Fruit-Induced Anaphylaxis: Clinical Presentation and Management

• DOI: 10.1016/j.jaip.2021.02.055
• Publication Date: 2021-03-14T06:47:05Z
• Authors: Sofianne Gabrielli; Ann E. Clarke; Judy Morris; Jocelyn Gravel; Rodrick Lim; Edmond S. Chan; Ran D. Goldman; Andrew O'Keefe; Jennifer Gerdts; Derek K. Chu; Julia Upton; Elana Hochstadter; Jocelyn Moisan; Adam Bretholz; Christine McCusker; Xun Zhang; Jennifer L.P. Pro...; Elissa M. Abrams; Elinor Simons; Moshe Ben-Shoshan
• Keywords: Adult; Male; Canada; Epinephrine; Quebec; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Fruit; Humans; Child; Emergency Service, Hospital; Anaphylaxis; Food Hypersensitivity

Data are sparse regarding the clinical characteristics and management of fruit-induced anaphylaxis.To assess clinical characteristics and management of patients with fruit-induced anaphylaxis and determine factors associated with severe reactions and epinephrine use.Over 9 years, children and adults presenting with anaphylaxis to seven emergency departments in four Canadian provinces and patients requiring emergency medical services in Outaouais, Quebec were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized form documenting symptoms, triggers, and management was collected. Multivariate logistic regression was used to identify factors associated with severe reactions and epinephrine treatment in the pre-hospital setting.We recruited 250 patients with fruit-induced anaphylaxis, median age 10.2 years (interquartile range, 3.6-23.4 years); 48.8% were male. The most common fruit triggers were kiwi (15.6%), banana (10.8%), and mango (9.2%). Twenty-three patients reported having eczema (9.3%). Epinephrine use was low in both the pre-hospital setting and the emergency department (28.4% and 40.8%, respectively). Severe reactions to fruit were more likely to occur in spring and among those with eczema (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI], 1.03-1.23; and 1.17, 95% CI, 1.03-1.34, respectively). Patients with moderate and severe reactions (aOR = 1.23; 95% CI, 1.06-1.43) and those with a known food allergy (aOR = 1.38; 95% CI, 1.24-1.54) were more likely to be treated with epinephrine in the pre-hospital setting.Severe anaphylaxis to fruit is more frequent in spring. Cross-reactivity to pollens is a potential explanation that should be evaluated further.