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  Substance Info: (and synonyms)
Kiwi Fruit - Green / Chinese Gooseberry

Background Info:

Common Names: Kiwi, Chinese Gooseberry, Kiwifruit, Monkey Peach, Sheep Peach

This interesting species is native to the Yangtze Valley, China and was known as the Chinese gooseberry. It was cultivated on a small scale at least 300 years ago, but still today most of the crop is derived from wild vines. The Chinese have never shown much interest in exploiting the fruit. Kiwi was developed commercially in New Zealand and named after their national bird. Commercial crops are grown mainly in New Zealand, the United States and France. Kiwi fruit is, however, a latecomer to Western cuisines and the extent of its use varies radically according to fashion.

The Kiwi plant is a tough, woody, deciduous twining vine or climbing shrub. The elongated, oblong fruit, up to 8cm long, has russet-brown skin densely covered with short, stiff brown hairs. The flesh is usually bright green and pleasantly acidic in flavour. The minute, dark-purple or nearly black seeds are unnoticeable in eating. Cross-sections are very attractive.

Kiwis are available year-round because the fruits hold so well in storage and are grown in both the Northern and Southern Hemispheres. The fruits are eaten out of hand and served as appetizers, in salads, in fish, fowl and meat dishes, and in pies, puddings and cakes. As the fruit contains enzymes similar to papain, the raw fruit can act as a meat tenderiser. After peeling (usually with lye), fruits are canned, frozen, or freeze-dried. Kiwi is used in sauces, jams, ice creams, breads and various beverages, including wine. Blending with Apple juice or malic acid tends to be important in Kiwi processing, for reduction of Kiwis’ acidity. Slightly underripe fruits, which are high in pectin, are chosen for making jelly, jam and chutney. In China the leaves are a famine food. Kiwi is rich in Vitamin C.

The scraped stems of the vine are used as rope in China, and paper has been made from the leaves and bark. The bark at the base of the vine can be processed into pencils.

The Chinese regard the Kiwi fruit mainly as a tonic for growing children and for women after childbirth. The branches and leaves are boiled in water and the liquid used for treating mange in dogs. The fruit and the juice of the stalk are esteemed for expelling gravel.

Because of shortages of the bees needed for pollination, pollen may be sprayed onto the plants in a suspension.

Sometimes confused with Chinese lantern; see Cape gooseberry.

Kiwi fruit, shows an increased rate of ripening in response to the application of exogenous ethylene. Moreover, late in ripening the fruit produced a burst of ethylene biosynthesis. (Whittaker 1997 ref.7685 1)

 

Adverse Reactions:

IMMUNE REACTIONS


[ 1 / 48 ]

The clinical characteristics of kiwi fruit allergy and kiwi specific IgE was investigated in Korean young children. The study was based on data of 18 patients, aged 11-108 months (median age 25 months), who were diagnosed with clinical kiwi fruit allergy at Ajou University Hospital from June 2005 to June 2012. Twelve out of 18 (66.7%) were diagnosed with angioedema or urticaria, 4 (22.2%) were diagnosed with oral allergy syndrome, 1 was presented with dyspnea, and 1 was diagnosed with anaphylaxis by kiwi fruit. Oral route of exposure (88.9%) was most common and 89% of subjects experienced systemic reactions at the time of first exposure. Hence, kiwi fruit allergy is not rare in Korean children, and that systemic reactions are more common in younger patients. (Lee 2013 ref.28808 8)

Reference:
Lee JM, Jeon SA, Lee SY. Clinical characteristics and value of specific IgE antibodies in children with kiwi fruit allergy Allergy Asthma Respir Dis 2013 (forthcoming)



[ 2 / 48 ]

A 44-year-old male with an episode of severe anaphylaxis displaying generalized urticaria and dyspnea 1 hour after consuming a kiwifruit. Initially, the patient reported discrete itching of his abdominal skin and was in moderate respiratory distress. The patient's wheal response and itch were attenuated 30 minutes after emergency treatment with intravenous antianaphylaxis drugs. However, he had symptoms of the chest distress, dizzy, and dysphoria. His vital signs exacerbated. After sufficient antianaphylaxis treatment, the patient's anaphylaxis shock symptoms had not been significantly improved. The patient had eaten a full fresh kiwifruit, so there may had been some kiwifruit pulp left in the patient's stomach. After self-induced vomiting, the patient's clinical condition gradually improved without any changes in dosage of dopamine. After another 10 hours of observation and preventive therapy training, the patient was discharged. If the patient has consumed much food or drugs to cause the allergic reaction, self-induced vomiting or gastric lavage to clean allergen may be useful. (Zhu 2012 ref.28832 3)

Reference:
Zhu T, Zhou D, Shu Q. Anaphylactic shock due to kiwifruit. Am J Emerg Med 2012 Nov;30(9):2096-2



[ 3 / 48 ]

Differences in the allergenicity of 6 different kiwifruit cultivars analyzed by prick-to-prick testing, open food challenges, and ELISA. The finding that Summer 3373 and the gold Hort16A kiwifruit may be less allergenic than the common green kiwifruit Hayward in some of the patients with kiwifruit allergy may offer these patients a safe way to reintroduce kiwifruit into their diets. (Le 2010 ref.25481 5)

Reference:
Le TM, Fritsche P, Bublin M, Oberhuber C, Bulley S, van Hoffen E, Ballmer-Weber BK, Knulst AC, Hoffmann-Sommergruber K. Differences in the allergenicity of 6 different kiwifruit cultivars analyzed by prick-to-prick testing, open food challenges, and ELISA. J Allergy Clin Immunol 2011 Mar;127(3):677-9.e1-2.



