Isolated Anaphylaxis to Avocado- A Rare Presentation

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Anaphylaxis to avocado in a 15-year-old who was having guacamole dip with chips. A case of isolated anaphylaxis to avocado, without the usually associated latex-fruit syndrome.

A 15-year-old male presented to the emergency department with coughing, wheezing, nasal stuffiness, generalized urticaria, and periorbital oedema. One of his family members had given him antihistamine at home; however, the symptoms didn’t subside. Since the symptoms persisted, his family brought him to the emergency department where the doctors administered intravenous antihistamine and steroid. The family revealed that he experienced these symptoms half an hour after consuming guacamole dip with chips. Thereafter, the patient stabilised, and the doctors discharged with a prescription of oral steroids and EpiPen®. Additionally, they referred him to an allergy clinic for suspected anaphylaxis/allergy to avocado.

At the clinic, the patient revealed that this wasn’t the first time he had eaten those chips. In fact, he had eaten the same brand of chips multiple times in the past. However, he did not remember if he had consumed avocado before.

The patient’s medical history was positive for eczema and cold-induced hives. There was no history of asthma or allergic rhinitis. However, his mother was a known asthmatic. Among his siblings, one elder brother and a sister had “environmental allergies” and asthma.

He consumed an unrestricted diet. Moreover, he had been exposed to latex (balloons) multiple times in the past without any consequences. In addition, his diet included other foods that are often included in latex-fruit syndrome (kiwi, banana, potato). However, he wasn’t sure about chestnut consumption. It was important to rule out latex-fruit syndrome, as most of the cases of avocado allergy are in association with the latex-fruit syndrome. It is quite rare to have isolated avocado allergy.

Physical examination was unremarkable.

The patient underwent an ice cube test and epicutaneous testing via prick technique for fresh avocado, commercial avocado extract, fresh and commercial chestnut, and guacamole dip.

 Skin testing was positive to fresh avocado with a 10 mm induration, and commercial extract gave a 5 mm induration. It was borderline to the guacamole mix (3 mm). Testing to fresh and commercial chestnut was positive to fresh chestnut (10 mm) and commercial chestnut (6 mm). Histamine was 5 mm, and saline control was 2 mm.

The ice cube test resulted in faint, transient localized urticaria. However, latex use test was negative. ImmunoCAP to avocado was positive at 0.9 KUA/L.

Since anaphylaxis is a life-threatening condition, it is imperative to counsel the patients with the prevention and immediate first-aid steps in cases of emergency. Moreover, it is equally important for such patients to always carry an EpiPen®. Patient education, counselling, and prompt management are the hallmarks of anaphylaxis management.

Reference: Abrams, E.M., Becker, A.B. & Gerstner, T.V. Anaphylaxis related to avocado ingestion: a case and review. All Asth Clin Immun 7, 12 (2011). https://doi.org/10.1186/1710-1492-7-12

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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