IgE-mediated reactions
Anecdotal evidence suggests that persimmon can occasionally induce symptoms of food allergy in sensitised individuals; however, few studies have been reported to date. (1-5)
Oral allergy to persimmon has been reported. One study reports on 3 patients: after the ingestion of persimmon, the first reacted with pruritus, penis oedema, urticaria, and asthma; the second with nausea and vomitus; and the third with rhinoconjunctivitis, asthma, and stomachache. (2)
A 13-month-old Japanese male infant was seen following a reaction to persimmon upon first ingestion. Symptoms included skin rash and itching on the face and soles of the feet. The symptoms had appeared immediately after biting a fresh persimmon and the itching on the soles persisted for more than 13 hours, despite treatment with oral antihistamines. Neither wheeze nor gastrointestinal symptoms were observed. He did not have asthma, eczema, or rhinoconjunctivitis. Skin-prick test was positive with fresh persimmon (18 mm). Serum specific IgE was 3.29 kU/L to persimmon. He was not sensitised to carrot, apple, kiwi, celery, melon, peach, timothy grass, mugwort, alder, birch, beech, oak, or Alternaria. The patient’s serum indicated IgE-binding proteins at positions corresponding to approximately 30 kDa and 60 kDa. (5)
In a study evaluating cross-reactivity with pollen allergens as a result of the presence of a profilin and Bet v 6-like and Bet v 1-like allergens, 2 patients with hypersensitivity reactions upon first exposure to persimmon, as well as 7 patients with birch-pollen-related apple allergy, were assessed. Sera from both patients were reactive to Bet v 1 and Bet v 6, which were cross-reactive with persimmon. The patient with the most severe reactions was reactive to profilin. An open challenge with persimmon in 7 patients allergic to birch pollen and apple, who had not eaten persimmon previously, was positive in 6/7 cases. The study concluded that birch-pollen-related allergy to persimmon is mediated by known cross-reactive pollen allergens, including Bet v 1, and may become more of a problem should persimmon consumption increase. (3)
A case was reported of a 33-year-old man with an anaphylactic reaction immediately after ingestion of persimmon fruit. A skin-prick test with persimmon fruit was positive. Serum-specific IgE was demonstrated. (1)
In another case of anaphylaxis, a 20-year-old man reported itching, generalised urticaria, facial oedema, asthma, gastrointestinal symptoms and diarrhoea 10 minutes after eating a fresh persimmon fruit. Prick-to-prick and SPT were positive. RAST was negative. (6)
Other reactions
Some patients complain of abdominal distension and excessive flatus after ingesting persimmon, and these reactions were attributed to fructose intolerance. (7)
Persimmon phytobezoar, although in general an infrequent entity, is not rare in some countries. (8) Because of their particular features, management of diospyrobezoars is difficult. (9) Most patients with bezoars have ingested unpeeled fruits. While ingestion of Persimmon carries a 9.8-fold elevated risk of bezoar development, ingestion of the unpeeled fruit increases the risk of this complication 56 times over that of age- and sex-matched controls. (10) Small bowel obstruction in children due to persimmon phytobezoars may occur. (11)
Lycopenaemia is a benign condition, secondary to an excessive dietary intake of lycopene-rich fruits. It was described in a 68-year-old Caucasian woman who presented with red-orange-tinged skin on her palms and soles. Her diet included about 1 kg of persimmon daily. The discolouration of the palms and soles resulted from pigment deposits, due to the slow conversion of carotene to vitamin A. This condition resolved after changes in her dietary habits. (12)
