Allergen Data Collection: Melon (Cucumis melo)
Internet Symposium on Food Allergens 3(3): 143 - 51 (2001) [http://www.food-allergens.de]
1 Prevalence of Melon Allergy

It is difficult to do an estimation of prevalence of melon allergy due to differences in study populations (latex allergy, pollen allergy, food allergy, fruit allergy, etc.), differences in dietary habits, geographical areas, or differences in diagnostic procedures. Prevalence data are based on different diagnostic procedures. While the prevalence of sensitization can be estimated by SPT, RAST, and immunoblot, a clinical relevant sensitization (allergy) is evaluated by convincing history or food challenge tests (ideally by DBPCFC).
 

1.1 Subjects with Atopic or Other Diseases
 
Country / Subjects Allergy / Sensitization References
France, Paris
a) 24 patients with latex and pollen allergy
b) 20 patients with latex allergy (no pollen allergy)
c) 25 patients with pollen allergy (no latex allergy)
clinical symptoms SPT
a) melon in 0% and 38%
b) melon in 5% and 5%
c) melon in 4% and 32%
Levy et al. 2000
France, Pierre Benite
580 patients with adverse reactions to food (study period 1984-92)
melon 11% (RAST) Andre et al. 1994
Germany
136 latex allergic patients
melon 19% (RAST)
melon 5.8% (self-reported)
Brehler et al. 1997
Italy, Genoa
132 pollen and food sensitive patients
melon 2.2% (self-reported) Troise et al. 1992
Italy, Milan
262 fruit and/or vegetable allergic patients
melon 16% (clinical history) Ortolani et al. 1988
Italy, Milan
100 fruit and/or vegetable allergic patients
melon 7% (clinical history) Ortolani et al. 1989
South Africa, Cape Town
112 children with atopic dermatitis (age of 5 months to 13 years)
melon 3.4% (questionnaire) Steinman & Potter 1994
Spain, Madrid
29 plant-derived food allergic patients
melon 38% (SPT) Diez-Gomez et al. 1999
Spain, Madrid
95 pollen allergic patients
melon 14% (skin test)
melon 7.4% (oral challenge test)
Cuesta-Herranz et al. 2000
Spain, Madrid and Toledo
Patients with allergy to Rosaceae fruits
a) 11 without pollinosis (mean age 26 years)
b) 22 with associated pollinosis (mean age 22 years)
melon a) 0% and b) 50%
(clinical history and SPT and/or RAST)
Fernandez-Rivas et al. 1997
Spain, Pamplona
7 patients with latex- fruit syndrome
melon 50% (SPT)
melon 14% (clinical history)
Latasa et al. 1995
Spain, Plasencia (Caceres)
262 patients with pollinosis
melon 9.1% (self-reported) Garcia-Ortiz et al. 1995
Spain, Salamanca
a) 57 fruit allergic patients (age of 6-56 years, mean 21.5)
b) 30 subjects with positive SPT and/or RAST to muskmelon.
a) muskmelon 58% (clinical history and SPT and/or RAST)
b) muskmelon 10% (reporting symptoms)
Garcia Ortiz et al. 1998
Sweden, Halmstad / Malmö
a) 380 birch pollen allergic patients
b) 103 patients without birch pollen allergy
a) melon 3%
b) melon 2%
(questionnaire)
Eriksson et al. 1982
Switzerland, Vaudois
111 patients with pollen- associated food allergy
melon 40% (RAST) Bircher et al. 1994
Switzerland, Zurich
383 food allergic patients (study period 1990-94)
melon 2.9% (clinical history, diagnostic tests) Etesamifar & Wüthrich 1998
USA, Rochester, NY
a) 2067 allergic patients including
b) 1447 with pollinosis
Percentage in group a)
melon and/or banana 4.2%
cantaloupe 3.6%
honeydew melon 1.7%
(cause of oral pruritus, interview survey)
all cases occurred in subgroup b)
Anderson et al. 1970

