[LONG-TERM FOLLOW-UP OF A CASE OF APPLE ALLERGY WITH SYSTEMIC SYMPTOMS THROUGH ORAL FOOD CHALLENGES].

To our knowledge, there are no previous reports of apple allergy with systemic symptoms for which repeated oral food challenges were performed over a long follow-up. The patient was an 8-year-old boy with hay fever. He visited our hospital because of nasal drop, itchy eyes, and dyspnea after lunch every two months for 2 years. Apple allergy was suspected through his medical interview and specific immunoglobulin (Ig) E levels, and he consequently underwent an oral food challenge test. Ninety minutes after ingestion of one whole apple, he experienced coughing, nasal drop, eyelid edema, and conjunctival injection. At age 14, he underwent a repeat oral food challenge test. This time, 55 minutes after ingestion, he experienced coughing, dyspnea, and wheezing and had to be treated by anti-histamine and steroid administration, as well as inhalation of a beta 2 stimulant. At ages 8, 9, 11, 12, 13, and 14, the apple-specific IgE levels (Ua/ml) were <0.35, <0.35, 0.36, 0.54, 0.47, and 0.66, respectively. The alder-specific IgE levels (Ua/ml) were <0.35, 0.49, 1.31, 2.14, 2.73, and 3.11; the Mal d 1-specific IgE levels (Ua/ml) were <0.10, 0.13, 0.25, 0.45, 0.88, and 1.1; and the Bet v 1-specific IgE levels (Ua/ml) were <0.10, 0.40, 1.0, 1.4, 2.4, and 2.8, respectively. These levels all gradually increased, whereas the specific IgE to Mal d 3 remained negative. The patient experienced systemic symptoms without mucosal symptoms, and these did not improve over time. In conclusion, we could follow this case of apple allergy with systemic symptoms through oral food challenge tests.