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Keywords:

  • anaphylaxis;
  • cross-reactivity;
  • Diospyros kaki;
  • persimmon fruit

The persimmon is the edible fruit of the persimmon tree (Diospyros kaki), which belongs to the Ebenaceae family. The fruit consists of a berry, as large as an apple, orange in color, with soft, juicy pulp, sweet if ripe. In northern Italy, it becomes ripe in late autumn and is usually eaten fresh by itself.

This report describes, for the first time, an anaphylactic reaction after eating of a fresh persimmon by an atopic patient.

A 20-year-old man exhibited itching, generalized urticaria, facial angioedema, asthma, gastrointestinal complaints, and diarrhea, 10 min after eating a fresh persimmon fruit. He was rushed to the hospital emergency ward. Chest examination identified wheezing. The usual blood pressure of 120/80 mmHg dropped to 90/60.

The patient had already been known to us for more than 10 years, initially for chronic rhinoconjunctivitis, and subsequently also for asthma. In 1986 and in 1994, the skin prick test (SPT) had been positive for dust mite (Dermatophagoides pteronyssinus [+++] and D. farinae [+++]) and for Alternaria alternata (++). In 1994, total and specific serum IgE was determined by ImmunoCAP tests (IgE-FEIA and RAST-FEIA, respectively; Pharmacia CAP-System, Uppsala, Sweden). The total IgE was >1000 kU/l. Specific serum IgE was class 4 for Der p (21.5 kU/l), class 6 for Der f (>100 kU/l), and class 4 for Alternaria (26.8 kU/l). In 1986 and 1994, SPT was negative for pollens, animal dander, molds, and a battery of commercially available (Lofarma, Milan, Italy) food allergens.

Since the patient's symptoms were perennial without seasonal modifications and since the atmospheric dispersion of Alternaria spores in our region occurs only from April to September, the positivity to Alternaria was considered only nonclinical sensitivity.

Eating persimmon had never affected the patient before, although he always used to eat it in autumn, but he had recently experienced oral allergy syndrome (OAS) to kiwi (Actidinia chinensis).

SPT were performed by placing a piece of persimmon fruit and a piece of kiwi on the forearm and pricking through them (the prick-prick method). SPT with persimmon and kiwi yielded a wheal and flare reaction (persimmon wheal 15 mm in diameter with pseudopods; the kiwi wheal was 9 mm in diameter). The RAST to persimmon and kiwi was negative, despite clearly positive SPT. At a follow-up after 1 year, the patient refused further blood examination.

To our knowledge, this is the first report of an anaphylactic reaction caused by persimmon fruit ingestion. The IgE-dependent mechanism was supported by immediate positive skin reaction. The RAST negativity was probably due to a marked increase in level of serum total IgE (total IgE was >1000 kU/l in 1994) and/or to the short time between symptoms and blood examination.

The patient was sensitized to dust mite and Alternaria, but not to pollens or food allergens except kiwi. Actidin (Act c 1), the main proteic component of kiwi (1), is an enzymatic protein belonging to the cysteine proteases, the structure of which is similar to Der p 1 (2).

These data suggest the intriguing possibility of cross-reactive allergenic structures in D. kaki and D. pteronyssinus.

References

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Footnotes
  1. Is there an allergenic cross-reaction between persimmon (Diospyros kaki) and Dermatophagoides?