Ayşen BİNGÖL, Serkan FİLİZ, Dilara Fatma KOCACIK UYGUN

An evaluation of banana allergy in children living in the Mediterranean region

Background/aim: We aimed to apply a double-blind placebo-controlled food challenge (DBPCFC) test to patients who reported areaction to banana and showed positivity for banana-specific IgE in Turkey.Materials and methods: Medical data of patients who had been analyzed for banana allergy were reviewed, focusing on banana-specificIgE positivity at the Department of Pediatric Allergy-Immunology at the Akdeniz University Faculty of Medicine between the years2004 and 2012. Patients were called to the clinic for a DBPCFC test.Results: A total of 47 patients participated. We determined reactions in 13% of DBPCFC patients. A cut-off value was determinedas 0.66 kU/L for banana-specific IgE, and sensitivity and specificity were 83% and 51%, respectively. The positive predictive value forspecific IgE was 20% while the negative predictive value was 96%. Sensitivity and specificity for banana prick-to-prick test (P + P) was33% and 93%, respectively; positive predictive value was 40% and negative predictive value was 91%.Conclusion: This is the first study conducted in Turkey to use a DBPCFC test in the diagnosis of banana allergy. Up until now, thepositive predictive value was not defined for banana-specific IgE. Our study showed that specific IgE or skin tests alone are not adequatefor the diagnosis of food allergy; to define subjective symptoms related to food and to determine cross-reactions, DBPCFC tests shouldbe done for confirmation.

PDF

___

Sanchez-Monge R, Blanco C, Perales AD, Collada C, Carrillo T, Aragoncillo C, Salcedo G. Class I chitinases, the panallergens responsible for the latex-fruit syndrome, are induced by ethylene treatment and inactivated by heating. J Allergy Clin Immun 2000; 106: 190-195.
Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS; Adverse Reactions to Food Committee of American Academy of Allergy, Asthma & Immunology. Work Group report: oral food challenge testing. J Allergy Clin Immun 2009; 123: 365-383.
Aleksic I, Popovic M, Dimitrijevic R, Andjelkovic U, Vassilopoulou E, Sinaniotis A, Atanaskovic-Markovic M, Lindner B, Petersen A, Papadopoulos NG et al. Molecular and immunological characterization of Mus a 5 allergen from banana fruit. Mol Nutr Food Res 2012; 56: 446-453.
Grob M, Reindl J, Vieths S, Wuthrich B, Ballmer-Weber BK. Heterogeneity of banana allergy: characterization of allergens in banana-allergic patients. Ann Allerg Asthma Im 2002; 89: 513-516.
Hauswirth DW, Burks AW. Banana anaphylaxis with a negative commercial skin test. J Allergy Clin Immun 2005; 115: 632- 633.
Palacin A, Quirce S, Sanchez-Monge R, Bobolea I, Diaz-Perales A, Martin-Munoz F, Pascual C, Salcedo G. Sensitization profiles to purified plant food allergens among pediatric patients with allergy to banana. Pediatr Allergy Immu 2011; 22: 186-195.
Bock SA, Sampson HA, Atkins FM, Zeiger RS, Lehrer S, Sachs M, Bush RK, Metcalfe DD. Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: a manual. J Allergy Clin Immun 1988; 82: 986-997.
Noe D, Bartemucci L, Mariani N, Cantari D. Practical aspects of preparation of foods for double-blind, placebo-controlled food challenge. Allergy 1998; 53: 75-77.
Delbourg MF, Guilloux L, Moneret-Vautrin DA, Ville G. Hypersensitivity to banana in latex-allergic patients. Identification of two major banana allergens of 33 and 37 kD. Ann Allerg Asthma Im 1996; 76: 321-326.
Makinen-Kiljunen S. Banana allergy in patients with immediate-type hypersensitivity to natural rubber latex: characterization of cross-reacting antibodies and allergens. J Allergy Clin Immun 1994; 93: 990-996.
El-Sayed ZA, El-Ghoneimy DH, El-Shennawy D, Nasser MW. Evaluation of banana hypersensitivity among a group of atopic Egyptian children: relation to parental/self reports. Allergy Asthma Immun 2013; 5: 150-154.
Lavaud F, Cossart C, Reiter V, Bernard J, Deltour G, Holmquist I. Latex allergy in patient with allergy to fruit. Lancet 1992; 339: 492-493.
M’Raihi L, Charpin D, Pons A, Bongrand P, Vervloet D. Crossreactivity between latex and banana. J Allergy Clin Immun 1991; 87: 129-130.
Karisola P, Kotovuori A, Poikonen S, Niskanen E, Kalkkinen N, Turjanmaa K, Palosuo T, Reunala T, Alenius H, Kulomaa MS. Isolated hevein-like domains, but not 31-kd endochitinases, are responsible for IgE-mediated in vitro and in vivo reactions in latex-fruit syndrome. J Allergy Clin Immun 2005; 115: 598- 605.
Wongrakpanich S, Klaewsongkram J, Chantaphakul H, Ruxrungtham K. Jackfruit anaphylaxis in a latex allergic patient. Asian Pac J Allergy 2015; 33: 65-68.
Santos A, Van Ree R. Profilins: mimickers of allergy or relevant allergens? Int Arch Allergy Imm 2011; 155: 191-204.