D3.298 - The Good, the Bad and the Ugly : Mugwort, Mango, and Pineapple

Background: The celery-mugwort-spice Syndrome is a pollen-food syndrome involving Art v 1, a defensin-polyproline-linked protein and major allergen of mugwort pollen. This syndrome is already well-known for celery (Api g 7) and has been described for mango. What about the role of these defensins in clinical reactions related to the consumption of plant-based foods other than celery and mango?

Clinical Observation: We present the case of an 18-year-old girl who experienced a reaction in 2020 involving lip edema and generalized urticaria (oFASS-5 grade 2) a few minutes after consuming raw pineapple. In 2021, she also had a facial urticaria (oFASS-5 grade 2) a few minutes after consuming raw mango. Despite avoiding these two foods, she experienced two further reactions: in 2024, oral pruritus and moderate respiratory distress (oFASS-5 grade 4) a few minutes after eating ice cream with raw mango chunks; and in 2025, oral pruritus (oFASS-5 grade 1) a few minutes after consuming a fruit juice containing pineapple. All reactions were effectively treated with antihistamines.

Patient History: The patient has a history of perennial asthma and rhinitis, with symptoms worsening from April to August. She has previously undergone Allergen Immunotherapy for dust mites and grass pollen.

Exploration:

· Skin prick tests: Positive for dust mites, grass and plantain pollen, cat dander, and Alternaria

· Prick-to-prick tests: Positive for mango and pineapple (3mm for a positive control at 3 mm)

· Serum Specific IgE (ImmunoCAP, ThermoFisher, Uppsala, Sweden):

IgE mango extract = 0.12 kUA/L

IgE mugwort extract = 0.56 kUA/L

Art v 1 = 0.33 kUA/L

No other panallergen was found (Profilin, LTP, PR-10, GRP): IgE Bet v 2, Pru p 3, Bet v 1 and Pru p 7 < 0.10 kUA/L

IgE Anti-CCD (MUXF3) = 0.24 kUA/L

· Basal serum tryptase = 3.3 µg/L

Conclusion: This observation raises the possibility of a cross-reaction between mango, pineapple, and mugwort pollen, mediated by the defensin family, suggesting that our understanding of this allergen family will continue to evolve in the coming years.