthenium). Prick to prick testing from a fresh ripe mango was done along with a negative control (buffered normal saline [1 × 1 mm]) and a positive control (histamine [6 × 6 mm]). This elicited an immediate type I hypersensitivity reaction to the mango extract (14 × 10 mm).

A week later, the patient agreed to ingest a small slice of fresh mango under observation in the emergency room. After an informed consent was taken, he was examined prior to ingestion of mango and spirometry and peak flow rates were also recorded. Oxygen saturation at room air was 98%. Within 5 minutes of ingestion of mango, he complained of itching in the oral cavity. Generalised itching and abdominal discomfort too commenced which peaked after 1 hour. This was followed by a bout of coughing, audible wheezing dyspnoea and throat irritation. Polyphonic rhonchi were audible over all lung fields. The peak flow rate fell from 4.10 L/min to 2.92 L/min, a decrease of 1180 mL (28%). The spO2 fell to 93% at room air and FEV1 fell from 3.3 L to 2.67 L. These manifestations subsided within half an hour after injectable adrenaline, pheniramine and dexamethasone along with nebulisation with salbutamol, ipratropium and budesonide. After 2 hours of mango ingestion, he vomited mango remnants (Table 1).

 

Table 1. Mango ingestion provocation test

Time

Clinical profile

spO2

PFR (L/min)

FEV1 (L)

Pre-mango ingestion

No symptoms with normal vesicular breathing

98%

410

3.3

5 minutes

Itching in oral cavity

98%

420

15 minutes

Generalised itching and abdominal discomfort

98%

410

30 minutes

Increasing generalised itching and abdominal discomfort

98%

410

45 minutes

Further aggravation of generalised itching and abdominal discomfort

97%

400

60 minutes

Generalised itching and abdominal discomfort accompanied by throat irritation, bout of coughing, audible wheezing dyspnoea and polyphonic rhonchi

95%

290

70 minutes

Aggravation of all symptoms including generalised itching and abdominal discomfort, throat irritation, coughing, wheezing dyspnoea, polyphonic rhonchi

93%

200

2.67

Post-treatment 15 minutes

itching, cough and wheezing dyspnoea, rhonchi

96%

320

Post-treatment 30 minutes

cough and wheezing dyspnoea, rhonchi

96%

360

Post-treatment 60 minutes

Vomiting containing mango remnants, no cough, wheezing dyspnoea or rhonchi

98%

400

 

A diagnosis of bronchial asthma and allergic rhinitis along with immediate hypersensitivity to the fruit mango was made and the patient was strongly advised not to ingest mango in any form. He was also initiated on a combination of inhaled budesonide and formoterol along with mometasone nasal spray. This was done as soon as the diagnosis was established. With this, the patient experienced significant relief and his symptoms were minimised on maintenance therapy.

 

Discussion

Mango is native to southern Asia and has been cultivated in the Indian subcontinent for thousands of years. It is consumed in various forms both during the season as well as off season. During season, it is partaken in form of fresh fruits, shakes and ice creams while during off season, it is cherished as pickles, jams and juices. Immediate hypersensitivity can manifest as anaphylaxis, angioedema, erythema, urticaria, wheezing dyspnoea while delayed reaction as contact dermatitis, oral allergy syndrome and periorbital oedema [18].

A recent review [18] presented 22 patients with documented hypersensitivity to the fruit mango, 10 of whom had immediate hypersensitivity, while 12 presented with delayed hypersensitivity reactions with predominant skin manifestations. The first report of an allergic reaction to mango was a description of delayed hypersensitivity manifestation from USA in 1939 by Zakon [10]. The report described a young female who developed acute vesicular dermatitis involving lips and circumoral area, 24 hours after ingestion of mango. The first case of immediate hypersensitivity too was reported from USA by Kahn [1] in 1942. The patient developed hoarseness, dyspnoea and wheezing within 30 minutes of mango ingestion. These symptoms were relieved with injectable epinephrine. Our patient too, a case of immediate hypersensitivity type I reaction to mango, experienced bout of coughing, wheezing dyspnoea, throat irritation within 1 hour of mango ingestion.

