Kiwifruit's Allergy in Children: What Do We Know?

Abstract

Kiwifruit allergy is an emerging pathological condition in both general and pediatric populations with a wide range of symptoms linked to variable molecular patterns, justifying systemic and cross-reactions with other allergens (i.e., latex, pollen, and fruit). Skin prick test (SPT), specific serum IgE (Act d 1, Act d 2, Act d 5, Act d 8, and Act d 10) directed against five out of thirteen molecular allergens described in the literature, and oral test challenge with kiwifruit are available for defining diagnosis. The management is similar to that of other food allergies, mostly based on an elimination diet. Although kiwi allergy has been on the rise in recent years, few studies have evaluated the clinical characteristics and methods of investigating this form of allergy. Data collected so far show severe allergic reaction to be more frequent in children compared to adults. Therefore, the aim of this review is to collect the reported clinical features and the available association with specific molecular patterns of recognition to better understand how to manage these patients and improve daily clinical practice.

Keywords: Act d 1; allergy; children; cross-reactivity; kiwifruit.

Figure 1

Diagnostic flowchart. Patient personal histories of severe reactions need to be tested via SPT, RAST, and CRD. Anaphylaxis is indicated by “severe reaction”. In this case, if the laboratory test result is positive, a food allergy is claimed; the timing for the challenge test is decided after considering the clinical response and the outcome of the CRD test. If the serological exams are negative, a focused elimination diet should follow. Based on the diet change response, the challenge test becomes worthy in revealing the diagnosis. The diagnostic process is similar in patients with immediate nonsevere reactions after kiwifruit ingestion, such as rash, urticaria, dyspnea, intense coughing, swelling of tongue, lips, and extremities, and itching. Apart from the results of the diagnostic tools, an elimination diet should be implemented. If relief from symptoms is achieved, the challenge test should be performed; on the contrary, it is possible to reintroduce the food, especially with negative serum diagnostic test results (including the CRD) [40]. In this case, there is no evidence to claim the specific kiwifruit allergy.