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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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SHOULD MULTIPLE FRUIT ALLERGY BE A SUSPICION OF LATEX ALLERGY?

Cátia Alves, Ana Margarida Romeira, Sara Prates, Paula Leiria Pinto.

Immunoallergology Department, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central E.P.E.

- EAACI Congress 2012, Genebra, 16-20 de Junho 2012 (Poster).

Background: Fruit allergy may occur in the context of latex-fruit syndrome. This raises the question if in the presence of multiple fruit allergy we should investigate latex sensitization.

Case Report: The authors describe the clinical case of a10 year old girl, with brachial plexus palsy and dislocated right shoulder at birth, who underwent two surgeries. At the age of 9, she refers for the first time two episodes of swelling of the hands and ears, facial erythema and dyspnea a few minutes after a meal. At the age of 10, after eating chestnuts she develops lip angioedema, erythema of the face, coughing and dyspnea. In both cases she attended the emergency department (ED) and was treated with oral antihistamine and steroids, with good response. The patient also described oropharyngeal itching while eating peach. It is important to mention that she has no symptoms in daily life with latex contact. She was evaluated in Immunoallergology, where skin prick tests (ST) were made. They were negative for aeroallergens, commercial extracts of peach and chestnut and positive for latex and fresh peach and chestnut. Specific IgE was positive for latex (18.40 KUA/L) and negative for chestnut and peach. Immunocap ISAC was positive only for rHev b1 and rHev b5. Eviction of latex, chestnut and peach was recommended and a self-administration kit of epinephrine, corticosteroid and antihistamine were prescribed as needed. Six months later, after ingestion of pear, she developed urticaria, dyspnea, and tightness of the oropharynx. ST was positive for pear (pulp and peel). She has the indication to do pear eviction.

Discussion: In this case we found a multiple fruit allergy and asymptomatic sensitization to latex in a patient with two surgeries in the past. The sensitization profile to latex proteins is not the usual one, since it includes rHev b1, typical in spina bifida patients, and rHev b5, typical of health care professionals. Despite the absence of symptoms, we considered safer to recommend latex eviction. The results don't allow us to affirm that fruit allergy is due to a latex-fruit syndrome or a co-sensitization. We are waiting for the results of inhibition tests.

Palavras-chave: multiple fruit allergy, latex allergy, children.