Of the ten patients documented with immediate reaction to mango, erythema developed in three [3–4, 7], angioedema in five [2, 4, 6–8], respiratory distress/dyspnea in nine [1–9] and anaphylaxis in two patients [2, 3], one of whom had a life threatening anaphylactic shock [2]. Symptoms in most of these patients occurred almost immediately [3–9], while in two patients, symptoms commenced in around 30 minutes [1, 2]. History of atopy, also present in our patient, was available in eight others [1, 2, 4, 5, 7–9].

Skin prick tests and immunoassays of serum food specific IgE levels can detect the allergen specific IgE. These tests are only supportive and can aid in the diagnosis but it is imperative that it be performed in light of an appropriate clinical history. In IgE mediated food allergy, the wheal size correlates with the likelihood of clinical allergy. However, wheal size can be highly variable as it depends on age, diurnal variation and site on the body where SPT is performed. The individual’s skin reactivity as well as the SPT device and reagents used also play a role [19].

The ICON statement on “Food Allergy” [19] issued jointly by the American Academy of Allergy, Asthma and Immunology; European Academy of Allergy and Clinical Immunology; World Allergy Organization; and the American College of Allergy, Asthma & Immunology has stressed the need for studies to define the diagnostic accuracy of 95% positive predictive value wheal sizes for different foods, ages, diseases, and populations. Information regarding the skin allergy test to mango was available in eight of the ten patients with immediate hypersensitivity to mango and was positive in all [2, 4, 5, 6–9]. Our patient too had a skin prick test positive to mango extract.

Food specific IgE is also often used for establishing the diagnosis of food allergy but has the same status as skin prick testing [19]. Specific IgE against mango was evaluated in six patients [4–8], but was positive in only three [5, 6, 8]. In our patient too, specific IgE against mango antigens was detected in moderate levels. The possible explanation behind the under detection of specific IgE may be the unstability of the corresponding allergens, which remain undetected and also the current IgE detection system appears to lack some of the specific mango allergens [18]. Combining skin prick testing results with serum food specific IgE may be of value in diagnosing food allergy [20]. Wheal size with skin prick testing and serum food specific IgE levels correspond with the plausibility of clinical allergy but it must be highlighted that they do not correlate with or predict the severity of allergic reaction to a food [19].

Although, the double-blind, placebo-controlled food challenge (DBPCFC) remains the gold standard for the diagnosis of food allergy, it is less frequently performed as it requires time, huge resources and appropriate set-up. In clinical practice, single blind or open food challenges are generally performed, though DBPCFC is the most specific test to confirm food allergy. There is a risk of immediate allergy and anaphylaxis, so it is essential that food challenge should always be performed in a well equipped facility under medical supervision with appropriate medications and resources available for emergency management of anaphylaxis [19].

Immediate hypersensitivity is a classical IgE mediated reaction and usually occurs in individuals who are previously sensitised to mango antigens [5]. Sensitisation may occur by prior mango ingestion or by intake of other fruits belonging to Anacardiaceae family. Even unrecognisable forms such as fruit punch can also sensitise the patient [2]. Allergenicity of mango nectar persists even after heating, enzymatic degradation and mechanically caused tissue degradation as evidenced by allergic reaction to canned or packaged mango [21].

Mango antigen also cross-reacts with artemisia pollen, birch pollen, poison ivy, mugwort, celery, carrot, pistachio nut, tomato, papaya and banana [10]. Mostly, Bet v1, Bet v6, and Art v1 related allergens lead to cross-reactions between mango and other plants and fruits [7]. A study has documented that the common epitopes are shared by allergens from mango fruit and allergens from birch pollen, mugwort pollen, celery, and carrot [22]. Mango allergy was also seen in individuals with latex hypersensitivity [7, 23]. The possible explanation is that multiple antigens can bind to an IgE antibody at corresponding sites, thus mediating an immune response. Allergens, termed as profilins, responsible for cross reactivities between botanically unrelated pollens and fruits can account for this phenomenon [22]. However, this has yet to be proved conclusively.

