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Keywords:

  • anaphylaxis;
  • durian;
  • exotic fruit

Tropical fruits are part of the natural diet in countries in which these fruits are indigenous, and are now more frequently consumed in industrialized countries. We report a case of food anaphylaxis in a 47-year-old female of Thai origin. This patient with no history of atopy, had a past history of recurrent episodes of generalized urticarial eruptions (in one case associated with Quincke's edema) after ingestion of various foods, including papaya, shrimps, Thai beans, Chinese cabbage and Asian soup. Spontaneous resolution was the rule, occasionally after antihistamine intake. The last episode appeared 30 min after ingestion of durian, a tropical fruit. She presented with generalized urticaria, nasal congestion and rhinorrhea, laryngeal discomfort with hoarseness, diarrhoea and vomiting. Rapid recovery was observed after dimetindene (Fenistil®) medication.

The allergy work-up demonstrated positive skin prick tests (SPT) to various pollens (grass, trees), cat dander, house dust mites and cockroaches. SPT with commercial food extracts were also positive for papaya, shrimps, and various spices such as coriander, paprika, and black pepper. SPT to lobster, crab, celery, onion and peanut remained negative. SPT with durian, freshly prepared according to Ortolani (1), was classified as strongly positive (wheal 7 × 36); fresh papaya was also positive (5 × 32 mm). Fresh dried shrimps, Thai beans and Chinese cabbage tested positive. None of the three nonatopic control individuals showed a positive reaction to fresh durian, ruling out a nonspecific irritant reaction.

The durian species with synonyms such as dourian or durio belong to the Angiosperm (order Malvales) and to the Bombacacae family (tropical trees such as Baobab). There are 27 known species of the genus Durio of which only six have edible fruits (Table 1). The common durian refers only to Durio zibethinius, named by the botanist Murray who compared the strong offensive odour of its fruit with that of the civet cat (Zibethinius). Durian fruits are globular fruits measuring 15–25 cm, covered with spines and showing different colours ranging from dark green to brownish yellow. The Durian tree can reach up to 45 m in height and requires an equatorial climate. When ripe, the fruits fall from the tree. It is mainly grown in tropical areas such as Malaysia, Thailand, Cambodia, Birmany, Sri Lanka and south India. The fleshy part of the fruit, with a cream-like aspect has a powerful garlic-like smell, probably due to a sulphuric compound (perhaps related to butyric acid). Its composition is rich in proteins, fats, minerals and carbohydrates (34.1%, mainly sugar and starch).

Table 1.  Edible species of durian
 OriginLocal nameProduction
D. zibethiniusMalaysiadurianCultivated
D. kutjensisBorneolaiCultivated
D. oxleyanusBorneo, SumatrakeratonganWild
D. graveolensBorneo, SumatratabelakWild
D. dulcisBorneolahongWild
DgrandiflorusBorneodurian munjiWild

This patient is sensitized to papaya (Carica papaya), that's main allergen, a cysteine protease, is well known, and is probably responsible for numerous descriptions of anaphylactic reactions reported in the literature (2).

Sensitization to coriander, paprika and black pepper is probably responsible for the multiple past urticarial episodes in relation with the ingestion of Thai beans and Chinese cabbage (served with a spicy sauce).

The correlation between durian ingestion followed by anaphylaxis and positive SPT to durian in this patient, with three negative nonatopic controls, is highly suggestive of allergic food anaphylaxis (3) to durian. To our knowledge this is the first description of an allergic food anaphylaxis related to this tropical fruit.

References

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  2. References
  • 1
    Ortolani C, Ispano M, Pastorello A, Ansaloni R, Magri GC. Comparison of results of skin pricks tests (with fresh foods and commercial food extracts) and RAST in 100 patients with oral allergy syndrome. J Allergy Clin Immunol 1989;83:683690.
  • 2
    Ezeoke AC. Hypersensitivity to paw-paw (Carica papaya): report of a case. Afr J Med Sci 1985;14:121124.
  • 3
    Johansson SGO, O'B Hourihane J, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, Van Cauwenberge P, Van Hage-Hamsten M, Wüthrich B. A revised nomenclature for Allergy. Allergy 2001;56:813824.

Accepted for publication 9 November 2001