[ 4 / 48 ]

Kounis syndrome has been defined as an acute coronary syndrome that manifests as unstable vasospastic or nonvasospastic angina, and even as acute myocardial infarction. It is triggered by the release of inflammatory mediators following an allergic insult. We report 5 patients who were diagnosed with unstable angina or acute myocardial infarction–in the context of an anaphylactic episode. Age at the time of the episode, age ranged between 50 and 68 years. The results of an allergology study revealed the causal agents to be drugs in 4 cases (nonsteroidal anti-inflammatory drugs and omeprazole) and food in 1 case (kiwi). Coronary disease of a blood vessel was observed in 2 patients. Serious allergic reactions may be the cause of acute coronary syndrome in patients with healthy or altered coronary arteries and no cardiovascular risk factors. (Gázquez 2010 ref.28292 5)

Reference:
Gázquez V, Dalmau G, Gaig P, Gómez C, Navarro S, Mercé J. Kounis syndrome: report of 5 cases. J Investig Allergol Clin Immunol 2010;20(2):162-5.



[ 5 / 48 ]

Kiwifruit allergy is most frequently associated with birch and grass pollinosis but it is also involved in the latex-fruit syndrome, with 12% to 39% of individuals allergic to latex also allergic to this food. In reported studies, the symptoms of 65% to 72% of patients with kiwifruit allergy were confined to the oral allergy syndrome (OAS), often seen in patients with pollen-fruit allergy, although in 18% to 28% of the cases, kiwifruit allergy was manifested by systemic reactions. Monosensitization to kiwifruit was observed in 21% to 50%. Many of these individuals reacted with severe symptoms such as urticaria, gastrointestinal symptoms, or anaphylactic shock on kiwifruit ingestion. (Bublin 2010 ref.24487 0)

Reference:
Bublin M, Pfister M, Radauer C, Oberhuber C, Bulley S, Dewitt AM, Lidholm J, Reese G, Vieths S, Breiteneder H, Hoffmann-Sommergruber K, Ballmer-Weber BK. Component-resolved diagnosis of kiwifruit allergy with purified natural and recombinant kiwifruit allergens. J Allergy Clin Immunol 2010 Mar;125(3):687-94, 694.e1.



[ 6 / 48 ]

A report of 2 cases of anaphylactic reactions to peach with a negative peach ImmunoCAP. A 35-year-old man, who felt an itch in his oral cavity immediately after ingesting a whole fresh peach, rapidly developed generalized urticaria, dyspnea, vomiting, and loss of consciousness. Peach ImmunoCAP conducted for screening allergens was negative for peach and the cause of anaphylaxis remained unclear resulting in his referral. He was pollen allergic and reported previously experiencing an itch on his oral cavity after ingesting melon, watermelon, apple, and strawberry. Total serum IgE was 436 IU/ml. CAP-RAST was negative for peach, strawberry and kiwi. Skin prick tests with raw peach pulp, canned peach pulp, strawberry and kiwi were positive. The second patient, was a 30-year-old woman who felt an itch on her oral cavity accompanied by blepharedema, rhinorrhea, generalized urticaria, nausea, abdominal pain and diarrhea after eating peach. She was pollen allergic. She had previously developed urticaria after ingesting an apple. Total serum IgE was 85 IU/ml. ImmunoCAP was negative for peach and apple. SPTs with canned yellow peach, strawberry and apple were positive. In both patients ImmunoCAP to rPru p 1, rPru p 3, and rPru p 4 were negative. However, in IgE-immunoblotting of peach, serum IgE antibodies of two patients were bound to approximately 10 kDa proteins. These results suggest that in patients suspected of having peach anaphylaxis and with a negative peach ImmunoCAP, additional testing, such as SPT with peach, should be performed for diagnosis. (Maeda 2009 ref.23336 7)

Reference:
Maeda N, Inomata N, Morita A, Kirino M, Moriyama T, Ikezawa Z. Anaphylaxis due to peach with negative ImmunoCAP result to peach allergens, including rPru p 1, rPru p 3, AND rPru p 4: A report of two cases. [Japanese] Arerugi 2009 Feb;58(2):140-7.



[ 7 / 48 ]

Immunological contact urticarial and/or protein contact dermatitis. Classically, the protein sources are divided into 4 main groups: group 1: fruits, vegetables, spices, plants, and woods; group 2: animal proteins; group 3: grains and group 4: enzymes. Taking into account the nature of the causal proteins, a wide variety of jobs can be affected. (Amaro 2008 ref.20923 7)

Reference:
Amaro C, Goossens A. Immunological occupational contact urticaria and contact dermatitis from proteins: a review. Contact Dermatitis 2008 Feb;58(2):67-75.



