5 Individual Foods

Pages 225-245 from The Food Intolerance Handbook
Copyright (c) Sharla Race. All rights reserved.

5.1 INDIVIDUAL FOODS

Testing of individual foods does contain an element of risk which is why I advice that you carry out these tests in conjunction with your doctor. Even if you have been given the go-ahead to test a food at home I would advise that somebody is with you for at least the first two to three hours after testing—if you have a severe reaction they can obtain medical help for you. Remember, anaphylaxis can be life threatening.

The other advantage of having someone present is that we are not always very good at noticing changes within ourselves. Although you will know if you have a headache, rash or stomach ache easily enough, a change in how you are speaking or behaving is not always easy to detect. These behaviour changes are difficult to spot because if you have been reacting in the same way to a particular food for many years the change may not seem unusual to you, in fact it may feel familiar and “safe”.

If you already avoid a food then do not test it. You are probably avoiding it for a very good reason. This of course does not apply to foods that you have never tried.

It is impossible to provide a full list of potential symptoms for each food as any food can cause any problem—it is very much an individual specific response. In some cases it has been possible to draw up a list of the type of symptoms that have been reported but these lists are only telling us some of the recorded symptoms. Please remember that:

Any food can cause any symptom

When testing a food eat it in its most simple form. For example, testing milk by eating ice cream is not okay, nor is testing hazelnuts by eating a chocolate bar containing them. Keep it simple. In the examples given above simply drink some milk or eat some hazelnuts on their own. If at all possible use organic foods for testing—this is to avoid conflicting results due to pesticides. If you cannot find an organic version do still carry out the test and if you are uncertain of the results simply repeat the test.

Chocolate

Chocolate is commonly seen as an allergenic food but very few actual “allergies” to chocolate have been documented. It would appear that most chocolate allergies are usually linked with one of the other ingredients such as milk, peanuts and eggs or with a sensitivity to a food chemical such as caffeine, tyramine or phenylethylamine.

Maslansky and Wein reported on three people who reacted to an allergy test for chocolate using cocoa capsules. One reacted with urticaria, another with fatigue and gastric bloating and one with nausea and cramp. Only one of the three was sensitised to cocoa as detected by allergy skin testing. [Maslansky L, Wein G. Chocolate allergy: a double-blind study. Conn Med J 1971;35:5-9.]

Merret et al tested to see if food allergy was a major cause of migraine. Their findings were that allergies could not often be detected and concluded that the food intolerance associated with migraine headaches was not related to the conventionally defined allergic mechanism—the adverse reaction was being caused by another factor such as a food chemical intolerance.[Merrett J, Peatfield RC, Rose FC, Merrett TG. Food related antibodies in headache patients. J Neurol Neurosurg Psychiatry 1983;46(8):738-42.]

Adverse reactions that have been linked with chocolate include:

Abdominal cramps and pain, Angioedema, Asthma, Bronchial complaints, Coughs, Dermatitis, Diarrhoea, Flushing, Headaches, Hypotension, Itching, Migraine, Nausea, Red ears, Rhinitis, Sneezing, Urticaria, Vomiting.

An actual intolerance or allergy to chocolate or cocoa would have to be an intolerance of either cocoa mass or cocoa butter yet these are rarely checked independently of other ingredients. Eating a chocolate bar or drinking hot chocolate is not the way to test for a “chocolate” intolerance—if you have a problem with either product it would simply mean that you could not eat that particular brand of chocolate bar or hot chocolate drink.

Intolerance problems with chocolate can be caused by any ingredient or naturally occurring chemical. In respect of ingredients it could be any of the following:

Artificial sweeteners, butter, cocoa mass, cocoa butter, emulsifiers (usually lecithin—soya or egg), flavourings (usually vanilla—natural or man-made), grains (such as wheat, oats and rice), lactose, milk or milk powder, nuts, vegetable oils, peanuts, sugar.

In respect of a food chemical it could be any of the following: Caffeine and theobromine, histamine, phenylethylamine, serotonin, tyramine.

