D1.50 - Coconut Oil Anaphylaxis after Mucous Exposure, in a Patient with Primary Coconut Allergy

Introduction: Coconut as primary sensitization food allergy is considered to be rare, mostly is related to cross-reactivity with other nuts, lentils or latex due to allergens such 7S and 11S globulins.

Case presentation: We present a case of 43 years old male, diagnosed with anaphylaxis after rectal exposure to coconut oil. The patient was presented for allergy consultation 1 month after anaphylaxis episode from coconut oil used as homeopathic treatment for anal fissure. The reaction occurred within 1 hour from first application, with erythema and pruritus regionally to the application area, and then generalized, accompanied by hypotension, dyspnea, fatigue, lips angioedema and edema of the hands. The patient was treated in emergency and hospitalized for 4 days.  Personal history included an episode of generalized urticaria, few minutes after consuming chocolate containing coconut, several months before the anaphylaxis episode. No past suspected allergy for other food. In allergy workup resulted: Normal hemogram, total IgE 259 IU/ml (ref. value <100 IU/ml, largest available panel of sIgE including 295 elements (molecular and extract) resulted negative, sIgE <0.1 IU/ml, coconut allergens were not available for testing in commercialized panels.  A prick test with undiluted coconut oil, that was the trigger of anaphylaxis was performed and resulted positive (3mm papule and 15mm erythema), histamine control test (7mm papule and 12mm erythema), saline control and latex were negative. The coconut oil manufacturer declared to have no excipients and to be organic. Under the circumstances of no available commercial tests and patient’s history with coconut exposure a diagnosis of primary coconut allergy was done.

Conclusions: Exposure to food allergens through mucous membranes, can trigger anaphylaxis in sensitized patients. Food allergy can suddenly appear in adults, with no history of atopy. This is first coconut primary allergy diagnosed in our practice.