Anaphylaxis to mango fruit and cross-reactivity with Artemisia vulgaris pollen.

on wet hands induced intense pruritis and erythema almost immediately, and this extended to the forearm when the test was terminated. The BAT result was positive for expression of CD63. A 27-year-old female shop assistant had a history of recurrent local irritation and swelling after contact with a condom. Following normal vaginal delivery in an obstetric unit where no NRL avoidance measures were taken, she developed signifi cant infl ammation in her genitalia requiring a prolonged stay in hospital. She also had a history of mild asthma and chronic idiopathic urticaria, which was in remission at the time. Application of the glove use test produced no symptoms, although rubbing the mucosa of the lip with the NRL glove resulted in pronounced swelling. The BAT was negative for expression of CD63. This report demonstrates that immediate hypersensitivity to latex can occur in the absence of demonstrable specifi c IgE and a negative BAT result. Interestingly, neither case showed a positive response to prick-prick skin testing despite a positive result with provocation testing using the same glove. One possible explanation for this discrepancy is that non-IgE–mediated mechanisms may be involved, although it is more likely that conventional diagnostic methodologies were not sensitive enough to detect specifi c IgE. It is plausible that specifi c IgE in these patients is directed against an epitope that was either not present at a suffi cient concentration or was absent or denatured in the SPT extract and in vitro tests. Chromatographic studies to separate the NRL proteins in the glove may be used to identify undetermined latex antigens in such circumstances. This could pave the way for the development of additional diagnostic approaches; however, such studies are outside the remit of our clinical service. Improved diagnostic testing is necessary because of the small yet real risk of anaphylaxis associated with provocation testing, which should only be undertaken when the history is suggestive and diagnostic test results are indeterminate. An accurate diagnosis of latex allergy is paramount, since it has important health, occupational, and medicolegal implications.