[ 8 / 48 ]

A 5-yr-old boy with spina bifida and known latex allergy presented with severe lip swelling, facial oedema and a new onset of wheeze following exposure to latex dust from a burst balloon. A second case report of a kiwi allergic child who fell and cut her head with a large 5 cm laceration, who when touched at hospital with latex gloves, developed urticaria on her face, arms and legs. Kiwi produced a 7 mm wheal on SPT and a kiwi-specific IgE of 48 Kui/l and latex a 5 mm wheal using a commercial extract and a latex-specific IgE of 17 Kui/l. (Baker 2008 ref.22243 7)

Reference:
Baker L, Hourihane J O'B. Latex allergy: Two educational cases. Pediatr Allergy Immunol 2008;19(6):477-481)



[ 9 / 48 ]

In a study isolating and characterising Act c 8 and Act d 8, sera of kiwifruit/birch pollen allergic patients (n=8) were utilised. All patients were ImmunoCAP positive for birch pollen extract and positive in a prick to prick skin test with native kiwi-fruit extract. All these patients were also positive in DBPCFC to kiwifruit. Symptoms under DBPCFC consisted of an oral allergy syndrome in four patients, dysphagia in one patient, dyspnea in two patient, and flush of the face in one patient each. All birch pollen control subjects. (Oberhuber 2008 ref.22624 5)

Reference:
Oberhuber C, Bulley SM, Ballmer-Weber BK, Bublin M, Gaier S, DeWitt AM, Briza P, Hofstetter G, Lidholm J, Vieths S, Hoffmann-Sommergruber K. Characterization of Bet v 1-related allergens from kiwifruit relevant for patients with combined kiwifruit and birch pollen allergy Mol Nutr Food Res 2008 Nov;52 Suppl 2:S230-40.



[ 10 / 48 ]

In an overview of the role of hidden allergens in allergic reactions in a geographical area of Spain, although fruit was the most frequent cause of food allergy in our study (33%), reactions by hidden fruits were very uncommon (2.8%). Two of these reactions were due to kiwi, one was caused by melon, another by peach and the last by apple, hidden in ice-creams or by indirect contact through kisses or utensils. All the patients affected had previous anaphylactic sensitivity to these fruits. Nuts were the second cause (25%) of allergic reactions, acting as hidden allergens in 11 cases (8.4%). The most frequent sources of hidden nuts were chocolates, cookies, pastries and cakes. Peanut was the nut most frequently involved (8 cases).

Reference:
Añíbarro B, Seoane FJ, Múgica MV. Involvement of hidden allergens in food allergic reactions. J Investig Allergol Clin Immunol 2007;17(3):168-172



[ 11 / 48 ]

A report on 16 cases of childhood OAS in a Japanese study. The rate of sensitization against four major pollens (Japanese cedar, orchard grass, short ragweed, alder) among 1067 pediatric patients with allergic diseases was investigated. OAS in childhood differs from that in adulthood in some ways. One is that childhood OAS does not always accompany with pollinosis. The most frequent allergen in this study was kiwi fruit followed by tomato, orange and melon. The sensitization rate against alder was equivalent as that against orchard grass and short ragweed, but less than that against Japanese cedar. The study concludes that Childhood OAS may have different mechanisms from adulthood OAS which almost always accompanies with pollinosis or latex allergy. (Sugii 2006 ref.16084 3)

Reference:
Sugii K, Tachimoto H, Syukuya A, Suzuki M, Ebisawa M. Association between childhood oral allergy syndrome and sensitization against four major pollens (Japanese cedar, orchard grass, short ragweed, alder). [Japanese] Arerugi 2006 Nov;55(11):1400-1408



[ 12 / 48 ]

The syndrome of kiss-induced allergy (KIA) is an original form of allergy by proxy. Its true prevalence, probably underestimated, is not known but is reported to be between 1 and 10% in individuals suspected of being or actually allergic to food. The symptoms of KIA, local or regional, mild or moderate in 70% of the cases, can also turn out to be severe, with angioedema, bronchospasm, acute respiratory distress or anaphylaxis. FIA should be considered systematically in the following circumstances: 1) In pollen allergic patients who have an oral allergy reaction to fruits and vegetables; 2) patients who have severe food allergy and react to very small amounts of the responsible allergen; and 3) those who are having an “idiopathic” anaphylactic reaction. The diagnosis, above all clinical, requires a very careful history, noting that the symptoms appeared within minutes after a kiss. The time between eating the allergen and the kiss can be quite variable, from a few minutes up to two hours. Any food can be responsible, for example, common fruit (apple and kiwi), dried nuts (peanuts, almonds, hazel nuts, exotic nuts), fish, seafood, eggs, cow milk, etc. (Dutau 2006 ref.13850 9)

Reference:
Dutau G, Rancé F. Le syndrome des allergies induites par le baiser / Kiss-induced allergy Revue francaise d allergologie 2006;46(2):80-84



[ 13 / 48 ]

This study investigated the clinical reactivity of gold kiwi - Actinidia chinensis (compared with green kiwi - Actinidia deliciosa ). Five patients clinically allergic to green kiwi were investigated by skin test and double-blind placebo controlled food challenge. Four of the five patients had a positive DBPCFC to gold kiwi. Western blotting showed marked differences in the allergen patterns of green and gold kiwi. However, inhibition of the immunoblots and ELISA assay reveals extensive inhibition of IgE binding to proteins in each fruit by the alternative species. Despite having different protein profiles and IgE-binding patterns, the two species have proteins that extensively cross-inhibit the binding to IgE. (Lucas 2005 ref.13139 0)

Reference:
Lucas JS, Lewis SA, Trewin JB, Grimshaw KE, Warner JO, Hourihane JO. Comparison of the allergenicity of Actinidia deliciosa (kiwi fruit) and Actinidia chinensis (gold kiwi). Pediatr Allergy Immunol 2005 Dec;16(8):647-54.