Perhaps the simplest way of testing if chocolate is a problem is to eliminate chocolate in all its forms from your diet for at least seven days. Make sure that you check all confectionery for cocoa.

If you eliminate all forms of chocolate and cocoa powder from your diet for at least seven days you will then be able to test it by first making a drink using cocoa powder, a milk and sugar or other sweetener that you know you are safe with. Make sure the cocoa powder is just that and does not contain any additional ingredients.

If you are free of any adverse reactions then you may wish to try your usual chocolate—if there is a problem then the ingredients will provide you with a list of suspects to test more fully. It is not unusual for people to react adversely to flavourings that are artificial such as vanillin.

If you find that you seem to be okay with chocolate and then your symptoms reappear it is probably worth checking the information on the different food chemicals as the problem could be as a result of a build up.

Corn

Eggs

Reactions to eggs are quite common, especially amongst children. Reported symptoms include: Allergic rhinitis, Anaphylaxis, Angioedema, Asthma, Catarrh, Dermatitis, Diarrhoea, Gastrointestinal symptoms, Hives, Migraine, Nausea, Oral allergy syndrome, Respiratory difficulties, Urticaria, Vomiting.

Rowntree et al found that 65% of children with persistent eczema and respiratory tract symptoms had a problem with eggs.[i] Guariso[ii] found that for some migraine sufferers the trigger food was eggs, as did Egger.[iii] Langeland in a study of eighty four children allergic to eggs, found that pruritis and exacerbations of atopic dermatitis were the most common symptoms.[iv]
[i] Rowntree S et al. Development of IgE and IgG antibodies to food and inhalant allergens in children at risk of allergic disease. Arch Dis Childh 1985;60: 727-735.
[ii] Guariso G, Bertoli S, Cernetti R, Battistella PA, Setari M, Zacchello F. Migraine and food intolerance: a controlled study in pediatric patients. Pediatr Med Chir 1993;15(1):57-61.
[iii] Egger J, Wilson J, Carter CM, Tuner MW, Soothill JF. Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment. Lancet 1983;2:865-869.
[iv] Langeland T. Allergy to hen's egg white in atopic dermatitis. Acta Derm Verereol: 1985;114(Suppl):109-12.

It has also been associated with inhalation of tame bird dander and known as “bird-egg syndrome”. Maat-bleeker et al present the case of a woman who developed an egg allergy as a result of inhaled allergen sensitisation from a parrot.[Maat-Bleeker de F, Van Dijik A G, Berrens L. Allergy to egg yolk possibly induced by a sensitisation to bird serum antigens. Ann Allergy 1985;54:245-48.] Mandallaz et al suggest that “bird-egg syndrome” is to do with the individual developing a sensitisation to egg-yolk livetins.[Mandallaz M, de Weck AL, Dahinden CA. Bird egg syndrome. Int Arch Allergy Appl Immunol 1988;87:143-50.]

Although egg intolerance has often been associated with children, it can arise at any age. Egg allergens are well known with those in egg white often being the most common. Holen and Elsayed identified ovalbumin as the most allergenic portion of egg white, followed by ovomucoid, ovotransferrin and lysozyme.[Holen E, Elsayed S. Characterisation of four major allergens of hen egg-white by IEF/SDS-PAGE combined with electrophoretic transfer and IgE immunoautoradiography. Int Arch Allergy Appl Immunol 1990;9:136-41.] Allergies are also possible to the proteins in egg yolk.

Problems with eggs can arise at any age. Unsel et al describe the case of a fifty-five year old woman who experienced repeated episodes of eyelid and lip swelling; itching of the throat, ears and eyes; redness and watering of the eyes; hoarseness, shortness of breath, wheezing, and coughing. The episodes began when she was fifty-three and had resulted in many visits to the emergency department. The cause was only identified when the women herself realised that the symptoms appeared soon after she ate egg or egg-containing products such as cake or pastry. Allergy tests confirmed that she did have an allergy to egg.[Unsel M, Sin AZ, Ardeniz O, Erdem N, Ersoy R, Gulbahar O, Mete N, Kokuludağ A. New onset egg allergy in an adult. J Investig Allergol Clin Immunol.2007;17(1):55-8.]

