Anaphylactic reaction in patient allergic to mango

Area of Science:

• Allergology and Immunology
• Food Allergy Research
• Molecular Allergology

Background:

• Mango allergy is uncommon, with profilin identified as a potential cross-reactive allergen with fruits like pear, apple, and peach.
• A panallergen, mugwort defensin (Art v 1), known for cross-reactivity with various vegetables and spices, was previously described.

Observation:

• A 30-year-old female presented with recurrent allergic reactions, including severe anaphylaxis after mango consumption.
• Symptoms included generalized urticaria, facial edema, abdominal pain, and diarrhea, alongside oral allergy syndrome with fruits and vegetables.

Findings:

• Skin prick tests and specific IgE levels indicated allergies to grass, weeds, cat dander, mugwort, and mango.
• Elevated IgE to timothy grass (rPhl p 1) and mugwort (Art v 1) was confirmed via ImmunoCap ISAC.
• An IgE inhibition test confirmed a cross-reaction between mugwort Art v 1 and mango, identifying it as the cause of the patient's symptoms.

Implications:

• The patient's anaphylactic reaction to mango was attributed to cross-allergy with mugwort Art v 1, a manifestation of IgE-mediated food allergy.
• Elevated IgE to multiple food allergens (celery, peppers, carrot, banana, peach, apple, shrimp) was noted.
• Recommendations included an elimination diet and carrying emergency medication (adrenaline, steroids, antihistamines) due to the risk of anaphylaxis.