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We confirmed sensi-za-on to nsLTP, thermally stable and resistant to pep-c diges-on panallergens present in apple and peach peel. Although peach is the most frequently implicated fruit in Rosaceae anaphylaxis, both pa-ents had a more severe reac-on to apple. We hypothesize this may be due to an increased content of Mal d 3 in both apple species consumed, or by cofactors that might amplify an anaphylac-c episode as fas-ng and exercise. Natacha Santos , Ângela Gaspar, Graça Pires, Mário MoraisAlmeida Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal Rosaceae fruits are an important cause of food allergy in the Southern Europe. Peach is the most implied Rosaceae in anaphylaxis reports. We describe 2 less usual case reports of anaphylaxis to apple: 29 yearold woman Allergic rhinoconjunc-vi-s and asthma, sensi-zed to grass and parietaria pollen, mites and cat Immediate anaphylac(c reac(on (generalized ur-caria and shortness of breath) aTer ea-ng an unpeeled Granny smith apple, and aTer a fas(ng period. Treated with oral an-histamine and cor-costeroid and inhaled bronchodilator, the reac-on was surpassed in one hour. ATerward, she reported two episodes of labial angioedema aTer inges-on of peach fruit and juice. 18 yearold male Allergic rhini-s and asthma, sensi-zed to grass and cypress pollen and to mites Immediate anaphylac(c reac(on (generalized pruritus, lips, hands and feet angioedema and shortness of breath) aTer ea-ng an unpeeled Golden delicious apple during a football game. Treated in the emergency with i.m. an-histamine, i.v. cor-costeroid, inhaled bronchodilator and oxygen therapy, with full recovery in three hours. He referred one previous episode of facial angioedema aTer drinking peach juice. Fig. 1 – Results of the prick tests with BialAristegui® extracts (PT), prick to prick with the fresh food (PPT) and specific IgE (sIgE) Fig. 2 – Results of the ImmunoCAP ISAC® (Phadia) for non specific Lipid Transfer Proteins (nsLTP) PT (mm) PPT (mm) sIgE (kU/L) apple (peel) 3x3 7x6 0.48 (pulp) peach (peel) 5x4 14x6 0.51 (pulp) plum (peel) (pulp) pear (peel) (pulp) chery (peel) (pulp) almond n.t. strawberry rPru p 3 0.69 PT (mm) PPT (mm) sIgE (kU/L) apple (peel) 3x3 4x3 10.3 (pulp) peach (peel) 11x7 n.t 13.2 (pulp) 4x3 plum (peel) 3x3 n.t 8.36 (pulp) pear (peel) 5x3 5.33 (pulp) chery (peel) 3x3 n.t 8.0 (pulp) almond 3x3 n.t. 0.66 strawberry 10x4 1.18 rPru p 3 8.3 In rela-on to this presenta-on, I declare that there are no conflicts of interest. n.t. – not tested Peach Parietaria Peach Hazelnut