Celakovská et al report on the case of a woman who at fifty-three developed severe atopic eczema. Allergy testing confirmed that one of the problem foods was egg. She had not experienced any problems with egg when younger but the allergy identified at age fifty-three was still present six years later.[Celakovská J, Ettlerová K, Ettler K, Krcmová I. Food allergy to egg with the onset at adult age. Revue Française d'Allergologie 2010;50:628-633.]

If you have always eaten eggs you will not know if they are causing you a problem. There is a much repeated story that well illustrates this point. Dr Rinkel suffered from chronic catarrh, fatigue and headaches. As his symptoms got progressively worse he began to follow advice on dietary changes and tested eggs by eating six in quick succession—rather than a worsening of symptoms he felt better.[Mackarness R. Not All In The Mind. Pan 1976.]

The key factor in this case was that Dr Rinkel had been eating lots of eggs each day over a long period of time. Later he eliminated eggs completely from his diet. Within a couple of days he began to feel better. On the fifth day he ate a piece of cake and fell unconscious. The cake had, of course, contained eggs. Dr Rinkel went on to become a leading allergy specialist.

The easiest way of assessing egg intolerance is to remove egg in all its forms from the diet for at least four days and then test. Avoiding eggs means avoiding it in all its forms, as whole egg, egg white, egg yolk, powdered or dry egg, so check sauces, cakes and all processed food. The following terms may also indicate the presence of egg:

Albumin, Apovitellin, Binder, Coagulant, Emulsifier, Globulin, Lecithin, Livetin, Lysozyme, Mayonnaise, Meringue, Natural flavourings, Ovalbumin, Ovomucoid, Ovaglobulin, Ovomucin, Ovomucoid, Ovotransferrin, Ovovitellin, Seasonings, Vitellin.

Products to check carefully include: Baked goods, baking mixes, breakfast cereals, cakes, creamy fillings, egg noodles, fat substitutes, french toast, batters, bouillon, candy, custard, ice cream, soufflés, sherbets, lemon curd, macaroni, malted drinks, marshmallows, processed meat and fish products, puddings, salad dressings, sauces, soups.

The severity of egg sensitivity varies. Some people are at serious risk from anaphylactic shock and must avoid egg in all its forms, others can eat small amounts of egg, for example, in baked goods. Should you find you only react to hard boiled eggs I suggest you read the section on the naturally occurring food chemical Tyramine.

Eggs creep into a range of foods and other goods and may not always be listed. For example:

In some countries, including Japan and Switzerland, lysozyme is used in medications.
The egg used could have been in such small amounts that the manufacturer is not obliged to list it as an ingredient as may be the case with a glazing agent on baked goods. Freemont et al found lysozyme was an unlabeled additive in cheese preparation .[Fremont S, Kanny G, Nicolas JP, Moneret-Vautrin DA. Prevalence of lysozyme sensitization in an egg-allergic population Allergy 1997;52(2):224-8.]
Egg components may also, according to Steinman, be found in cosmetics, shampoos and medications.[Steinman HA. Hidden allergens in foods. J Allergy Clin Immuno 1996;98(2):241-50.]

Some points to note:

Intolerance can be of the whole egg, egg white or egg yolk.
Some studies have found that egg is less allergenic when cooked.
Many vaccines are based on egg—check with your doctor before agreeing to any injection.
It is also possible to react to other bird eggs. Langeland found cross-reactivity between hen egg white and that of turkey, goose, duck and seagull.[Langeland T. A clinical and immunological study of allergy to hen's egg white. Allergy 1983;38:399-412.]
Many egg intolerant people can quite safely eat chicken but others experience problems.

Fish

Reactions to seafood are not uncommon and usually occur within six hours of eating. Shellfish in particular have been found to cause problems with shrimp being considered a highly allergenic food. Sicherer identifies shellfish and fish as one of the most common foods that causes problems for both children and adults.[Sicherer SH. Manifestations of food allergy: evaluation and management. Am Fam Physician 199915;59(2):415-24,429-30.]

