Unpeeled Fruit: Improve risk assessment by testing with allergen components
Maria, a 5-year-old girl with a history of mild atopic dermatitis, wheeze, and oral allergy syndrome when eating unpeeled fruit, visits her healthcare provider following a recent emergency admission after developing severe urticaria and respiratory symptoms. Maria recovered well after emergency treatment. Her mother reported that Maria had eaten a slice of peeled apple 30 minutes before the onset of symptoms.
Her healthcare provider conducts a full clinical history and physical examination and decides to test using apple components.
After a trip to the ER, Maria gets testing with allergen components to help determine her risk for a severe reaction.
Patient History
Family History
- None
Maria’s Personal History
- Maria has had on-going mild allergic symptoms since infancy.
- Maria has suffered from rhinitis during summer for the last couple of years and she has had oral symptoms from eating unpeeled fruit. She was previously tested and subsequently diagnosed with grass pollen allergy.
Test |
Type |
Maria’s Results |
Timothy Grass |
Whole Allergen |
+2 |
Negative skin-prick test to milk, mugwort, cat, dog, and mold.
Test |
Type |
Maria's Results |
Timothy Grass |
Whole Allergen |
5.2 |
Her previous physician recommended that Maria use oral antihistamines during grass pollen season and avoid eating unpeeled fruit if unpleasant.
Maria’s ImmunoCAP Test Results
These results together with this patient's case history and symptoms, help confirm the diagnosis.
Test |
Type |
Maria’s Results |
Timothy Grass |
Whole Allergen |
15.3 |
Apple |
Whole Allergen |
17.9 |
Test |
Type |
Maria’s Results |
Phl p 1 |
Allergen Component |
9.5 |
Phl p 5b |
Allergen Component |
3.3 |
Phl p 7 |
Allergen Component |
<0.1 |
Phl p 12 |
Allergen Component |
4.2 |
Mal d 1 |
Allergen Component |
<0.1 |
Mal d 3 |
Allergen Component |
16.2 |
Differential Diagnosis
Maria’s severe reaction may be explained by her sensitization to Mal d 3, a lipid transfer protein, which indicates that Maria has an apple sensitization that is associated with an increased risk for severe and systemic symptoms.
Mal d 3 - a lipid transfer protein
- The test results indicate sensitization to Mal d 3, which is often associated with a higher risk of developing systemic reactions. Allergic reactions in patients with sensitization to lipid transfer protein (LTP) range from oral allergy syndrome to severe anaphylaxis.1
REFINED DIAGNOSIS
- Grass pollen allergy and LTP-dependent apple allergy.
HEALTHCARE PROVIDER MANAGEMENT PLAN
- Maria’s healthcare professional advises that she avoid apples in all forms, and be cautious with other fruits and nuts, such as peach and walnut.
- Maria’s healthcare professional advises her to always carry an emergency adrenaline autoinjector.
- Maria should continue to use antihistamines for grass-pollen symptoms.
FOLLOW UP
- Maria with her mother is seen by her healthcare provider one year later. Maria has had no further episodes, and is doing well. Her healthcare provider checks her autoinjector technique and is satisfied.
The people, places, and events depicted in these case studies and photographs do not represent actual patients, nor are they affiliated in any way with Thermo Fisher Scientific.
- Gomez F, Aranda A, Campo P, et al. High Prevalence of Lipid Transfer Protein Sensitization in Apple Allergic Patients with Systemic Symptoms. Hogan SP, ed. PLoS ONE. 2014;9(9):e107304. doi:10.1371/journal.pone.0107304.