[ 14 / 48 ]

Grass allergy is the most common pollinosis in Northern Italy. Some patients with grass allergy show polysensitization against other pollens and plant-derived foods. In these patients oral allergic syndrome (OAS) is frequently associated. 56 children suffering from respiratory allergy due to grass pollens were enrolled. We found 14 children (25%) sensitized to Bet v 1 and 13 (23%) to Bet v 2; in 24 cases (42.3%) a sensitization to at least one of the 2 panallergens was observed. Five of the 14 cases (36%) sensitized to Bet v 1 showed food allergy and 8 (57%) food sensitization; 6 (46%) of the 13 children sensitized to Bet v 2 showed food allergy and 7 (54%) food sensitization; only one case of Bet v 1 specific IgE without food allergy or sensitization was seen. Sixteen subjects (29%) showed food allergy (group A); 20 children (35.5%) multiple sensitizations to inhalant and at least one plant-derived food (group B); 20 subjects (35.5%) only inhalant allergens (group C). Sensitization to Bet v 1 and Bet v 2 is from a statistical point of view significantly higher in groups A and B than in group C. In the 16 patients with food allergy hazelnut was the major triggering food (50%), followed by peanut (38%), kiwi (31%), apple and walnut (19%). Specific IgE for Bet v 1 is more associated with nuts and legumes, while Bet v 2 is more related to fresh fruit and vegetables. (Ricci 2005 ref.12840 5)

Reference:
Ricci G, Righetti F, Menna G, Bellini F, Miniaci A, Masi M. Relationship between Bet v 1 and Bet v 2 specific IgE and food allergy in children with grass pollen respiratory allergy. Mol Immunol 2005 Jun;42(10):1251-7.



[ 15 / 48 ]

In 273 subjects with a history suggestive of allergy to kiwi, 45 were investigated by DBPCFC, prick-to-prick skin testing with fresh kiwi pulp, and specific IgE measurement and 19 were also skin tested using a commercially available solution. The most frequently reported symptoms were localized to the oral mucosa (65%), but severe symptoms (wheeze, cyanosis or collapse) were reported by 18% of subjects. Young children were significantly more likely than adults to react on their first known exposure, and to report severe symptoms. Twenty-four of 45 subjects (53%) had allergy confirmed by DBPCFC. Prick-to-prick skin test with fresh kiwi was positive in 93% of subjects who had allergy confirmed by DBPCFC, and also in 55% of subjects with a negative food challenge. The commercial extract was significantly less sensitive, but with fewer false-positive reactions. CAP sIgE was only positive in 54% of subjects who had a positive challenge. (Lucas 2004 ref.9702 3)

Reference:
Lucas JS, Grimshaw KE, Collins K, Warner JO, Hourihane JO. Kiwi fruit is a significant allergen and is associated with differing patterns of reactivity in children and adults. Clin Exp Allergy 2004;34(7):1115-21



[ 16 / 48 ]

Forty-three patients with allergy symptoms who were sensitized to kiwi were evaluated DBPCFCs were performed in 33 patients; 4 patients had experienced severe anaphylaxis, and 6 patients declined informed consent. DBPCFC results were positive in 23 patients and negative in 10 patients. The most frequent clinical manifestation was oral allergy syndrome. Twenty-one percent of the patients were not allergic to pollen. Forty-six percent of patients experienced systemic symptoms, and this happened with higher frequency in patients not allergic to pollen (100%). Twenty-eight percent of the patients were sensitized to latex. The IgE-binding bands in kiwi extract more frequently recognized by patient sera were those of 30, 24, 66, and 12 kd, and they could not be associated with any pattern of kiwi-induced allergic reactions, including the already known Act c 1 (actinidin) and Act c 2, a thaumatin-like protein (TLP). The results provide evidence that kiwi allergy is not a homogeneous disorder because several clinical subgroups can be established. (Aleman 2004 ref.9170 4)

Reference:
Aleman A, Sastre J, Quirce S, De Las Heras M, Carnes J, Fernandez-Caldas E, Pastor C, Blazquez AB, Vivanco F, Cuesta-Herranz J. Allergy to kiwi: A double-blind, placebo-controlled food challenge study in patients from a birch-free area. J Allergy Clin Immunol 2004;113(3):543-550



[ 17 / 48 ]