The type of fish available to you will, to a large extent, be determined by where you live. You should know that reactions have been recorded for most varieties. For example, Pascual et al, in a study from Spain, found that fish allergy was present in 22% of all people with a diagnosis of food hypersensitivity. They looked at the allergenic significance of the type of fish most commonly eaten in the area which were flatfish such as sole and hake. They found hake to be the most allergenic.[Pascual C, Martin Esteban M, Crespo JF. Fish allergy: evaluation of the importance of cross-reactivity. J Pediatr 1992;121(5 Pt 2):S29-34.]

Symptoms range from mild to life-threatening. Even tiny amounts of fish substances can trigger a reaction in some people. Symptoms can include:

Anaphylaxis, Bloating, Brain fogging, Breathing difficulties, Hives, Itching, Light headedness, Nasal congestion, Nausea, Stomach problems ranging from heartburn to diarrhoea, Wheezing.

Oehling et al found that the most frequent skin manifestation of fish intolerance was atopic dermatitis.[Oehling A, Fernandez M, Cordoba H, Sanz ML. Skin manifestations and immunological parameters in childhood food allergy. J Investig Allergol Clin Immunol 1997;7(3):155-9.] In a study of forty eight people with crustacean allergy, the most frequent cause of symptoms was shrimp (thirty three cases) followed by squid (twenty four cases). The most frequently found symptoms were:

Urticaria/angioedema (39 individuals),
Asthma (18 individuals) and
Rhinitis (14 individuals).[Castillo R, Carrilo T, Blanco C, Quiralte J, Cuevas M. Shellfish hypersensitivity: clinical and immunological characteristics. Allergol Immunopathol (Madr) 1994;22(2):83-7.]

It is possible to misinterpret a reaction to fish, such as tuna and mackerel, as an allergy when it might be due to a histamine sensitivity (see the section on Histamine). It is also possible to react to another ingredient in a fish product and so misdiagnose the cause of the problem: for example, Asero presented the case of a nineteen-year old man who experienced several episodes of angioedema of the penis and scrotum within two hours of eating canned tuna. The angioedema was found to be due to tartrazine that had been added to the tuna.[Asero R. A strange case of "tuna allergy". Allergy 1998;53(8):816-7.]

Some people react solely to shellfish, any fish with high levels of histamine, or any single type of fish whether it be salmon, trout, cod, hake, herring, tuna, swordfish and so on. In a study, by Bernihisee-Broadbent et al, of people allergic to fish a number of double blind challenges to different fish species were carried out. Most of those in this study were found to be able to safely eat a different species of fish than the one they were allergic too.[Bernihisel-Broadbent J, Scanlon SM, Sampson HA. Fish hypersensitivity.1. In vitro and oral challenge results in fish-allergic patients. J Allergy Clin Immunol 1992; 89:730-7.]

Other studies have, however, shown that cross-reactivity does take place.[Bernihisel-Broadbent J, Scanlon SM, Sampson HA. Fish hypersensitivity.1. In vitro and oral challenge results in fish-allergic patients. J Allergy Clin Immunol 1992; 89:730-7.] Tanaka et al found reactions often took place to groups of fish and they classified seafood allergens into four groups:[Tanaka R, Ichikawa K, Hamano K. Clinical characteristics of seafood allergy and classification of 10 seafood allergens by cluster analysis. Arerugi 2000;49(6):479-86.]

Salmon, sardine, horse mackerel and mackerel.
Cod and tuna.
Octopus and squid.
Crab and shrimp.

Hansen et al set out to test cross-reactivity of four species of fish—cod, mackerel, herring, and plaice—in adults with codfish allergy. Reactions were found to take place to all four types of fish and their study suggests that cross-reactivity to different fish species in adults with cod fish allergy exists, and that cod, mackerel, herring and plaice share a common antigenic structure.[Hansen TK, Bindslev-Jensen C, Skov PS, Poulsen LK. Codfish allergy in adults: IgE cross-reactivity among fish species. Ann Allergy Asthma Immunol 1997;78(2):187-94.]

