Abstract
BackgroundFicus carica is an edible fruit, belonging to the Moraceae family, rarely described as cause of food allergy. We describe the first case of fig allergy that occurred as a cross-reactivity between fig and Derp 1.Case presentationWe present a case of a 10-years-old-girl, with a history of no-seasonal mild intermittent rhinitis, who experienced an immediate reaction after ingestion of a fresh fig. Skin prick tests (SPT) with commercial extracts of food, airborne allergens, latex and panallergens (profilin, PR-10 and lipid transfer protein) were performed. SPT revealed a sensitization only for dermatophagoides farina and dermatophagoides pteronyssinus which was then confirmed with by specific IgE assay (UniCAP, Phadia, Uppsala, Sweden). We also carried out a positive SPT with a commercial fig allergen (Lofarma, Milan, Italy) and prick-by-prick (PBP) both with skin and pulp of green raw and cooked fig. Fig specific serum IgE levels were 1.08 U/ml and specific IgE for rDer p1 was 16.20 U/ml (total serum IgE = 377 U/ml). In contrast specific IgE levels for latex, LTP, profilin, PR-10 and pollen allergens were negative.ConclusionThe ficin, the major fig allergen, belongs to cysteine protease family like Der p 1. The symptoms presented by our patient could be related to a cross reactivity between these two proteins which present a structural homology.
Highlights
Ficus carica is an edible fruit, belonging to the Moraceae family, rarely described as cause of food allergy
The symptoms presented by our patient could be related to a cross reactivity between these two proteins which present a structural homology
We describe the first case of fig allergy that occurred as a cross-reactivity between fig and dust mite proteins
Summary
Ficus carica is an edible fruit, belonging to the Moraceae family, and rarely described as cause of food allergy. Case presentation We present a case of a 10-years-old-girl with a history of no-seasonal mild intermittent rhinitis, who experienced an immediate reaction characterized by an oral allergy syndrome (OAS), drooling, urticaria, lips and face angioedema and dyspnea after ingestion of a fresh fig. She was treated in emergency room with inhalator salbutamol and intravenous antihistamines and corticosteroids showing a progressive improvement of symptoms. We performed a complete allergological work-up including skin prick tests (SPTs) (Lofarma, Milan, Italy; Alk-abellò, Lainate, Milan) with commercial extracts of latex, apple profilin, peach lipid transfer protein (LTP), other food and airborne allergens. Our patient refused an oral placebo-controlled challenge with the fig, the diagnosis of fig allergy is very probable on the basis of clinical history and allergological work-out
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