In 2002, 107 cases were reported to the French Allergy Vigilance Network of which 59.8 % were cases of anaphylactic shock (one being fatal), 18.7% systemic reaction, 15.9% laryngeal angio-edema, 5.6% serious acute asthma (one fatal). Adults represented 69% of cases (74 cases). The most frequent causal allergens were peanut (14), nuts (16), shellfish (9) latex group fruit (9 patients), and most often in-patients allergic to latex: avocado (4), kiwi (2), fig (2), and banana (1). Next came lupine flour (7), wheat flour (7), celery (5) and snails (5), sesame (4), milk (3), buckwheat (3), fish (3), peach (2), chicken (2). Single observations included sulfites, quinine (an additive in a tonic drink), mustard, lentils, kidneys, pork, melon, grapes, pears, chicory, artichokes, oranges and Anisakis simplex. Four patients had an immediate post-prandial shock and were reported as idiopathic shock. The allergen was present in a masked form in 13% of cases: peanut (6 - with one fatal), lupine (4), sesame (3), and hazelnut (1).
In 4 cases of which one lethal a severe anaphylactic reaction occurred after consumption of macaroon in which the almonds have been replaced by peanuts paste without an adequate labeling. Two cases of anaphylactic shocks in hospitalized children were due to chocolate drink containing lupine flour. Both children were allergic to peanuts and AS occurred by cross allergy. A case of food allergy to hazelnuts is due to a mislabeling on chocolate packaging at Halloween. Two cases of severe anaphylaxis by proxy are reported: the incriminated allergenic peanuts. The patient presented the allergic reaction by contact with another person eating peanuts. (Moneret-Vautrin 2004 ref.10176 0)

Reference:
Moneret-Vautrin DA, Kanny G, Morisset M, Rance F, Fardeau MF, Beaudouin E. Severe food anaphylaxis: 107 cases registered in 2002 by the Allergy Vigilance Network. Allerg Immunol (Paris) 2004;36(2):46-51



[ 18 / 48 ]

90 patients with kiwifruit allergy from Austria, central Italy, and the Netherlands were tested for IgE binding to green and gold kiwifruit protein extracts and to purified actinidin, the major kiwifruit allergen, most of them having OAS and associated systemic symptoms. differences between allergens recognized by sera from northern European countries and those available from Italian patients. Actinidin (Act c 1) was recognized by IgE from almost all the Northern European patients, but by less than 50% of the Italian patients. (Bublin 2004 ref.10105 3)

Reference:
Bublin M, Mari A, Ebner C, Knulst A, Scheiner O, Hoffmann-Sommergruber K, Breiteneder H, Radauer C. IgE sensitization profiles toward green and gold kiwifruits differ among patients allergic to kiwifruit from 3 European countries. J Allergy Clin Immunol 2004;114(5):1169-75.



[ 19 / 48 ]

In this prospective trial, 20 children with a history of immediate allergic reactions to fresh kiwifruit underwent double-blind placebo-controlled food challenges with steam-cooked (100 degrees C for 5') and industrially homogenised kiwifruit. Fresh kiwifruit induced positive skin prick wheals in all children (confirmed during challenge in 19 patients). All children's sera showed specific IgE at immunoblotting with raw kiwifruit and one with the homogenised preparation (major allergens identified: Act c 1 and Act c 2). There was no clinical reactivity following challenge with homogenised kiwifruit but one child reacted to cooked kiwifruit challenge. Industrial heat treatment and homogenisation can make kiwifruit safe for children who are allergic to this increasingly popular fruit. (Riocchi 2004 ref.9972 3)

Reference:
Fiocchi A, Restani P, Bernardo L, Martelli A, Ballabio C, D'Auria E, Riva E. Tolerance of heat-treated kiwi by children with kiwifruit allergy. Pediatr Allergy Immunol 2004;15(5):454-8.



[ 20 / 48 ]

The perception of food-related symptoms is common among children and adolescents from the general population. Foods most commonly identified by oral challenges were apple, hazelnut, soy, kiwi, carrot and wheat. (Roehr 2004 ref.12297 8)

Reference:
Roehr CC, Edenharter G, Reimann S, Ehlers I, Worm M, Zuberbier T, Niggemann B. Food allergy and non-allergic food hypersensitivity in children and adolescents. Clin Exp Allergy 2004 Oct;34(10):1534-41.



[ 21 / 48 ]

The allergy presents with a wide range of symptoms from localized oral allergy syndrome (OAS) to life-threatening anaphylaxis. (Lucas 2003 ref.8811 2)

Reference:
Lucas JS, Lewis SA, Hourihane JO. Kiwi fruit allergy: A review. Pediatr Allergy Immunol 2003;14(6):420-428



[ 22 / 48 ]

Severe anaphylaxis to kiwi fruit: Successful sublingual allergen immunotherapy with kiwi. a 29-year-old white woman who had several episodes of severe anaphylaxis after consumption of kiwi fruit, including 3 episodes of allergic shock with loss of consciousness and subsequent hospitalization. For the first 2 episodes, the symptoms started shortly after ingestion of pure fresh kiwi preparations without concomitant consumption of additional foods, pointing to the causative role of kiwi. Most remarkably, in a third episode anaphylaxis had been elicited by minute amounts of kiwi left on a knife that was subsequently used to prepare a strawberry dessert served to the patient in a restaurant. (Mempel 2003 ref.11676 5) (See also Kerzl 2007 ref.16015 5 for the follow up)

Reference:
Mempel M, Rakoski J, Ring J, Ollert M. Severe anaphylaxis to kiwi fruit: Immunologic changes related to successful sublingual allergen immunotherapy. J Allergy Clin Immunol 2003;111(6):1406-9



