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A rare case of anaphylaxis to Indian jujube (Ziziphus Mauritiana Lam).

Abstract

Background

Indian jujube (Ziziphus Mauritiana Lam) is a sweet fruit from a tree native to tropical and subtropical regions of Asia and India. A few case reports have implicated Indian jujube to cause latex-fruit syndrome. We present the first case of an anaphylactic reaction to this fruit in a patient with no latex allergy.

Case presentation

A 55-year-old male was referred to the Outpatient Allergy Clinic at Queen's University for evaluation of anaphylaxis caused by ingestion of Indian jujube. He presented to the Emergency Department (ED) with scalp pruritus, dyspnea and generalized urticaria, which occurred two hours after he had consumed a homemade candied fruit cocktail consisting of Indian jujube, water, Thai and Indian sweetener. In the ED, he was treated with epinephrine, intravenous diphenhydramine and steroids. He did not have any previous history of environmental or food allergies but had consumed this fruit frequently since childhood. In clinic, he underwent skin-prick testing with a saline slurry of candied jujube, which resulted in a positive wheal and flare response with appropriate controls. On subsequent visit, skin-prick tests were performed with saline slurries of the Thai and Indian sweetener used to make the cocktail. Both tests were negative when applied to a healthy volunteer. Skin-prick testing to latex allergen and latex specific IgE were both negative. He was diagnosed with an IgE-mediated anaphylactic reaction to the Indian jujube fruit. He was advised to avoid consumption of Indian jujubes and carry an epinephrine autoinjector.

Conclusions

Anaphylaxis secondary to Indian jujube ingestion is an extremely rare phenomenon in patients without a latex allergy. A possible allergy to Indian jujube should be taken into consideration when working up anaphylaxis, especially in patient of Asian and Indian descent who have ceased regular consumption of the fruit.

Authors+Show Affiliations

Department of Medicine, Queen's University, Kingston, ON Canada.Division of Allergy & Immunology, Department of Medicine, Queen's University, Hotel Dieu Hospital, 166 Brock Street, Kingston, ON K7L 5G2 Canada.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32565843

Citation

Aberumand, Babak, and Rozita Borici-Mazi. "A Rare Case of Anaphylaxis to Indian Jujube (Ziziphus Mauritiana Lam)." Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology, vol. 16, 2020, p. 48.
Aberumand B, Borici-Mazi R. A rare case of anaphylaxis to Indian jujube (Ziziphus Mauritiana Lam). Allergy Asthma Clin Immunol. 2020;16:48.
Aberumand, B., & Borici-Mazi, R. (2020). A rare case of anaphylaxis to Indian jujube (Ziziphus Mauritiana Lam). Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology, 16, 48. https://doi.org/10.1186/s13223-020-00444-y
Aberumand B, Borici-Mazi R. A Rare Case of Anaphylaxis to Indian Jujube (Ziziphus Mauritiana Lam). Allergy Asthma Clin Immunol. 2020;16:48. PubMed PMID: 32565843.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A rare case of anaphylaxis to Indian jujube (Ziziphus Mauritiana Lam). AU - Aberumand,Babak, AU - Borici-Mazi,Rozita, Y1 - 2020/06/17/ PY - 2019/08/11/received PY - 2020/05/23/accepted PY - 2020/6/23/entrez PY - 2020/6/23/pubmed PY - 2020/6/23/medline KW - Anaphylaxis KW - Food allergy KW - Indian jujube KW - Ziziphus Mauritiana Lam SP - 48 EP - 48 JF - Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology JO - Allergy Asthma Clin Immunol VL - 16 N2 - Background: Indian jujube (Ziziphus Mauritiana Lam) is a sweet fruit from a tree native to tropical and subtropical regions of Asia and India. A few case reports have implicated Indian jujube to cause latex-fruit syndrome. We present the first case of an anaphylactic reaction to this fruit in a patient with no latex allergy. Case presentation: A 55-year-old male was referred to the Outpatient Allergy Clinic at Queen's University for evaluation of anaphylaxis caused by ingestion of Indian jujube. He presented to the Emergency Department (ED) with scalp pruritus, dyspnea and generalized urticaria, which occurred two hours after he had consumed a homemade candied fruit cocktail consisting of Indian jujube, water, Thai and Indian sweetener. In the ED, he was treated with epinephrine, intravenous diphenhydramine and steroids. He did not have any previous history of environmental or food allergies but had consumed this fruit frequently since childhood. In clinic, he underwent skin-prick testing with a saline slurry of candied jujube, which resulted in a positive wheal and flare response with appropriate controls. On subsequent visit, skin-prick tests were performed with saline slurries of the Thai and Indian sweetener used to make the cocktail. Both tests were negative when applied to a healthy volunteer. Skin-prick testing to latex allergen and latex specific IgE were both negative. He was diagnosed with an IgE-mediated anaphylactic reaction to the Indian jujube fruit. He was advised to avoid consumption of Indian jujubes and carry an epinephrine autoinjector. Conclusions: Anaphylaxis secondary to Indian jujube ingestion is an extremely rare phenomenon in patients without a latex allergy. A possible allergy to Indian jujube should be taken into consideration when working up anaphylaxis, especially in patient of Asian and Indian descent who have ceased regular consumption of the fruit. SN - 1710-1484 UR - https://www.unboundmedicine.com/medline/citation/32565843/A_rare_case_of_anaphylaxis_to_Indian_jujube_(Ziziphus_Mauritiana_Lam) L2 - https://aacijournal.biomedcentral.com/articles/10.1186/s13223-020-00444-y DB - PRIME DP - Unbound Medicine ER -
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