DeMartino et al found that some individuals with a codfish allergy could tolerate other species of fish but were more likely to react to the other species than those with non-fish allergies.[de Martino M, Novembre E, Galli L, de Marco A, Botarelli P, Marano E, Vierucci A. Allergy to different fish species in cod-allergic children: in vivo and in vitro studies. J Allergy Clin Immunol 1990;86(6,Pt1):909-14.]

Chen et al outlined the case of a forty-two year old woman who experienced itching wheals, flushing, abdominal cramps, bronchospasm, and shock approximately thirty minutes after eating kingfish (Spanish mackerel) caviar salad. She developed acute respiratory failure and profound shock. She had previously experienced acute urticaria after consuming shrimp, but did not recall any problems related to fish, milk, or chicken egg. Testing revealed that the anaphylactic reaction the woman experienced was to the kingfish caviar.[Chen YH, Wu HJ, Tsai JJ, Lee MF. Anaphylactic shock caused by a 33-kDa alpha S1-casein-like allergen in kingfish caviar. J Investig Allergol Clin Immunol 2009;19(3):245-246.]

They note that roe is an extremely rare cause of anaphylaxis and only one case of Russian Beluga caviar-induced anaphylaxis and one case of salmon caviar-induced anaphylactic shock have been reported in the literature pre 2009.

As fish is one of the foods that tends to provoke a very quick reaction it is unlikely that you would need to carry out any test unless you suspect histamine may be a problem or you eat fish every day. If you suspect histamine—follow the guidelines in that section. If you eat fish every day then try eliminating it from your diet for seven days to ascertain if there is a problem. Arrange for an allergy test under medical supervision.

Avoiding fish is not too difficult as it rarely creeps into non-fish dishes but do take care in restaurants where cross contamination is possible especially if the same oil is used for frying fish as well as other products such as potatoes. If you are only allergic to one form of fish you also need to be careful when eating out in case there has been cross contamination or substitution.

Shellfish, in particular, may appear in a variety of dishes and a waiter may not always be aware of their presence—ask him to check with the chef.

Lin et al gave details of a four-year old boy who had an anaphylactic reaction whenever he contacted food prepared with fish. His symptoms included intense itching in the throat and eyes, generalised urticaria, facial angioedema, coughing, wheezing and dyspnea. He reacted to several different types of fish including cod, tuna, salmon, trout, and eel, also to chopsticks contaminated with fish preparations. They suggest that the best treatment for fish allergy is avoidance which may also have to include avoiding inhalation of cooking vapours.[Lin HY, Shyur SD, Fu JL, Lai YC, Lin JS. Fish induced anaphylactic reaction: report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1998;39(3):200-2.]

Monti et al describe the case of a child allergic to fish who reacted with facial urticaria and angioedema after a kiss.[Monti G, Bonfante G, Muratore MC, Peltran A, Oggero R, Silvestro L, Mussa GC. Kiss-induced facial urticaria and angioedema in a child allergic to fish. Allergy 2003;58(7):684-5.]

Fruit

Any fruit can cause problems. Skin rashes, as often seen with strawberries, are a common reaction but by no means the only one. Other symptoms can include itching and swelling of the mouth, tongue and lips, and breathing problems.

It is possible to be sensitive to any individual fruit, to a number of fruits or to one of the naturally occurring chemicals found within fruit. One indicator that may help you identify a problem with fruit is seasonal fluctuation of symptoms. Do you always get rashes in the summer months? And, if yes do you at the same time eat large amounts of any of the summer fruits?

If you eat a lot of dried fruits then you could be sensitive to sulphites or salicylates—check out the respective sections. Problems with a range of fruit and vegetables is most likely to indicate a sensitivity to salicylates so if you suspect that you are reacting to a range of fruits then do please read the section on Salicylates before testing any individual fruit. You may find it useful to know that the only fruits that are very low in salicylate are peeled pears and bananas.