The first case of delayed hypersensitivity to mango was reported in 1939 in USA. Subsequent reports are from Asia, Australia and North America. Amongst the twelve such patients documented in the literature so far [10–17], urticaria was present in eight [10–13, 15], oral allergy syndrome in two [1, 17] and periorbital edema in two [13, 15]. Three of these patients [10, 13, 15] developed the symptoms after mango ingestion, while in the remaining nine patients, the reaction occurred after contact with mango skin or bark of mango tree [11, 12, 14, 16, 17]. Duration of onset of symptoms was variable and ranged from 4 hours [11] to 7 days [12]. Patch testing, done in ten patients [11, 13–17], was positive in all. Cross reactivity was not reported in any patient nor was there any information regarding specific IgE antibody against mango antigen in any of the twelve patients.

Delayed hypersensitivity reaction to mango is cell mediated and was seen mainly in form of contact dermatitis, oral allergy syndrome and periorbital oedema. Direct contact with the mango or tree itself and ingestion too, can lead to a cell mediated reaction. Sensitising substances present in the skin, bark, pericarp as well as the mango pulp up to five millimeters below the skin include uroshiol, cardol, limonene and B-pinene [18].

Since 8 of the 10 patients with immediate type I hypersensitivity reactions had a history of atopy, it appears that atopy may be a risk factor for a type I reaction with mango. In contrast, in patients with delayed manifestations, history of atopy was seen in only one of 12 documented patients, suggesting that delayed hypersensitivity occurs in non-atopic subjects.

Further, geographical region may influence the type of reaction. There are five reports of hypersensitivity to mango from Australia, all of whom presented with delayed hypersensitivity reaction and none had history of atopy. All these five patients had negative skin prick test for mango while patch testing was positive in all [11, 16] (Table 2). On the other hand, all five patients documented from Europe had immediate type I hypersensitivity reactions and history of atopy was present in all. All these five patients also had a positive skin prick test for mango [4, 5, 7, 8] (Table 3). Of the six patients documented from Asia, two were immediate from India while four presented with delayed hypersensitivity (two from Japan, one from Thailand and one from Korea) [14, 15, 17]. There are no reports of delayed hypersensitivity reaction from India (Table 4). Of the six patients documented from North America, all from USA, three each presented with immediate and delayed hypersensitivity (Table 5).

 

Table 2. Documented reports of hypersensitivity to mango from Australia

Age, Sex, Year, Country, Reference

Geographical region cultivating the fruit

Type of reaction

History of atopy

Presenting symptoms after mango ingestion

Time of onset of symptoms

Treatment received

SPT to mango extract

Patch testing to mango extract

Cross reactivity

Specific IgE against mango

Symptoms
after mango ingestion provocation test

21, female, 1995, Australia [11]

Yes

Delayed hypersensitivity

No

Intensely pruritic linear papulo-vesicular

lesions on lower legs, urticarial plaques

on forearms (contact dermatitis)

4 hours

NA

NA

Positive

NA

NA

NA

31, female, 1995, Australia [11]

Yes

Delayed hypersensitivity

No

Intensely pruritic confluent urticaria

over arms and abdomen (contact

dermatitis)

12 hours

NA

NA

Positive

NA

NA

NA

27, female, 1995, Australia [11]

Yes

Delayed hypersensitivity

No

Pruritic confluent urticaria on neck,

acute eczematous plaques with bullae

on arms (contact dermatitis)

6 days

NA

NA

Positive

NA

NA

NA

36, male, 1995, Australia [11]

Yes

Delayed hypersensitivity

No

Widespread acute eczematous and

urticarial plaques (contact dermatitis)

5 hours

NA

NA

Positive

NA

NA

NA

42, female, 2008, Australia [16]

Yes

Delayed hypersensitivity

No

Itchy palpable, pruritic lesions over

arms, legs, neck and abdomen (contact

dermatitis)

4 days

Prolonged treatment with topical steroids

NA

Positive to mango

NA

NA

NA

IgE — immunoglobulin E; NA — not available; SPT — skin prick test

 

