Repeated anaphylactic episodes to orange and apple.

Area of Science:

• Food Allergy and Immunology
• Clinical Medicine
• Dermatology

Background:

• Plant lipid transfer proteins (LTPs) are common allergens causing systemic reactions.
• Peach LTP allergy is well-documented, often associated with cross-reactivity to other fruits and vegetables.

Observation:

• A patient experienced recurrent anaphylaxis upon consuming oranges and apples.
• Initial assessment showed no sensitization to peach LTP, a common allergen.

Findings:

• In vitro and in vivo tests confirmed heat-stable allergens in oranges and apples.
• Significant differences in allergenicity were observed among various apple cultivars.
• Strong cross-reactivity was noted between citrus fruits, suggesting shared allergenic components.

Implications:

• This case highlights the possibility of primary sensitization to non-peach LTPs in fruit allergies.
• The findings emphasize the need to consider diverse fruit allergens and their cross-reactivity patterns.
• The prick-to-prick method using fresh fruits is a practical and effective diagnostic tool for fruit-induced allergies.