[ 23 / 48 ]

Four patients with known allergy (symptoms, positive skin tests and specific IgE) to Ficus benjamina (Fb) leaves, fig and kiwi and one patient allergic to Fb leaves and kiwi were studied. EAST-inhibition showed a high degree of cross-reactivity between Fb leaves and fig extracts and a lower level between these and kiwi extract. (Bartra 2002 ref.13787 8)

Reference:
Bartra J, Tella R, Bartolome B, Gaig P, Garcia-Ortega P. Ficus benjamina-fruits syndrome. [Poster: XXI Congress of EAACI] Allergy 2002;57 Suppl 73:85-105



[ 24 / 48 ]

Food-dependant exercise-induced anaphylaxis. (Perkins 2002 ref.6599 4)

Reference:
Perkins DN, Keith PK. Food- and exercise-induced anaphylaxis: importance of history in diagnosis. Ann Allergy Asthma Immunol 2002;89:15-23



[ 25 / 48 ]

Oral allergy syndrome. (OAS) (Gavrovic-Jankulovic 2002 ref.7043 1) (Arai 1998 ref.7680 5) (Pastorello 1996 ref.82 232)

Reference:
Gavrovic-Jankulovic M, cIrkovic T, Vuckovic O, Atanaskovic-Markovic M, Petersen A, Gojgic G, Burazer L, Jankov RM. Isolation and biochemical characterization of a thaumatin-like kiwi allergen. J Allergy Clin Immunol 2002;110(5):805-810



[ 26 / 48 ]

Oral allergy syndrome from kiwi fruit after a lover's kiss. (Mancuso 2001 ref.4321 8)

Reference:
Mancuso G, Berdondini RM. Oral allergy syndrome from kiwi fruit after a lover's kiss. Contact Dermatitis 2001;45(1):41



[ 27 / 48 ]

Oral Allergy Syndrome. In a Japanese study, 23 patients with Japanese cedar pollinosis and OAS for fresh fruits and vegetables were included in this study (age range = 5 to 62). The fruits that caused OAS in these patients included melon, apple, peach, and kiwi fruit. Most patients with OAS exhibited hypersensitivity to more than two foods. Eleven of the 16 subjects with specific IgE antibodies for birch pollen, did not suffer symptoms during the birch and alder pollen season. In subjects with specific IgE antibodies for fruits, 13 out of 20 patients showed specific IgE antibodies for apple, and 8 out of 9 patients with OAS for apples were also positive for specific IgE antibodies for apples. On the other hand, 17 patients had no specific IgE antibodies for melon, and only two patients and one patient showed specific IgE antibodies for kiwi fruit and peach, respectively. (Ishida 2000 4493 1)

Reference:
Ishida T, Murai K, Yasuda T, Satou T, Sejima T, Kitamura K. Oral allergy syndrome in patients with Japanese cedar pollinosis. [Japanese] Nippon Jibiinkoka Gakkai Kaiho 2000;103(3):199-205



[ 28 / 48 ]

Sensitization to kiwi skin. (Huertas 1998 ref.7679 7)

Reference:
Huertas AJ, Iriarte P, Mengual P. Sensitization to kiwi skin. [Spanish] [Letter] Med Clin (Barc) 1998;111(13):518-9



[ 29 / 48 ]

Acute pancreatitis in a 48-year-old man. (Gastaminza 1998 ref.3061 8)

Reference:
Gastaminza G, Bernaola G, Camino ME Acute pancreatitis caused by allergy to kiwi fruit. Allergy 1998:53;1104-1105



[ 30 / 48 ]

Of 59 consecutive subjects 2 to 40 years old with spina bifida, latex sensitization was present in 15 patients (25%) (presence of IgE specific to latex, as detected by a skin prick test in 9 and/or RAST CAP in 13.) Five latex sensitized patients (33.3%) had clinical manifestations, such as urticaria, conjuctivitis, angioedema, rhinitis and bronchial asthma, while using a latex glove and inflating a latex balloon. Atopy was present in 21 patients (35.6%). In 14 patients (23%) 1 or more skin tests were positive for fresh foods using a prick plus prick technique. Tomato, kiwi, and pear were the most common skin test positive foods. Univariate analysis revealed that a history of 5 or more operations, atopy and positive prick plus prick tests results for pear and kiwi were significantly associated with latex sensitization. (Bernardini 1998 ref.21757 0)

Reference:
Bernardini R, Novembre E, Lombardi E, Mezzetti P, Cianferoni A, Danti AD, Mercurella A, Vierucci A. Prevalence of and risk factors for latex sensitization in patients with spina bifida. J Urol 1998 Nov;160(5):1775-8.