Table 3. Documented reports of hypersensitivity from Europe

Age, Sex, Year, Country, Reference

Geographical region cultivating the fruit

Type of reaction

History of atopy

Presenting symptoms after mango ingestion

Time of onset of symptoms

Treatment received

SPT to mango extract

Patch testing to mango extract

Cross reactivity

Specific IgE against mango

Symptoms after mango ingestion provocation test

32, male, 1988, UK [4]

No

Immediate hypersensitivity

Positive

Periorbital edema, facial erythema, diffuse urticaria, dyspnoea

20 minutes

Inj. epinephrine and inj. hydrocortisone

Positive

NA

NA

Negative by RAST

NA

45, female, 1999, Spain [5]

Yes

Immediate hypersensitivity

Positive, latex sensitivity present

Rhino–conjunctivitis, oral allergy, cough, dyspnoea

Immediately

Antihistamines and corticosteroids

Positive

Not done

Positive for latex

Raised by RAST

NA

46, female, 2008, Germany [7]

No

Immediate hypersensitivity

Positive

Sneezing, rhinorrhoea, dyspnoea, dysphagia, anxiety

< 10 minutes

NA

Positive

NA

Positive for ginger and pistachio

Negative

NA

24, male, 2008, Germany [7]

No

Immediate hypersensitivity

Received

immunotherapy for mugwort sensitization

Urticaria, swelling of face and

hands

10 minutes

NA

Positive

NA

Positive for mugwort, pistachio and ragweed

Negative

NA

39, female, 2009, Spain [8]

Yes

Immediate hypersensitivity

Positive

Facial angioedema, hoarseness, pruritis of palms, respiratory distress (oral allergy syndrome)

Immediately

Inj. epinephrine and corticosteroids

Positive

Not done

Positive to Artemesia pollen and house dust mites

Positive

NA

IgE — immunoglobulin E; NA — not available; RAST — radio allergo sorbet assay; SPT — skin prick test

 

Table 4. Documented reports of hypersensitivity to mango from Asia

Age, Sex, Year, Country, Reference

Geographical region cultivating the fruit

Type of reaction

History of atopy

Presenting symptoms after mango ingestion

Time of onset of symptoms

Treatment received

SPT to mango extract

Patch testing to mango extract

Cross reactivity

Specific IgE against mango

Symptoms after mango ingestion provocation test

NA (2 patients), 2004, Japan [14]

No

Delayed hyper-
sensitivity

No

History of mango dermatitis

present (contact dermatitis)

NA

NA

NA

Positive to mango extract

Positive for uroshiol

NA

NA

43, female, 2007, India [6]

Yes

Immediate hyper-
sensitivity

Negative

Oropharyngeal itching, angioedema of face, respiratory distress

< 10 minutes

Inj. hydrocortisone and antihistamines

Positive

Not done

Positive for Indian dill, cashew apple, Anethum, Anacardium

Positive by ELISA and SDS–PAGE

NA

42, female, 2008, Thailand [15]

Yes

Delayed hyper-
sensitivity

No

Patchy pruritic erythema of the face, and extremities with periorbital edema (contact dermatitis)

1 day

S/S subsided after 5 days with oral prednisolone and chlorpheniramine

NA

Positive to mango extract

NA

NA

NA

27, female, 2009, Korea [17]

No

Delayed hyper-
sensitivity

No

Eczematous rash and blister formation around lips (oral allergy syndrome)

NA

NA

NA

Positive to mango

NA

NA

NA

46, female, 2011, India [9]

Yes

Immediate hyper-
sensitivity

Positive

Wheezing dyspnoea, paroxysmal cough, throat irritation

15 minutes

Nebulization with albuterol and ipratropium

Positive

Not done

NA

NA

Immediate bout of coughing, dyspnoea, throat irritation. Fall in PFR of 490 ml. (9%) 30 min later

*50, male, 2013, India

Yes

Immediate hyper-
sensitivity

Positive

Oropharyngeal itching, throat irritation, itching and erythema over body, abdominal discomfort, wheezing dyspnoea, paroxysmal cough

10 minutes

Nebulisation with salbutamol and ipratropium, inj. hydrocortisone and inj. pheniramine

