Allergic reaction after ingestion of orange blossom pollen

A 31-year-old atopic subject with allergic rhinoconjunctivitis with sensitization to several pollens, presented with urticaria and angioedema after ingestion of orange blossom pollen (Citrus sinensis). A positive skin prick test for orange blossom pollen extract (BIAL-Aristegui, Bilbao, Spain) at a concentration of 1.2 mg/ml was obtained. Serum specific IgE antibodies to orange blossom pollen were shown (Unicap Pharmacia System, Uppsala, Sweeden). A conjunctival provocation test was negative with orange blossom pollen extract dilutions of 1:1000, 1:100 and 1:10 w/v. We describe a patient with an IgE-mediated reaction caused by hypersensitivity to orange blossom pollen. Although the pollen is an aeroallergen and the way of sensitization and entrance is the airway, and therefore the symptoms appear in this location, when contact is through some other route such as the digestive tract, it is also able to sensitize reporting urticaria and angioedema like in our case, instead of respiratory symptoms.