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A series of 202 labial food challenges (LFC) performed over two years in 142 children with food allergy suspected from the case history, positive skin prick tests and specific serum IgE assays: 156 LFC were positive; and 46 negative, followed by positive single-blind, placebo-controlled food challenges (SBPCFC). The foods provoking reactions were egg white (75 cases), peanut (60 cases), mustard (23 cases), cow's milk (13 cases), cod (8 cases), kiwi fruit, shrimp (4 cases each), chicken, peanut oil (3 cases each), hazel nuts (2 cases), and snails, apple, fennel, garlic, chilli peppers, pepper, and duck (1 case each). LFC positivity was mostly (89.7% of cases) manifested as a labial edema with contiguous urticaria. There were systemic reactions in 4.5% of cases: generalized urticaria, hoarseness and rapid-onset and generalized eczema. The 46 infants with negative LFC results had positive SBPCFC. The reactions were in 34 cases generalized urticaria, 10 cases asthma attacks, 2 cases early and generalized eczema, and in one case general anaphylactic shock. The sensitivity of the LFC was 77%. The LFC was easy to perform with children. Positive results indicate the presence of food allergy, but negative results require further investigations preferably double-blind, placebo-controlled food challenge (DBPCFC).

Reference:
Rance F, Dutau G. Labial food challenge in children with food allergy. Pediatr Allergy Immunol 1997;8(1):41-44



[ 32 / 48 ]

A report of a 6-year-old Caucasian boy without known atopy who presented with a history of cutaneous and respiratory reactions to banana and avocado and from whom a history of adverse reactions to common latex products was also elicited. The RAST to latex was strongly positive, equivocal to avocado and chestnut, and negative to banana and kiwi fruit. The prick skin test was positive for banana, avocado and chestnut. (Freeman 1997 ref.690 12)

Reference:
Freeman GL. Cooccurrence of latex and fruit allergies. [Review] Allergy Asthma Proc 1997;18(2):85-8



[ 33 / 48 ]

A German study of 25 subjects with birch pollen and kiwi allergies reported that 23 had localized oral symptoms and two had urticaria. Sensitisation was demonstrated to a 67 kDa allergen in 55%, a 43 kDa in 68%, a 30 kDa in 19%, a 22 kDa in 31%, and a 13 kDa in 9%. (Möller 1997 ref.22603 5)

Reference:
Möller M, Paschke A, Vieluf D, Kayma M, Vieths S, Steinhart H. Characterisation of allergens in kiwi fruit and detection of cross-reactivities with allergens of birch pollen and related fruits. Food Agric Immunol 1997;9:107-121



[ 34 / 48 ]

In a study of 47 latex allergic patients, immunological reactivity to foods was found in 33. Seventeen patients manifested a clinical allergy to at least one food including 11 with anaphylaxis, and 14 with local sensitivity reactions. Positive food skin tests occurred most frequently with avocado (53%), potato (40%), banana (38%), tomato (28%), chestnut (28%), and kiwi (17%). Latex-allergic patients (23%) recognize a protein that had sequence homology to a broad class of plant proteins known as patatins. Crossreactivity between latex and several potato proteins was observed by immunoblot inhibition analysis. Potatoes and tomatoes are newly reported cross-reacting foods. (Beezhold 1996 ref.84 675)

Reference:
Beezhold DH, Sussman GL, Liss GM, Chang NS. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy 1996;26(4):416-22



[ 35 / 48 ]

Two atopic patients, with allergy to latex (by clinical history, positive skin test and RAST). Both patients showed a positive skin test and RAST to fruits (banana, kiwi, avocado and chestnut), but clinically caused no symptoms. (Monreal 1996 ref.1414 5)

Reference:
Monreal P, Server MT, Torrens I, Soler Escoda JM. Hipersensitivity to fruits in latex allergic patients. Allergol Immunopathol (Madr) 1996;24(1):33-5



[ 36 / 48 ]

Allergic contact dermatitis. (Rademaker 1996 ref.2060 3)

Reference:
Rademaker M Allergic contact dermatitis from kiwi fruit vine (actinidia chinensis). Contact Dermatitis 1996;34(3):221-222



[ 37 / 48 ]

A study of 27 patients with OAS following Kiwi fruit ingestion. (Pastorello 1996 ref.82 232)

Reference:
Pastorello EA, Pravettoni V, Ispano M, et al. Identification of the allergenic components of kiwi fruit and evaluation of their cross-reactivity with timothy and birch pollens. J Allergy Clin Immunol 1996;98(3):601-10



[ 38 / 48 ]

A 57-year-old man who had suffered two anaphylactic reactions when eating kiwi, had a severe systemic reaction on skin testing (6) performed at home by his daughter. (Novembre 1995 ref.7701 1)

Reference:
Novembre E, Bernardini R, Bertini G, Massai G, Vierucci A. Skin-prick-test-induced anaphylaxis. Allergy 1995;50(6):511-3



[ 39 / 48 ]

Atopic dermatitis. (Ottolenghi 1995 ref.6803 1)

Reference:
Ottolenghi A, De Chiara A, Arrigoni S, Terracciano L, De Amici M. Diagnosis of food allergy caused by fruit and vegetables in children with atopic dermatitis. [Italian] Pediatr Med Chir 1995;17(6):525-30



[ 40 / 48 ]

Localized oral symptoms, vomiting, urticaria and dizziness, followed by anaphylaxis to kiwi fruit in a 12-year-old Japanese boy. (Shimizu 1995 ref.2061 3)

Reference:
Shimizu T, Morikawa A Anaphylaxis to kiwi fruit in a 12-year-old boy. J Asthma 1995;32(2):159-160



[ 41 / 48 ]

