Concern for mango allergy

Patient is 20-year-old female that has a history of these hives and itching complaint. These seemed to be associated with eating mango. She states that first time this happened was last year. She was peeling mango and cutting up and then eating it. A couple of days later she developed this rash around her mouth that was more of a contact dermatitis. She did go to the doctor for this and that is what they diagnosed her with and said that she was not allergic to the mango and it is just irritating her skin. That did resolve and then about six months later she did have a second exposure to mango causing this again and causing a rash on her hands. She also had what she thinks is hives on her face as well. She then went to an urgent care again and they did state that they did not think it was a mango allergy. She then about two months ago had a mango smoothie and it caused diffuse hives reaction along her face and down her neck and down her arms. She did take Benadryl at that time and Aller-Tec and it did seem to help resolve the reaction. She wants to be officially tested for mango to see if that is what troubling her. She does have a history about two years ago of cold-induced urticaria that they tested with ice cube at home and it did seem to react, but it has been two years since she has had this trouble.

She denies any history of seasonal allergies including nasal drainage, frequent nose rubbing or sneezing. She denies any sinus infection troubles, nasal polyps, TMJ, frequent headaches, aspirin-induced nasal symptoms, nasal surgery, frequent bad cold, frequent tonsillitis. She denies any frequent ear infections, any eye irritation, redness, tearing, dryness, burning, eyelid swelling or yellow discharge from eyes.

She denies any history of wheezing or lung problems. She denies any other allergic skin problems. She does not have any metal allergies or other allergic contact dermatitis reaction that she knows of. She has never been evaluated for allergies before.

ASSESSMENT:
1. Concern for mango allergy.
2. Allergic contact dermatitis to mango.

PLAN:
1. At this time unfortunately we do not have a skin testing for mango, but I will pursue ImmunoCAP blood testing for mango IgE and see if she is having a direct allergy reaction to this. We did talk about contact dermatitis being a common factor with peeling of mangoes due to it being in the family of poison ivy as well as pistachio and cashew family. Rarely, there is a cross reaction to individuals who have mango allergy to pistachio and cashew however she states that she can tolerate these nuts just fine and does not exhibit any allergy symptoms or itching in the mouth.
2. I will call her when I get her IgE level back for mango and let her know what the results are. We will follow up as needed.

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