Positive

Not done

Positive for Ageratum, Amaranthus Spinosus, Argemone, Artemisia, Gynandropsis, Parthenium

1.38 kUA/L (moderate) by Immunocap [100] system

Oropharyngeal itching, throat irritation, wheezing dyspnoea, cough. Fall in PFR of 1180 ml. (28%) 1 hour later

*current report; ELISA — enzyme linked immunosorbent assay; IgE — immunoglobulin E; NA — not available; PFR — peak flow rate; SDS PAGE — sodium dodecyl sulphate polyacrylamide gel electrophoresis; SPT — skin prick test

 

Table 5. Documented reports of hypersensitivity to mango from North America

Age, Sex, Year, Country, Reference

Geographical region cultivating the fruit

Type of reaction

History of atopy

Presenting symptoms after mango ingestion

Time of onset of symptoms

Treatment received

SPT to mango extract

Patch testing to mango extract

Cross reactivity

Specific IgE against mango

Symptoms after mango ingestion provocation test

29, female, 1939, USA [10]

No

Delayed hypersensitivity

NA

Itching and vesicular lesions in

circumoral region, swelling of lips (oral allergy syndrome)

24 hours

NA

NA

NA

NA

NA

NA

NA, female, 1942, USA [1]

No

Immediate hyper-
sensitivity

Positive

Hoarseness, dyspnoea and wheezing

30 minutes

Inj. epinephrine

NA

NA

NA

NA

Rapidly acute symptoms of hoarseness and wheezing

32, male, 1965, USA [2]

No

Immediate hyper-
sensitivity

Positive

Itching of eyes, lacrimation, swelling of eyelids, chest tightness, noisy breathing

30 minutes

Inj. epinephrine and inj. hydrocortisone

Positive passive transfer reaction

NA

Positive to house dust, almond, wheat, watermelon

NA

NA

24, female, 1967, USA [3]

No

Immediate hyper-
sensitivity

Negative

Gasping for breath, erythema, swelling of face and extremities, hypotension and shock

10 minutes

Inj. dexamethasone and inj. epinephrine

NA

NA

NA

NA

NA

27, male, 1998, USA [12]

No

Delayed hyper-
sensitivity

Sensitivity to poison oak and poison ivy

Pruritic and eczematous rash (contact dermatitis)

7 days

Resolved after a week’s treatment with topical steroids

NA

NA

NA

NA

NA

22, female, 2004, USA [13]

No

Delayed hyper-
sensitivity

No

Patchy pruritic erythema of face, neck and arms with periorbital edema.

Papular lesions extended to chest, upper extremities. (contact dermatitis)

2 days

S/S subsided after few days with oral steroids and topical fluocinonide cream

NA

Positive to mango

skin, nickel and p–tert butylphenol

formaldehyde

NA

NA

NA

IgE — immunoglobulin E; NA — not available; SPT — skin prick test

 

Both in vitro and the in vivo tests were performed in our patient to confirm the mango allergy. Skin test with extract showed wheal and flare reaction of more than histamine (positive control) indicating IgE against mango allergen bound to the mast cells were degranulated by the allergen extract. Similarly, Immuncocap results indicated the free IgE in serum of patient. In the study, skin prick testing was done with weeds to find out whether food-specific IgE antibodies were cross-reacting in nature or not. Therefore, an oral mango challenge was performed to confirm food allergy. These data proved that our patient had immediate hypersensitivity to mango.

Our report highlights the fact that hypersensitivity manifestations to mango can include both immediate and delayed reactions. Immediate reaction can also result in life threatening events. If not diagnosed on time, allergic reactions to the fruit can lead to significant morbidity and possible mortality.

 

Conflict of interest

The authors declare no conflict of interest.

 

Address for correspondence: Prof. Ashok Shah, MD FAMS, Department of Respiratory Medicine Vallabhbhai Patel Chest Institute University of Delhi, P.O. BOX 2101, Delhi-110 007, India, tel/fax: + 91-11- 2766 6549, e-mail: ashokshah99@yahoo.com

 

DOI: 10.5603/PiAP.2014.0058

Praca wpłynęła do Redakcji: 6.02.2014 r.

