Anaphylaxis related to avocado ingestion: a case and review

Anaphylaxis is a life threatening reaction that occurs in between 0.05 to 2% of the general population [1]. While there have been efforts made to identify and clone the major allergen of avocado [2], Prs a 1, the majority of cases of anaphylaxis to avocado have been described in the context of latex sensitization, otherwise termed "latex-fruit syndrome" [3]. Isolated anaphylaxis to avocado is rarely described in the literature. The following case report describes an individual who developed anaphylaxis after eating guacamole without concurrent clinical reactivity to latex.The patient was a 15 year old male who was referred to the allergy clinic for suspected anaphylaxis to avocado. In the summer of 2010, the patient was eating guacamole dip with chips and within a half an hour of eating the guacamole, he developed coughing, wheezing, nasal stuffiness, generalized urticaria and periorbital edema. He did not experience any nausea, vomiting, diarrhea, syncope or loss of consciousness. The patient had eaten the same brand of chips multiple times in the past, but did not remember if he had consumed avocado before.A family member provided the patient with an antihistamine but the symptoms didn't improve so he went to the emergency department. At the emergency department, intravenous antihistamine and steroid were administered. Within a few hours, the symptoms resolved and the patient was discharged with a script for oral steroid as well as an EpiPen？.The diet of the patient was unrestricted. He had been exposed to latex in the form of balloons multiple times in the past without a reaction. In addition, his diet included other foods that are often included in latex-fruit syndrome (kiwi, banana, potato) [4]. It was unclear if he had previously ingested chestnut.The patient's past medical history revealed resolved "eczema" to the neck, posterior popliteal and antecubital fossae. There was no history of asthma or allergic rhinitis. The patient reported a history of cold induc