Citrus fruits contain high concentrations of chlorogenic acid which has been thought to be responsible for allergic type reactions. If you know you have a problem with any one citrus fruit you might want to consider eliminating them all for a few days and then testing. You would need to avoid all the following: clementine, grapefruit, lemon, lime, mandarin, orange, pomelo, satsuma, tangelo.

If you suspect a single fruit or summer fruits then eliminate them accordingly for at least four days and test by eating them in their most natural state which means fresh not tinned, frozen or cooked. If you do have problems with some fruits and experience an improvement in symptoms and then, later, have a return of symptoms check whether your problem is in fact one of salicylate sensitivity.

All fruits have at some point been implicated in negative reactions. Two and a half hours after eating red currants a forty-seven year old woman had symptoms including generalised urticaria, dysphagia, dyspnoea, pruritis of the palms and soles, hypotonia, and tachycardia.[Zollner TM, Schmidt P, Kalveram CM, Emman AC, Boehncke WH. Allergy 2000;55(5):511.]

Oranges have been implicated in migraines[Egger J, Wilson J, Carter CM, Tuner MW, Soothill JF. Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment. Lancet 1983;2:865-869.] although this could be as a result of a tyramine sensitivity. Zhu et al report that oranges are considered to be common allergenic fruits in China. They analysed the allergic histories of twenty six orange sensitive people. Their analysis suggested that clinical symptoms of some orange-allergic subjects were different from other fruit allergies but similar to nut and other oil plant seed allergies. Interestingly they found the major allergenic components of orange reside in orange seeds instead of orange juice.[Zhu SL, Ye ST, Yu Y. Allergenicity of orange juice and orange seeds: a clinical study. Asian Pac J Allergy Immunol 1989;7(1):5-8.]

Urticaria and colitis have been noted as reactions after eating papaya.[i] The oral allergy syndrome has been found to be provoked by bananas.[ii] Ortoloni detected pear allergy in 22% of those with hay fever and oral allergy syndrome after eating fruit.[iii] Kleinheinz et al reported on the case of a nineteen-year old woman who experienced two allergic reactions five to fifteen minutes after drinking fruit juice. Testing identified that the culprit in the fruit juice was dragon fruit.[iv] Raap et al describe the case of a twenty-six year old man who developed itchy skin, urticaria, severe swelling of his lips and tongue and breathing problems within fifteen minutes after eating lychee.[v]
[i] CJ. Anaphylaxis to kiwi fruit and related 'exotic' items. J Asthma 1983;20:193-6.
[ii] Ortoloni C, Ispano M, Pastorello E, Bisi A, Ansaloni R. The oral allergy syndrome. Ann Allergy 1988;61:47-52.
[iii] Ibid.
[iv] Kleinheinz A, Lepp U, Hausen BM, Petersen A, Becker WM. Anaphylactic reaction to (mixed) fruit juice containing dragon fruit. J Allergy Clin Immunol 2009 Jul 9.
[v] Raap U, Schaefer T, Kapp A, Wedi B. Exotic food allergy: anaphylactic reaction to lychee. J Investig Allergol Clin Immunol. 2007;17(3):199-201.

A French study identified ten cases (nine women, one man) of severe mango anaphylaxis.[M. Morisset, D.-A. Moneret-Vautrin, P. Beaumont, B. Bonnefoy-Guionnet, et al. Anaphylaxie à la mangue : dix cas rapportés au Réseau allergovigilance aspects cliniques et fréquence actuelle. Revue Française d'Allergologie 2010;50(4):406-409.] A twenty-five year old man developed severe swelling of his lips, a cold sore on the inside of his lower lip, swelling of the face, and red patches on his face and ears. He had previously experienced two episodes of poison oak dermatitis. Mango contact allergy was diagnosed—he had used his teeth to peel a mango on each of the two previous days.[Trehan I, Meuli GJ. Mango contact allergy. J Travel Med 2010 Jul-Aug;17(4):284.]

