Fruit-Induced Anaphylaxis: Clinical Presentation and Management.

Area of Science:

• Allergy and Immunology
• Clinical Medicine
• Epidemiology

Background:

• Clinical data on fruit-induced anaphylaxis and its management are limited.
• Understanding triggers and patient characteristics is crucial for effective treatment.
• Fruit allergies represent a significant public health concern, particularly in pediatric populations.

Purpose of the Study:

• To characterize clinical presentations of fruit-induced anaphylaxis.
• To evaluate management strategies, including epinephrine use.
• To identify factors associated with severe reactions and pre-hospital epinephrine administration.

Main Methods:

• A prospective registry study (Cross-Canada Anaphylaxis Registry) over 9 years.
• Inclusion of pediatric and adult patients from emergency departments and pre-hospital services.
• Multivariate logistic regression analysis to determine predictors of severe reactions and epinephrine use.

Main Results:

• 250 patients with fruit-induced anaphylaxis were identified; median age 10.2 years.
• Kiwi, banana, and mango were the most frequent triggers.
• Severe reactions were associated with spring seasonality and eczema (aOR=1.12-1.17).
• Pre-hospital epinephrine use was 28.4%, higher in moderate/severe reactions and known food allergies (aOR=1.23-1.38).

Conclusions:

• Fruit-induced anaphylaxis exhibits seasonal patterns, with increased severity in spring.
• Eczema is a significant risk factor for severe fruit anaphylaxis.
• Further research into pollen cross-reactivity is warranted to explain seasonal variations.