Hypersensitivity manifestations to the fruit mango

Abstract

The objectives of this study are 1) To review the published data and document the current knowledge on allergic manifestations to the fruit mango 2) To highlight the two distinct clinical presentations of hypersensitivity reactions caused by mango 3) To discuss the role of cross-reactivity 4) To increase awareness of potentially life threatening complications that can be caused by allergy to mango. An extensive search of the literature was performed in Medline/PubMed with the key terms "mango", "anaphylaxis", "contact dermatitis", "cross-reactivity", "food hypersensitivity", "oral allergy syndrome" and "urticaria". The bibliographies of all papers thus located were searched for further relevant articles. A total of 17 reports describing 22 patients were documented, including ten patients with immediate hypersensitivity reaction and twelve patients with delayed hypersensitivity reaction to mango. Ten of these patients (four with immediate reaction; six with delayed reaction) were from geographical areas cultivating mango, whereas twelve patients (six with immediate reaction; six with delayed reaction) were from the countries where large scale mango cultivation does not occur. The clinical features, pathogenesis and diagnostic modalities of both these presentations are highlighted. The fruit mango can cause immediate and delayed hypersensitivity reactions, as also "oral allergy syndrome". Although rare, it can even result in a life threatening event. Reactions may even occur in individuals without prior exposure to mango, owing to cross reactivity. It is imperative to recognize such a phenomenon early so as to avoid potentially severe clinical reactions in susceptible patients.

Immediate Hypersensitivity Reaction with Mango

“…During season, it is partaken in form of fresh fruits, shakes and ice creams while during off season, it is cherished as pickles, jams and juices. Immediate hypersensitivity can manifest as anaphylaxis, angioedema, erythema, urticaria, wheezing dyspnoea while delayed reaction as contact dermatitis, oral allergy syndrome and periorbital oedema [18].…”

“…A recent review [18] presented 22 patients with documented hypersensitivity to the fruit mango, 10 of whom had immediate hypersensitivity, while 12 presented with delayed hypersensitivity reactions with predominant skin manifestations. The first report of an allergic reaction to mango was a description of delayed hypersensitivity manifestation from USA in 1939 by Zakon [10].…”

“…In our patient too, specific IgE against mango antigens was detected in moderate levels. The possible explanation behind the under detection of specific IgE may be the unstability of the corresponding allergens, which remain undetected and also the current IgE detection system appears to lack some of the specific mango allergens [18]. Combining skin prick testing results with serum food specific IgE may be of value in diagnosing food allergy [20].…”

“…Direct contact with the mango or tree itself and ingestion too, can lead to a cell mediated reaction. Sensitising substances present in the skin, bark, pericarp as well as the mango pulp up to five millimeters below the skin include uroshiol, cardol, limonene and B-pinene [18].…”

A crop of mango dermatitis in the Northern Territory

“…To the Editor : Mango sap is released from broken stems and branches of mango trees. It contains substances that are thought to elicit a T cell‐mediated response (urushiol, cardol, limonene and β‐pinene) 1 . The response occurs over days and results in severe inflammation and blistering; the blistering can last weeks, similar to that produced by other plants in the Anachardiaceae family (poison oak, poison ivy, etc).…”