Kiwi and Fig Allergy Associated with Papain Occupational Allergy

Papain is a proteolytic enzyme that is widely used in the food, pharmaceutical and cosmetic industry. Occupational and non-occupational papain allergy has been previously documented, however, there are limited publications about papain allergy with relative food allergy. Here we present a case of occupational, IgE mediated papain allergy with kiwifruit and fig fruit allergy. A 53-year-old man has suffered from rhinitis for several years, with the onset of his symptoms coinciding with the time he started to work at a sausage processing plant. Papain is often used as a meat tenderizer during sausage processing. Shortly after starting work 5 years ago, he began to experience symptoms of chest tightness, shortness of breath, and wheezing. Furthermore, he experienced several episodes of oral itching and angioedema of the oropharyngeal tract and tongue after eating kiwi and fig fruit. The patient has a lifelong history of allergic conjunctivitis, allergic rhinitis and childhood asthma. Specific IgE was positive to kiwi fruit (2.95kUA/L). Papain and chymopapain were both positive as well(＞100kUA/L and 95.0 kUA/L respectively). A similar band at 10~15 kDa in blotting with papain and kiwi fruit extracts was found. This patient showed potential association between papain allergy and sensitization to kiwifruit fruit. We also reviewed 13 papain allergy cases published in literature, with 85% (11/13) of the cases having patients sensitized through the respiratory tract and 40% of the cases (4/11) having patients that were atopic individuals. Further study should focus on the determination of cross-reactive allergy between papain and relative fruits. The prevalence of food allergy in papain allergy patients should be also investigated in a relatively large cohort as well.Papain is a proteolytic enzyme that is widely used in the food, pharmaceutical and cosmetic industry. Occupational and non-occupational papain allergy has been previously documented, however, there are limited publications about papain allergy with relative food allergy. Here we present a case of occupational, IgE mediated papain allergy with kiwifruit and fig fruit allergy. A 53-year-old man has suffered from rhinitis for several years, with the onset of his symptoms coinciding with the time he started to work at a sausage processing plant. Papain is often used as a meat tenderizer during sausage processing. Shortly after starting work 5 years ago, he began to experience symptoms of chest tightness, shortness of breath, and wheezing. Furthermore, he experienced several episodes of oral itching and angioedema of the oropharyngeal tract and tongue after eating kiwi and fig fruit. The patient has a lifelong history of allergic conjunctivitis, allergic rhinitis and childhood asthma. Specific IgE was positive to kiwi fruit (2.95kUA/L). Papain and chymopapain were both positive as well(＞100kUA/L and 95.0 kUA/L respectively). A similar band at 10~15 kDa in blotting with papain and kiwi fruit extracts was found. This patient showed potential association between papain allergy and sensitization to kiwifruit fruit. We also reviewed 13 papain allergy cases published in literature, with 85% (11/13) of the cases having patients sensitized through the respiratory tract and 40% of the cases (4/11) having patients that were atopic individuals. Further study should focus on the determination of cross-reactive allergy between papain and relative fruits. The prevalence of food allergy in papain allergy patients should be also investigated in a relatively large cohort as well.