Damian et al present four instances of Pomegranate allergy:

A nineteen-year old man who experienced angioedema of the upper lips and tongue. The symptoms appeared a few minutes after eating fresh pomegranate.
A thirteen-year old boy who had an episode of widespread urticaria and angioedema of the lips after ingestion of the fresh fruit.
A thirty-one year old woman who experienced an episode of urticaria within twenty minutes eating fresh pomegranate.
A twenty-three year old woman who complained of an episode of angioedema of the face and lips, itching of the throat, abdominal pain, and widespread urticaria, which developed approximately an hour after eating pomegranate fruit.

The reactions were confirmed as allergies using skin prick testing.[Damiani E, Aloia AM, Priore MG, Nardulli S, Ferrannini A. Pomegranate (Punica granatum) allergy: clinical and immunological findings. Ann Allergy Asthma Immunol 2009 Aug;103(2):178-180.]

Think of a fruit and someone, somewhere, will have had a negative reaction to it.

There have also been recorded instances of cross-reactivity with pollen. Ortoloni et al found cross-reactivity with almond, cherries, peaches and birch pollen in individuals with an identified birch pollen allergy.[i] Dreborg and Foucard found an association between apple, potato, carrot and birch pollen.[ii] Anderson and Dreyfus found that some ragweed sensitive individuals experienced itching within the mouth when eating melons and bananas.[iii]
[i] Ortoloni C, Ispano M, Pastorello E, Bisi A, Ansaloni R. The oral allergy syndrome. Ann Allergy 1988;61:47-52.
[ii] Dreborg S, Foucard T. Allergy to apple, carrot and potato in children with birch pollen allergy. Allergy 1983; 38:167-72.
[iii] Anderson BL, Dreyfuss EM, Logan J, Johnstone DE, Glaser J. Melon and banana sensitivity coincident with ragweed pollinosis. J Allergy 1970;45:310-18.

Kim and Hussain examined the prevalence of food allergy in one hundred and thirty seven latex allergic people. They identified forty nine potential allergic reactions to foods in 21.1% of the people. The foods responsible for those reactions included: Apple, apricot, avocado, banana, carrot, cherry, kiwi, loquat, peach, strawberry, tomato, and watermelon.

The reactions included: Anaphylaxis, Angioedema, Asthma, Diarrhoea, Local mouth irritation, Nausea, Rhinitis, Urticaria, Vomiting.

They were unsure as to whether there was cross-reactivity or not.

Other studies have found strong links between latex allergy and certain foods most notably fruits. Brehler et al noted cross-reactions with avocado, banana, chestnut, fig, kiwi, mango, melon, papaya, passion fruit, peach, pineapple and tomato.[i] These findings have been confirmed by others.[ii],[iii] It is also possible that anyone with allergic reactions to these foods could possibly go on to develop a sensitivity to latex.
[i] Brehler-R; Theissen-U; Mohr-C; Luger-T. Latex-fruit syndrome: frequency of cross-reacting IgE antibodies. Allergy. 1997; 52(4): 404-10.
[ii] Beezhold DH, Sussman GL, Liss GM, Chang NS. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy 1996;26:416-22.
[iii] Blanco C, Carrillo T, Castillo R, Quiralte J, Cuevas M. Latex allergy: clinical features and cross-reactivity with fruits. Ann Allergy 1994;73:309-14

There have been few reported cases of fig allergy and those that have been reported have been linked with cross-sensitisation to weeping fig. Antico et al found that oral allergy syndrome to fig followed by respiratory symptoms can be present in individuals not sensitised to weeping fig or having the latex-fruit syndrome. They confirmed that different parts of the fig can have different allergenicities and called for improved commercial fig extracts to be used for the diagnosis of this type of allergy.[Antico A, Zoccatelli G, Marcotulli C, Curioni A. Oral allergy syndrome to fig. Int Arch Allergy Immunol. 2003 Jul;131(2):138-42.]

Trehan and Meuli note that mango contact allergy is more common in those with a history of poison ivy and poison oak dermatitis—these plants are closely related and mango sap contains the same uroshiol allergen.[Trehan I, Meuli GJ. Mango contact allergy. J Travel Med 2010 Jul-Aug;17(4):284.]

Next - 5.2 Individual foods