 

References

  1. Kahn I.S. Fruit sensitivity. Southern Med. J. 1942; 35: 858–859.

  2. Rubin J.M., Shapiro J., Muehlbauer P., Grolnick M. Shock reaction following ingestion of mango. JAMA 1965; 193: 397–398.

  3. Dang R.W., Bell D.B. Anaphylactic reaction to the ingestion of mango. Case report. Hawaii Med. J. 1967; 27: 149–150.

  4. Miell J., Papouchado M., Marshall A.J. Anaphylactic reaction after eating a mango. BMJ 1988; 297: 1639–1640.

  5. Duque S., Fernandez-Pellon L., Rodriguez F. Mango allergy in a latex sensitised patient. Allergy 1999; 54: 1004–1005.

  6. Hegde V.L., Venkatesh Y.P. Anaphylaxis following ingestion of mango fruit. J. Investig. Allergol. Clin. Immunol. 2007; 17: 341–344.

  7. Renner R., Hipler C., Treudler R., Harth W., Sub A., Simon J.C. Identification of a 27 kDa protein in patients with anaphylactic reactions to mango. J. Investig. Allergol. Clin. Immunol. 2008; 18: 476–481.

  8. Silva R., Lopes C., Castro E., Ferraz de Oliviera J., Bartolome B., Castel-Branco M.G. Anaphylaxis to mango fruit and cross-reactivity with Artemisia vulgaris pollen. J. Investig. Allergol. Clin. Immunol. 2009; 19: 414–422.

  9. Sareen R., Gupta A., Shah A. Immediate hypersensitivity to mango manifesting as asthma exacerbation. J. Bras. Pneumol. 2011; 37: 135–138.

  10. Zakon S.J. Contact dermatitis due to mango. JAMA 1939; 113: 1808.

  11. Calvert M.L., Robertson I., Samaratunga H. Mango dermatitis: allergic contact dermatitis to Mangifera indica. Australas J. Dermatol. 1996; 37: 59–60.

  12. Tucker M.O., Swan C.R. The mango-poison ivy connection. New Eng J. Med. 1998; 339: 235.

  13. Weinstein S., Tehrani S.B., Cohen D.E. Allergic contact dermatitis to mango flesh. Int. J. Dermatol. 2004; 43: 195–196.

  14. Oka K., Saito F., Yasuhara T., Sugimoto A. A study of cross-reactions between mango contact allergens and uroshiol. Contact Dermatitis 2004; 51: 292–296.

  15. Wiwanitkit V. Mango dermatitis. Indian. J. Dermatol. 2008; 53: 158.

  16. Thoo C.H., Freeman S. Hypersensitivity reaction to the ingestion of mango flesh. Australas. J. Dermatol. 2008; 49: 116–119.

  17. Lee D., Seo J.K., Lee H.J., Kang J.H., Sung H.S., Hwang S.W. A case of allergic contact dermatitis. Korean J. Dermatol. 2009; 47: 612–614.

  18. Sareen R., Shah A. Hypersensitivity manifestations to the fruit mango. Asia Pac. Allergy 2011; 1: 43–49.

  19. Burks A.W., Tang M., Sicherer S. et al. ICON: Food allergy. J. Allergy Clin. Immunol. 2012; 129: 906–920.

  20. Fiocchi A., Brozek J., Schunemann H. et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines. Pediatr. Allergy Immunol. 2010; 21 (suppl 21): 1–125.

  21. Saraswat A., Kumar B. Anaphylactic reaction to apple, banana and lychee: what is common between botanically disparate plant families? Int. J. Dermatol. 2005; 44: 996–998.

  22. Paschke A., Kinder H., Zunker K. et al. Characterisation of cross-reacting allergens in mango fruit. Allergy 2001; 56: 237–242.

  23. Brehler R., Theissen U., Mohr C., Luger T. ‘Latex-fruit syndrome’: frequency of cross-reacting IgE antibodies. Allergy 1997; 52: 404–410.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl