Passion fruit
Clinical Relevance
IgE-mediated reactions
Passion fruit may occasionally induce symptoms of food allergy in sensitised individuals, and more frequently in latex-allergic individuals.
A 36-year-old experienced generalised urticaria, oropharyngeal pruritus, tongue swelling, dysphagia, dysphonia, cough, rhinorrhea, sneezing, lacrimation, and ocular itching immediately after drinking a can of mango and passion fruit juice. Specific IgE levels to passion fruit, chestnut, latex, and rHev b 6.02 (hevein) were 2.17, 0.72, 10.50, and 14.30 kUA/L, respectively.
IgE-mediated occupational asthma and rhinitis to P. alata (related to P. edulis) and Rhamnus purshiana were reported in a patient who worked in a pharmacy devoted to the manual preparation of herbal products.
Other reactions
A 34-year-old female developed severe nausea, vomiting, drowsiness, prolonged QTc interval on her ECG, and episodes of non-sustained ventricular tachycardia following self-administration of the herbal remedy Passiflora incarnata (related to P. edulis, but with bioactivity) in therapeutic doses. The association of symptoms with Passiflora was not recognised for several days. She required hospital admission for cardiac monitoring and intravenous fluid therapy.
Vasculitis associated with an herbal preparation containing Passiflora extract has been reported.
Cross-Reactivity
Extensive cross-reactivity between the different individual species of the genus could be expected, but has not been formally evaluated.
A class I chitinase has been reported to be the relevant protein linked to cross-reactions in latex-fruit allergy syndrome, which includes passion fruit, cherimoya, kiwi, papaya, mango, tomato and wheat.
A class I chitinase from avocado or latex extract was used as an inhibitor in a study the aim of which was to evaluate the role of chitinases and complex glycans as cross-reactive determinants linked to latex-food allergy. Putative class I chitinases of 30 to 45 kDa were recognised by both specific polyclonal antibodies to chitinases and sera from patients with latex-fruit allergy in chestnut, cherimoya, passion fruit, kiwi, papaya, mango, tomato, and wheat flour extracts. Prs a 1, the major allergen and class I chitinase from avocado, along with the latex extract, strongly or fully inhibited IgE binding by these components when tested in immunoblot inhibition assays. Additional bands of 16 to 20 kDa, 23 to 28 kDa, and 50 to 70 kDa were detected by the anti-chitinase serum, but not by the patients' pooled sera. The putative 30- to 45-kDa chitinases present in different food extracts did not react with a pool of sera from subjects who were allergic to latex but not to fruit. The study concluded that putative class I chitinases seem to be relevant cross-reactive components in foods associated with latex-fruit syndrome, but do not play a specific role in those with allergy to latex but not to fruit. Cross-reactive carbohydrate determinants are not important structures in the context of latex-fruit cross-sensitisation.
Clinically relevant cross-reactivity between latex and passion fruit has been documented.
In children, cross-reactivity has been reported among apricot, avocado, banana, cherry, chestnut, grape, kiwi, papaya, passion fruit, peach and pineapple.
Healthcare providers who have coexisting risk factors, such as atopy and food allergies (chestnut, banana, avocado, passion fruit, celery, potato, and peach) are at an even greater risk of severe allergic reactions following repeated latex exposure.
References
- Brehler R, Theissen U, Mohr C, Luger T. "Latex-fruit syndrome": frequency of cross-reacting IgE antibodies. Allergy. 1997;52(4):404-10.
- Cabanillas B, Rodríguez J, Blanca N, Jiménez MA, Crespo JF. Clinically relevant cross-reactivity between latex and passion fruit. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2009;103(5):449.
- Diaz-Perales A, Collada C, Blanco C, Sánchez-Monge R, Carrillo T, Aragoncillo C, et al. Class I chitinases with hevein-like domain, but not class II enzymes, are relevant chestnut and avocado allergens. The Journal of allergy and clinical immunology. 1998;102(1):127-33.
- Twarog FJ. Food-induced allergy in childhood. Allergy and asthma proceedings. 1998;19(4):219-22.
- Zaglaniczny K. Latex allergy: are you at risk? AANA journal. 2001;69(5):413-24.
- Giavina-Bianchi PF, Jr., Castro FF, Machado ML, Duarte AJ. Occupational respiratory allergic disease induced by Passiflora alata and Rhamnus purshiana. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 1997;79(5):449-54.
- Fisher AA, Purcell P, Le Couteur DG. Toxicity of Passiflora incarnata L. Journal of toxicology Clinical toxicology. 2000;38(1):63-6.
- Smith GW, Chalmers TM, Nuki G. Vasculitis associated with herbal preparation containing Passiflora extract. British journal of rheumatology. 1993;32(1):87-8.
- Diaz-Perales A, Collada C, Blanco C, Sanchez-Monge R, Carrillo T, Aragoncillo C, et al. Cross-reactions in the latex-fruit syndrome: A relevant role of chitinases but not of complex asparagine-linked glycans. The Journal of allergy and clinical immunology. 1999;104(3 Pt 1):681-7.
- L Y. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed Pharmacia Diagnostics AB Uppsala Sweden. 1982.