1.2 Prevalence of Associated Allergies
 
Country / Subjects Sensitization / Allergy References
Spain, Madrid
10 children sensitized to melons
pollen approximately 90% (SPT) Crespo et al. 1995
Spain, Plasencia (Caceres)
24 melon allergic patients (age of 8-50 years, mean of 23 years)
RAST  
grass 100%
Plantago 100%
olive 63%
Chenopodium 38%
Artemisia 29%
Parietaria 29%
Rumex 17%
SPT  
monosensitized to melon 46%
watermelon  33%
Garcia-Ortiz et al. 1995
Spain, Madrid
19 patients with confirmed allergy to melon
avocado 37%
banana 37%
kiwi 32%
watermelon 32%
peach 26%
(DBPCFC or convincing episode of anaphylaxis)
asthma / allergic rhinitis 95%
(clinical history and SPT)
Rodríguez et al. 2000
Spain, Salamanca
33 melon allergic patients
latex 91% (SPT and/or RAST)
latex 10% (clinical history)
Garcia Ortiz et al. 1998
USA, Detroit, MI
192 patients allergic to cantaloupe, honeydew melon, watermelon, cucumber, zucchini, banana, and/or ragweed pollen
  RAST I II
cantaloupe 25% 1.000 0.849
honeydew melon 18% 0.849 1.000
watermelon 33% 0.896 0.820
zucchini 32% 0.897 0.835
cucumber 22% 0.807 0.900
banana 13% 0.664 0.666
ragweed pollen 63% 0.498 0.432
I: Correlation of specific IgE with cantaloupe or 
II: honeydew melon
Enberg et al. 1987
USA, Detroit, MI
a) 48 patients allergic to cantaloupe
b) 34 patients allergic to honeydew melon
a) ragweed pollen 96% (RAST)
b) ragweed pollen 100% (RAST)
Enberg et al. 1987
USA, Rochester, NY
90 patients who report symptoms of oral pruritus to melon and/or banana
watermelon 56%
banana 52%
citrus fruits 16%
peach, unpeeled 12%
tomato 8.9%
celery and walnut 6.7%, each
cucumber and pear 5.6%, each
green pepper, apple, grape, and pineapple 4.4%, each
other < 4%
(oral pruritus, interview survey)
ragweed pollen 100% (SPT, clinical history)
prevalence of asthma 78% (control group 47%)
Anderson et al. 1970

2 Symptoms of Melon Allergy
 
Symptoms & Case Reports References
Systemic reactions
anaphylaxis (5, 8), hypotension (8), systemic reactions (not specified) (1)

Symptoms of skin and mucous membranes
angioedema (8), urticaria (7), generalized urticaria (8)

Gastrointestinal symptoms
abdominal pain (4), laryngeal edema (6), lip / mouth angioedema (3), nausea (8), oral allergy syndrome (1, 5, 7, 8), oral itching (2, 4), oral pruritus (3), oropharyngeal symptoms (8), vomiting (8), in general / not specified (3)

Respiratory symptoms
rhinoconjunctivitis (8), wheezing (8)

(1) Ortolani et al. 1988
(2) Ortolani et al. 1989
(3) Garcia-Ortiz et al. 1995
(4) Latasa et al. 1995
(5) Garcia Ortiz et al. 1998
(6) Asero 2000
(7) Asero et al. 2000
(8) Rodríguez et al. 2000
Percentage of Reactions
Symptoms / Ref. (1)  (2) (3)  (4)
Systemic symptoms   2.4%*    
Anaphylaxis       11%
Cutaneous        
Angioedema (facial)       11%
Flare of eczema 1.1%      
Itching hands 1.1%      
Rash 1.1%      
Rhinoconjunctivitis       5%
Urticaria-angioedema 2.2%      
Oral allergy syndrome (OAS)   83%   89%
Isolated OAS       74%
Itching throat 82%      
Oral pruritus     92%  
Swollen lips 3.3%      
Swollen throat 1.1%      
Gastrointestinal     4%  
Angioedema of lips / mouth     8%  
Cramps and diarrhea 7.8%      
Gassiness and indigestion 14%      
Sore mouht or tongue, canker sores 6.7%      
Vomiting 2.2%      
Respiratory        
Hoarseness 2.2%      
Nasal congestion 3.3%      
Wheezing 1.1%     5%
Others        
Itching ears 3.3%      
Headache 1.1%      
No. of patients 90 42 24 19
(1) symptoms to melon (including symptoms to both melon and banana) reported by patients with melon and/or banana
(2) melon allergic patients (extra-oral symtoms in 12%)
* also having oral allergy syndrome
(3) melon allergic patients  (age of 8-50 years, mean of 23 years)
(4) patients with confirmed allergy to melon
(1) Anderson et al. 1970
(2) Ortolani et al. 1988
(3) Garcia-Ortiz et al. 1995
(4) Rodríguez et al. 2000
Onset of Symptoms
Onset of symptoms within 5 min after ingestion (1 melon allergic patient, open food challenge) (1)
Onset of symptoms within 30 min after ingestion (17 melon allergic patients, DBPCFC positive) (2)
Onset of symptoms in less than 1 h after ingestion in 2 patients with history of convincing anaphylaxis induced by melon (2)
(1) Ortolani et al. 1989
(2) Rodríguez et al. 2000
Age at Onset of Melon Allergy
Age at onset of ranged from 6 to 45 years (median 27 years) in 19 melon allergic patients (1)
(1) Rodríguez et al. 2000

