Oral provocation test with banana: a rare cause of anaphylaxis in a four year old child

Objective: Food allergy is the most common cause of anaphylaxis in children and recent studies suggest that the prevalence of food allergies has increased. Among foods, fruits are rarely the cause of anaphylaxis. Although banana allergy has been identified among the causes anaphylaxis in adults, the incidence of banana anaphylaxis reported in children is very rare. In this case report a patient who developed anaphylaxis after banana ingestion was discussed.
Case: A 4-year-old boy male patient admitted with widespread itching, swelling of the eyelids, urticarial rash in body following exposure to banana. In oral provocation test performed in order to confirm the diagnosis made with banana, urticarial papules were detected. Urticaria, swelling of the eyelids and wheezing complaints occured in the body in 10 minutes after banana was given. Bilateral rhonchus was presented in auscultation and the blood pressure of the patient measured was normal. The patient was diagnosed with anaphylaxis and 0.01 mg / kg IM epinephrine nebuliser with short-acting beta 2 agonists and antihistaminic treatment were given. The patient who recovered during follow-up was discharged with antihistaminics and 3-day oral methylprednisolone therapy. Recommendations were made to patient and adrenaline auto-injector was prescribed and its use was described.
Conclusion: Although rare, children may develop anaphylaxis with bananas. Therefore, oral provocations for diagnostic purposes should be performed by experienced centers and necessary precautions should be taken against the reactions that may occur.

Dört yaþýndaki bir çocukta nadir bir anafilaksi nedeni: Muz ile oral provokasyon testi

Amaç: Besin alerjisi çocuklarda anafilaksinin en sýk nedenidir ve çalýþmalar son yýllarda besin alerjisinin sýklýðýnýn arttýðýný göstermektedir. Besinler arasýnda, meyveler nadiren anafilaksi nedeni olarak yer almaktadýr. Muz alerjisi eriþkinler içinde anaflaksi nedenleri içinde saptanmýþ olmasýna raðmen, çocuklarda bildirilen muz anaflaksisi olgularý oldukça azdýr. Bu olgu sunumunda muz alýmý sonrasýnda geliþen bir anaflaksi olgusu tartýþýldý.
Olgu: Dört yaþýndaki erkek hasta, muz alýmý sonrasý vücudunda yaygýn kaþýntý, ürtikeryal döküntü ve göz kapaklarýnda þiþlik ile baþvurdu. Tanýnýn kesinleþtirilmesi amacýyla yapýlan muz ile oral provokasyon testinde ürtikeryal papül saptandý. Muz verildikten 10 dakika sonra gövdesinde ürtiker, göz kapaklarýnda þiþlik ve hýrýltý þikayeti geliþti, dinlemekle bilateral ronküs mevcuttu ve hastanýn ölçülen tansiyonu normaldi. Hastaya anafilaksi tanýsý konuldu ve 0.01 mg/kg dan IM adrenalin, nebulizatör ile kýsa etklili beta 2 agonist ve anti histaminik tedavisi verildi. Ýzlemde bulgularý düzelen hasta antihistaminik ve 3 günlük oral metilprednizolon tedavisiyle taburcu edildi. Hastaya önerilerde bulunuldu ve adrenalin otoenjektör reçete edilip kullanýmý gösterildi.
Sonuç: Nadir de olsa çocuklarda muz ile anafilaksi geliþebilmektedir. Bu nedenle taný amaçlý yapýlacak oral provokasyonlar deneyimli merkezlerce yapýlmalý ve geliþebilecek reaksiyonlara karþý gerekli önlemler alýnmalýdýr.