Mango, Pulp Fiction?

Abstract

Contact reactions to mango have been previously reported. Here we present an unusual dual reaction to mango peel and pulp. Skin prick, Finn Chamber and in-vitro IgE testing. A 23-year old gentleman was evaluated after 2 episodes of delayed reactions to mango ingestion. Both episodes involved a perioral and pruritic rash associated with dry and cracked lips developing 1 day after unpeeled mango consumption and lasting 1 week. The second episode involved significant periorbital and lip edema as well as extension of the rash to the abdomen and extremities. He denied systemic symptoms but recalled that a pruritic papulovesicular rash on his lower extremities had appeared after poison oak exposure 7 years prior. Physical exam revealed an erythematous papular rash on the left thigh and the right hand. In-vitro IgE testing was positive to dust mite but negative to mango. Skin prick testing was negative to mango skin and pulp. Epicutaneous patch testing using mango skin and pulp placed in duplicate under Finn Chambers was positive to mango skin at 72 hours and to mango pulp at 96 hours. We present a patient with contact dermatitis to mango skin and pulp. Patch testing using Finn Chambers is an efficient method for evaluating delayed type hypersensitivity to mango fruit. It is worth considering extending the observation to 96 hours given the clinically significant reaction to pulp.