3 Diagnostic Features of Melon Allergy
 
Parameters / Subjects Outcome References
Primary Sensitization
17 melon allergic patients
Seasonal rhinitis, asthma, or both preceeded the first reaction to melon in 88% of patients Rodríguez et al. 2000
Primary Sensitization (latex)
57 fruit allergic patients
In all patients, clinical symptoms of fruit allergy preceeded latex allergy, fruits mostly associated to latex sensitization: melon, peach, and banana Garcia Ortiz et al. 1998
IgE and Clinical Relevance
8 latex allergic patients with self-reported melon intolerance
Melon specific IgE (RAST):
Sensitivity 38%
Specificity 82%
Brehler et al. 1997
SPT, IgE and Clinical Relevance
melon allergic patients (positive clinical history)
Positivity in SPT:
Fresh food 76% (n=21)
Positivity in RAST: 0% (n=7)
Ortolani et al. 1988
SPT, IgE and Clinical Relevance
7 patients with clinical history of melon allergy
Positivity in SPT:
Fresh food  (prick-to-prick) 43% 
Positivity in RAST: 0%
Ortolani et al. 1989
Reported Reactions, Food Challenges
53 patients reporting adverse reactions to melon
Positivity
History of anaphylaxis 4%
Open food challenge (n=51) 49%
DBPCFC (n=25) 68%
Overall clinical reactivity (n=53) 36%
Rodríguez et al. 2000
SPT, IgE and Clinical Relevance
a) 53 patients reporting adverse reactions to melon
including  b) 19 patients with clinical reactivity to melon
in a) SPT RAST
Positivity 68% 43%
Positive predictive value 42% 44%
Negative predictive value 77% 70%

b) 79% had positive SPT and/or RAST to melon

Rodríguez et al. 2000
IgE, SPT, Fresh Food and Commercial Extracts
24 melon allergic patients  (age of 8-50 years, mean of 23 years)
Positivity in SPT:
Fresh food  100% 
Commercial extract  13%
Positivity in RAST: 88%
Garcia-Ortiz et al. 1995

4 Therapy of Melon Allergy
 
Treatment * Outcome References
Pollen Immunotherapy
A 34-year-old woman with long-standing pollinosis and oral allergy syndrome after ingestion of melon, fennel, and cucumber was treated with two commercial depot aluminium hydroxide-adsorbed extracts of grass pollen, mugwort pollen, and ragweed pollen
After 36 months of specific immunotherapy, the patient tolerated both fresh fennel and cucumber on open oral challenge tests; after 43 months of immunotherapy, the patient tolerated fresh melon as well on open oral challenge; vegetables were reintroduced in her normal diet Asero 2000
* Studies may be experimental, unproved, or controversial. Please notice the disclaimer !
 

5 Composition of Melon
 

6 Allergens of Melon
 
Proteins / Glycoproteins Allergen Nomenclature References
Allergens: 14, 31, and 40 to 92 kDa   Garcia Ortiz et al. 1996

7 Isolation & Preparation
 
Extract / Purified Allergens Methods References
Protein extract Fresh fruits (cantaloupe, honeydew melon) were diced, liquified in a blender, and centrifuged Enberg et al. 1987
Protein extract Melon was extracted with ammonium bicarbonate buffer (pH 8.5) (ratio 10%, w/v), stirred for 60 min at room temperature, centrifuged, dialyzed, membrane filtered, and lyophilized Garcia Ortiz et al. 1996


8 Cross-Reactivities
 
Cross-Reacting Allergens Subjects / Methods References
Melon: (fruits, vegetables)
significant associations to: watermelon and tomato*
262 fruit and/or vegetable allergic patients
(clinical history, SPT, RAST)
Ortolani et al. 1988
Melon: (fruits)
apple
1 patient with apple and pollen allergy: Approximately 95% inhibition of IgE binding to melon extract by apple peel extract  (RAST inhibition) Asero et al. 2000
Melon: (pollen)
Dactylis, Plantago, and olive pollen
Maximum inhibition of IgE-binding to melon extract by Dactylis, Plantago, and olive pollen were 84%, 84%, and 45%, respectively (pooled serum from melon sensitive patients, RAST inhibition) Garcia-Ortiz et al. 1995
Melon: (pollen)
Dactylis and Plantago pollen
IgE-binding to melon allergens almost completely
inhibited by grass and Plantago pollen extracts; melon extract inhibited IgE-binding to various allergens of Dactylis at high Mr and partially to 14 kDa and 40 kDa protein; almost complete inhibition of  IgE-binding to Plantago extract by melon extract (immunoblot inhibition, 3 sera from patients allergic to melon, and Dactylis glomerata and Plantago lanceolata pollens)
Garcia-Ortiz et al. 1996
Melon: (latex)
latex
5 latex allergic patients with melon sensitivity: 81-100% (mean 96%) inhibition of IgE binding to melon allergens by latex extract;
26-100% (mean 55%) inhibition of IgE binding to latex extract by melon extract (RAST inhibition)
Brehler et al. 1997
*  multiple sensitization (not proven by  inhibition-tests)
 

9 Allergen Sources
 
Reported Adverse Reactions References
Food / Food additives
After ingestion of fresh fruits (1)
(1) see 2 Symptoms of Melon Allergy
Overripe Melon
Anaphylactic reaction to endogenous ethanol in overripe-melon in a 24 year old woman with history of intolerance to beverages containing ethanol
Mallon & Katelaris 1997

10 References



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