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Non-IgE-mediated food allergy? A case report

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Background

A 23-year-old woman without personal or family history of atopy presented oral itching, tongue swelling, retrosternal pain and dysphagia when she ate peach, watermelon melon, banana, kiwi, pineapple, strawberry, walnut and hazelnut. She usually eats apple, pear, plum, grapes, peanuts, sunflower seeds and almond. She is asymptomatic on contact with rubber latex objects.

Method

We performed skin prick tests (SPT) with commercial extracts of common aeroallergens, fruits, nuts, latex, profilin (Pho d 2), polcalcin-enriched date palm, peach LTP (Pru p 3), prick by prick with fresh fruits, specific IgE to pollens, fruits, nuts and latex, epicutaneous food skin tests and simple blind oral provocation food tests. An upper endoscopy with biopsy was also carried out.

Results

All SPTs yielded negative results. IgE was <0.35 KU/L to all the allergens tested. Epicutaneous tests were negative as well. No pathological findings were found in the upper endoscopy or biopsies performed. Simple blind oral provocation test with pineapple was positive, with immediate report of oral itching, tongue edema, cough and dysphagia. The patient refused to continue the allergologic study.

Conclusion

We present a case of oral itching, lingual edema and dysphagia related to the ingestion of several fruits and nuts with a completely negative allergologic study except for a positive oral challenge test with pineapple. The reaction appears to be non-IgE mediated. The avoidance of these foods keeps the patient asymptomatic, tolerating the ingestion of other fruits and nuts.

The patient refused to undergo a new upper endoscopy after the oral provocation test. This might have confirmed suspected eosinophilic esophagitis. Our patient had avoided the foods that triggered her symptoms for a long time. This might be reason why the upper endoscopy was normal.

Consent

Written informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Author information

Correspondence to Rosario González-Mendiola.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Keywords

  • Esophagitis
  • Food Allergy
  • Date Palm
  • Eosinophilic Esophagitis
  • Rubber Latex