Asia Pac Allergy.  2020 Jan;10(1):e4. 10.5415/apallergy.2020.10.e4.

Banana anaphylaxis in Thailand: case series

Affiliations
  • 1Division of Allergy, Immunology and Rheumatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. wannada.lai@mahidol.ac.th
  • 2Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Abstract

BACKGROUND
Banana fruit has been recognized as an important food allergen source. Nowadays banana hypersensitivity had been reported more frequently with various presentations from oral allergy syndrome to anaphylaxis.
OBJECTIVE
This study aims to describe the pattern of banana hypersensitivity and the sensitivity of diagnostic test.
METHODS
Six patients who experienced banana hypersensitivity were recruited from adult allergy clinic, Ramathibodi Hospital, Mahidol University between 2015-2018. Demographic data, pattern of banana allergy consisted of the onset of reaction, symptoms, severity, cross-reactivity to kiwi, avocado, latex including type and amount of banana were collected. Skin test, serum specific IgE to banana and open-label food challenge test had been applied.
RESULTS
All patients experienced multiple episodes of banana anaphylaxis. Regarding the diagnostic investigation, prick-to-prick skin test had higher sensitivity (sensitivity, 100%; 95% confidence interval [CI], 54.07%-100%) than the commercial banana extract (sensitivity, 83.33%; 95% CI, 35.88%-99.58%) and serum specific IgE to banana (sensitivity, 50%; 95% CI, 11.81%-88.19%). The discordance between skin prick test using commercial banana extract and skin test was reported. The cross-reactivity between the species of banana, kiwi, the avocado was documented in all patients. Latex skin prick test and application test were applied with negative results. From the oral food challenge test, a case of banana anaphylaxis patient can tolerate heated banana.
CONCLUSION
The various phenotypes of banana hypersensitivity were identified. The prick-to-prick test showed the highest sensitivity for diagnosis of banana allergy. However, component resolved diagnostics might be needed for conclusive diagnosis.

Keyword

Food hypersensitivity; Banana anaphylaxis; Hypersensitivity, Immediate; Immunoglobulin E; Food allergy

MeSH Terms

Adult
Anaphylaxis*
Diagnosis
Diagnostic Tests, Routine
Food Hypersensitivity
Fruit
Hot Temperature
Humans
Hypersensitivity
Hypersensitivity, Immediate
Immunoglobulin E
Latex
Musa*
Persea
Phenotype
Skin
Skin Tests
Thailand*
Immunoglobulin E
Latex
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