Blueberry (Vaccinium myrtillus) Induced Anaphylaxis in a Chinese Child with Lipid Transfer Protein Sensitization

Abstract

Nannan Jiang,1– 3 Li Xiang,1– 3 Hui Guan,1– 3 Xudong Zhang1– 3 1Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 2Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, People’s Republic of China; 3China National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of ChinaCorrespondence: Li Xiang, Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, People’s Republic of China, Tel/Fax [phone], Email [email protected]: Fruits have been identified as the primary triggers of anaphylaxis in older children in the Chinese population, especially among individuals with pollen sensitization. To date, no allergies have been reported after blueberry ingestion in the Chinese population.Case Report: A 12-year-old girl experienced one episode of anaphylaxis within 30 minutes of having breakfast (including milk, egg, wheat bread, and blueberry) while walking to school. She menstruated during this episode. Prompt treatment with epinephrine and fluid therapy led to full recovery within 24 h. Specific IgE was conducted using ImmunoCAP, and the patient exhibited sensitization to several pollens, mainly Japanese hop (74.3 kUa/L) and mugwort (26.5 kUa/L). Regarding specific IgE to allergen components, the patient showed sensitization primarily to lipid transfer protein (LTP) components from mugwort Art v 3 (79.7 kUa/L), wheat Tri a 14 (12.4 kUa/L) and peach Pru p 3 (2.15 kUa/L), but tested negative for omega-5 gliadin. The prick test results were positive for blueberries (wheal size 9.5 mm), cherries (wheal size 6.5 mm), kiwifruits (wheal size 6 mm), and pears (wheal size 4.5 mm). Our patient was provided with an epi-pen and was advised to avoid consuming relevant fruits. After four months of follow-up, the patient had not experienced any episodes of anaphylaxis since these recommendations were implemented.Conclusion: We report for the first time a Chinese child with severe IgE-mediated immediate-type anaphylactic reaction to blueberries, in whom we identified LTP as the suspected allergen component.Keywords: anaphylaxis, lipid transfer protein, food allergy

Keywords

• anaphylaxis
• lipid transfer protein
• food allergy;