Case Studies

 Case 4.13 Latex-fruit allergy

A 25 yr old man was referred to the allergy clinic with a history of two significant allergic reactions in the preceding 3 years. The first occurred following a shuttle flight to London from Manchester. During the flight, he ate a chicken and avocado sandwich. About 30 mins later, and shortly after landing in London, he developed marked angioedema of his eyes and neck with a generalised urticarial eruption on his arms and trunk. First aid staff at the airport terminal placed him in a wheelchair for transport to an ambulance but during the journey he lost consciousness for 2-3 minutes and remembers nothing more. The second episode occurred about 6 months before referral. He had a meal in a Chinese restaurant, eating a mixture of foods : most of the ingredients were familiar and have been consumed subsequently without mishap. The exception was a dipping sauce made from plums or similar fruit. About 45 minutes later, he developed urticaria on his arms with angioedema of his hands but without bronchospasm or circulatory collapse.

Direct questioning elicitated additional clues. He had once had tingling of his lips eating a kiwi fruit and tingling and swelling of his hands after using a pump to blow up balloons for a party. He also remembered developing a rash on his penis after wearing a condom but had experienced no problems after visiting the dentist.

Examination was unremarkable but antigen-specific IgE antibody testing showed high levels of antibody to latex (40 u/ml - RAST class 4) and avocado (5.2 u/ml - RAST class 3) and moderate antibody levels to kiwi fruit (1.2 u/ml - RAST class 2).

The diagnosis was that of latex-fruit allergy illustrating cross reactivity between latex and certain fruits (see Table 4.3).

Table 4.3 Key features of Latex rubber allergy.

High-rsk groups

Patients with spina bifida or multiple urological procedures (10-50% risk) Health-care workers (5-10% risk)

Operating theatre staff Females Atopics

Rubbr industry workers (5-10% risk)

High-risk latex products

Surgical latex gloves latex rubber gloves for home use Balloons Catheters and enema tubes Teats and dummies (pacifiers)

Cross-reactivity with food allergies

Melon, banana, avocado, chestnut