D1.30 - An exotic anaphylaxis in the mediterranean: due to a clinical case

The pitaya or dragon fruit, is an exotic fruit from the cactus family, native to Latin America and Southest India. There are two commercial varieties: Hylocereus polyrhizus (red variety) and Selenicereus megalanthus (yellow variety). Its popularity in Europe has grown due to its high nutritional value. There have been reports linking the presence of lipid transfer proteins (LTP) in the fruit to allergic reactions. Sensitization to LTP is the most common cause of adult food allergies in the Mediterranean region.

We introduce a clinical case of a patient with anaphylaxis after the first intake of dragon fruit, who had been previously sensitized to LTPs.

We present the case of a 46-year-old male with a history of respiratory and cutaneous symptoms related to LTPs, who, in July 2024, developed dyspnea and a sensation of imminent death immediately after intake of red pitaya, which was resolved with antihistamines. Skin tests, multiplex assay (ISAC), and total serum IgE were performed. Additionally, an inhibition test and basophil activation test (BAT) were conducted using homemade pitaya extract.

The results found in the skin tests were positive for LTP, sesame, peanut, hazelnut, and white fish. A multiplex assay (ISAC) showed the following LTPs: Pru p 3 (1 ISU-E), Jug r 3 (1.2 ISU-E), Ara h 9 (1.3 ISU-E), Cor a8 (0.7 ISU-E), Tri a 14 (0.4 ISU-E), Art v 3 (0.8 ISU-E), and Pla a 3 (0.9 ISU-E), with a total IgE of 156 kUA/L.

The inhibition test with pitaya (Table 1) was positive for Pru p 3, Jug r 3, and Ara h 9 (analyzed with ImmunoCAP).

In the BAT, the negative control was 0.26%, the positive control was 16.71%, the 1/10 pitaya dilution resulted in 26.30% (Image 1), and the 1/1 dilution showed 13.84%. Verified with a negative control.

In this study, we highlight the presence of LTP in pitaya. We present a case of anaphylaxis caused by cross-reactivity with LTPs, rather than by primary sensitization. Additional research is necessary to enhance the understanding and management of food allergies.