In 22 patients allergic to kiwi fruit, 10 with severe systemic reactions and 12 with localized symptoms confined to oral and pharyngeal mucosa (oral allergy syndrome), prick tests showed positive reactions to kiwi fruit in all patients, whereas specific IgE to kiwi fruit could be demonstrated only in patients with generalized severe symptoms. Surprisingly, all 22 patients with clinical kiwi allergy showed positive prick test results and elevated IgE to birch pollen. Clinically, all complained of rhinitis during birch pollen season. Many patients showed sensitization to grass and mugwort pollen. Also, food allergy was found to be associated with kiwi allergy: we found strong reactions to apple and hazelnut; moderate reactions to carrot, potato, and avocado; and weak reactions to wheat and rye flour, pineapple and papaya, and their enzymes bromelain and papain. RAST inhibition studies revealed cross-reacting antigens between birch pollen and kiwi fruit. Interestingly, patients with birch pollen allergy without clinical signs of kiwi allergy had positive prick test reactions to kiwi. Patients with kiwi allergy showed higher concentrations to birch pollen IgE compared with patients with isolated birch pollen allergy. (Gall 1994 ref.535 34)

Reference:
Gall H, Kalevam KJ, Forck G, Sterry W. Kiwi fruit allergy: a new birch pollen-associated food allergy. J Allergy Clin Immunol 1994;94:70-76



[ 42 / 48 ]

Anaphylaxis. (Joral 1992 ref.2750 4) (Falliers 1983 ref.211 34)

Reference:
Joral A, Garmendia J. Dietary allergy to kiwi. [Spanish] [Letter] Med Clin (Barc) 1992;98(5):197-8



[ 43 / 48 ]

Hypotensive response to kiwi has been described in a 3-year-old boy. (Rance 1992 ref.22602 5)

Reference:
Rance F, Dutau G. Allergie alimentaire au kiwi chez l'enfant. Allergol 1992:32(4):203-206



[ 44 / 48 ]

Contact urticaria. (Veraldi 1990 ref.539 34) (Zina 1983 ref.541 21)

Reference:
Veraldi S, Schianchi Veraldi R. Contact urticaria from kiwi fruit. Contact Dermatitis 1990;22:244



[ 45 / 48 ]

A 26 year-old patient with a localized pruritic reaction a few minutes after eating kiwi fruit, repeated a few months later, accompanied by dysphagia, vomiting and urticaria. (Garcia1989 ref. 536 34)

Reference:
Garcia BE, de la Cuesta CG, Santos, Feliu X, Cordoba H. A rare case of food allergy: monosensitivity to kiwi (Actinidia chinensis). Allergol Immunopathol (Madr) 1989;17:217-218



[ 46 / 48 ]

Allergic Reactions to "Exotic" Natural Foods: A Selected List from Personal Clinical Observations (no other information supplied):
Common name -- Clinical symptoms
Kiwi fruit -- Anaphylaxis, angioedema
Pineapple -- Contact dermatitis, rhinitis, urticaria
Sea urchin -- Stomatitis, urticaria
Papaya -- Urticaria, colitis
Turtle -- Urticaria
Chickpea -- Urticaria, colitis
Fig -- Stomatitis, urticaria:
Squid -- Urticaria
Mango -- Urticaria, a ngi oedema
Pinon nut -- Anaphylasds, ang] oedema
Pomegranate -- Urticaria, rhinitis, asthma
(Falliers 1983 ref.211 37)

Reference:
Falliers CJ. Anaphylaxis to Kiwi fruit and related "exotic" items. J Asthma 1983;20:193-196



[ 47 / 48 ]

Anaphylaxis to kiwi fruit. The patient was A 26-year-old male who had severe chronic asthma in childhood and perennial allergic rhinitis, of variable severity, within 15 min after the ingestion of two slices of kiwi his throat and ears began to itch and this was followed by swelling and tearing of the eyes and a few minutes later he experienced hoarseness and swelling of the tongue and lips. He was given emergency treatment. However, the next day the patient complained of increasing nasal congestion and "cold symptoms" and there was evidence of a persistent or delayed systemic reaction. Skin prick test with undiluted pulp of kiwi fruit resulted in an immediate skin reaction. (Falliers 1983 ref.211 73)

Reference:
Falliers CJ. Anaphylaxis to Kiwi fruit and related "exotic" items. J Asthma 1983;20:193-196



[ 48 / 48 ]

The first reported case of kiwi fruit allergy was on a 53-year-old atopic woman who developed urticaria, wheeze and laryngeal oedema on handling the fruit. (Fine 1981 ref.7711 7)

Reference:
Fine AJ. Hypersensitivity reaction to kiwi fruit (Chinese gooseberry, Actinidia chinensis). J Allergy Clin Immunol 1981;68(3):235-7




Non-Immune reactions


[ 1 ]

Actinidic acid, a triterpene phytoalexin has been isolated from unripe kiwi fruit. (Lahlou 2001 ref.7674 2) This substance may result in contact dermatitis. (Lahlou 2001 ref.7674 3)

Reference:
Lahlou EH, Hirai N, Kamo T, Tsuda M, Ohigashi H. Actinidic acid, a new triterpene phytoalexin from unripe kiwi fruit. Biosci Biotechnol Biochem 2001;65(2):480-3




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