PILI NUT ANAPHYLAXIS

Abstract

<h3>Introduction</h3> A six-year-old female with food allergy to select tree nuts developed an anaphylactic reaction after ingesting commercially-produced yogurt derived from pili nuts (<i>Canarium ovatum</i>). <h3>Case Description</h3> A six-year-old female with food allergy to select tree nuts (hazelnut, cashew, pistachio, walnut, pecan, brazil nut) consumed dairy-free yogurt derived from pili nuts. The ingredient label read as follows: coconut water, coconut cream, plantains, pili butter (pili nuts, water), coconut powder, cassava root starch, lime juice, himalayan salt, and live vegan cultures. She reported tolerating all ingredients except pili nut, which she had never eaten. Within ten minutes of ingestion, she developed oral edema. Diphenhydramine was administered without improvement. The patient presented to an urgent care center where she was given prednisolone. Due to persistent symptoms, she was transferred to the emergency department where she developed wheezing and generalized hives two hours after initial ingestion. She was given epinephrine and her symptoms immediately improved. She was discharged home well after observation. Skin testing to pili nut was markedly positive (wheal of 13mm) at a follow-up visit at our outpatient pediatric allergy clinic. <h3>Discussion</h3> This is the second reported case of anaphylaxis to pili nut in a cashew and pistachio allergic individual in the United States. This case further demonstrates the allergenicity of this tree nut and the need for it to be labeled as such on packaged goods. Providers should counsel patients on the avoidance of pili nut, especially as mass-market pili nut yogurt becomes more widely available.