Fruit-Induced Anaphylaxis: Clinical Presentation and Management Journal Articles uri icon

  • Overview
  • Research
  • Identity
  • Additional Document Info
  • View All


  • BACKGROUND: Data are sparse regarding the clinical characteristics and management of fruit-induced anaphylaxis. OBJECTIVE: To assess clinical characteristics and management of patients with fruit-induced anaphylaxis and determine factors associated with severe reactions and epinephrine use. METHODS: Over 9 years, children and adults presenting with anaphylaxis to seven emergency departments in four Canadian provinces and patients requiring emergency medical services in Outaouais, Quebec were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized form documenting symptoms, triggers, and management was collected. Multivariate logistic regression was used to identify factors associated with severe reactions and epinephrine treatment in the pre-hospital setting. RESULTS: We recruited 250 patients with fruit-induced anaphylaxis, median age 10.2 years (interquartile range, 3.6-23.4 years); 48.8% were male. The most common fruit triggers were kiwi (15.6%), banana (10.8%), and mango (9.2%). Twenty-three patients reported having eczema (9.3%). Epinephrine use was low in both the pre-hospital setting and the emergency department (28.4% and 40.8%, respectively). Severe reactions to fruit were more likely to occur in spring and among those with eczema (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI], 1.03-1.23; and 1.17, 95% CI, 1.03-1.34, respectively). Patients with moderate and severe reactions (aOR = 1.23; 95% CI, 1.06-1.43) and those with a known food allergy (aOR = 1.38; 95% CI, 1.24-1.54) were more likely to be treated with epinephrine in the pre-hospital setting. CONCLUSIONS: Severe anaphylaxis to fruit is more frequent in spring. Cross-reactivity to pollens is a potential explanation that should be evaluated further.


  • Gabrielli, Sofianne
  • Clarke, Ann E
  • Morris, Judy
  • Gravel, Jocelyn
  • Lim, Rodrick
  • Chan, Edmond S
  • Goldman, Ran D
  • O'Keefe, Andrew
  • Gerdts, Jennifer
  • Chu, Derek
  • Upton, Julia
  • Hochstadter, Elana
  • Moisan, Jocelyn
  • Bretholz, Adam
  • McCusker, Christine
  • Zhang, Xun
  • Protudjer, Jennifer LP
  • Abrams, Elissa M
  • Simons, Elinor
  • Ben-Shoshan, Moshe

publication date

  • March 2021