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.

The First Case of Jujube allergy presented as anaphylaxis in a child sensitized multiple food allergens: A case report

“…There was previously a report on jujube allergy caused by latex-fruit syndrome 4 , and a recent report of IgE-mediated anaphylaxis without latex sensitization in an adult 5 ; however, our study is the first to report an anaphylaxis induced by jujube via IgE-mediated immune response in a child. In addition, unlike previous reports that were about allergy symptoms by Indian jujube (Z. mauritiana), this study is the first to report about Chinese jujube (Z. jujuba Mill).…”

“…4 7 However, although the patient in our study showed sensitization to kiwi and pine nuts from the skin prick test and clinically, the result from the skin prick test to latex was negative, this implied a chance of cross reaction of symptom-inducing Chinese date with components of kiwi or pine nuts. Particularly in the case of an adult patient in Canada 5 , who often had Indian jujube as dessert but did not take it at all after moving to Canada, symptoms appeared after reintake after a certain period of time. The skin prick test for jujube was positive, which suggested induction of allergy symptom by sensitization to jujube itself without sensitization to other antigens.…”

“…3 Although Jujube fruits are used in various forms in many countries, there are next to no reports on jujube side-effect or allergy. However, in Taiwan, there was a report of jujube allergy which appeared as a cross antigen reaction from a patient with latex allergy 4 , and recently in Canada, anaphylaxis symptom due to jujube was reported in an adult without latex sensization 5 . Herein, we report a case of anaphylatic reaction to jujube in a child allergic to pine nuts and kiwi for the first time and suggest the possibility that jujube allergy could be induced by a cross reaction with other food allergies apart from latex.…”