Contrary to popular belief, strawberry allergy is uncommon

Contrary to popular belief and the posts on some non-medical blogs, strawberry allergy is not common.

The most comprehensive specialty book, Middleton's Allergy (7th edition, 2008), does not even mention it on any of its 1924 pages. You can search for yourself another textbook - Allergy and Asthma: Practical Diagnosis and Management by Lange on Google Books - still no mention.
In fact, AAAAI lists "Fresh Strawberry Sorbet" as Food Allergy-Free Recipe:

Strawberry allergy is reported but not commonly. Only few cases of patients with adverse reactions to strawberry are listed in literature:

No strawberry allergen has been identified until 2004 when evidence about Bet v 1 emerged:

No clinical reactivity was found in 66% of positive skin prick tests and 63% of positive specific IgE determinations to Rosaceae fruits: The species of Fragaria (strawberries) belongs to the family Rosaceae.

In summary, strawberry and tomato allergies are very rare. It is suspected that the acidity in these fruits in addition to the histamine content may cause hives especially in the sensitive and "chapped" skin of children with eczema.

The double blind placebo controlled food challenge test remains the gold standard for exclusion test in suspected strawberry allergy.

Eight top allergens account for 90 percent of all food allergies. The 8 top allergens can be remembered by the mnemonic TEMPS WFS:

Tree nuts (almonds, cashews, walnuts)
Egg white (not egg yolk)
Shellfish (crab, lobster, shrimp)
Fish (bass, cod, flounder)

Diagnostic algorithm for food allergy: SAD Child:

1. Symptoms: close relation between specific food intake and symptoms, often affect 2 or more organs
2. Allergy testing: skin prick testing or ImmunoCAP.
3. Diagnostic diet: restricted diet leads to symptoms disappearance or significant reduction
4. Challenge - oral food challenge.

"True" tomato allergy was detected in 1% of patient with oral allergy syndrome but 33% had association with profilin hypersensitivity
Food Allergy: A Short Review
Clinical review: ABC of allergies, Food allergy. BMJ 1998;316:1299, figure.
Food Allergen Avoidance
Food Challenges
Mind Maps: Food Allergy
Mnemonics: Food Allergy
Image source: Fragaria × ananassa 'Gariguette,' a cultivar grown in southern France. Wikipedia, David Monniaux, GNU Free Documentation License.

1 comment:

  1. It is interesting that in our family, I can think of three people who have strawberry allergies. My older sister, my daughter, and my granddaughter through a son. My grand daughter is not just allergic to the strawberry food, but develops a rash if picking strawberries. Although I respect the research presented much of the "evidence" is based on a lack of entries in book. Retrospective analysis such as this, based on the absence of entries in encyclopedic volumes,is a form of faulty logic. Since encyclopedic volumes tend to reference others and follow a similar format, the lack of entries may have nothing to do with the prevalence of allergies.