Facial rash and palmoplantar pruritus in an infant after first contact with kaki.

Kaki, also known as Sharon fruit or persimmon, is the edible fruit of the persimmon tree (Diospyros kaki), which belongs to the Ebenaceae family. Although kaki has been a very popular food in Japan for centuries, no allergies to this fruit have been previously reported in this country. A 13-month-old male infant was brought to the outpatient clinic at Kumamoto University Hospital in Kumamoto, Japan with a reaction to kaki upon fi rst ingestion. He exhibited skin rash and itching on the face and soles of the feet. The symptoms had appeared immediately after biting a fresh kaki and the itching on the soles persisted for more than 13 hours despite treatment with oral antihistamines. Neither wheeze nor gastrointestinal symptoms were observed and there were no indications of asthma, eczema, or rhinoconjunctivitis. A positive skin prick test result was obtained with fresh kaki [1], yielding a wheal measuring 18 mm in diameter compared to 6 mm with 1% histamine solution and 0 mm with normal saline. Although the parents did not consent to an oral provocation test with kaki, the result of the CAP-fl uorescence enzyme immunoassay (Phadia Diagnotics, Uppsala, Sweden) analysis (3.29 kU/L) confi rmed sensitization to kaki. The patient was also sensitized to Dermatophagoides farinae (0.50 kU/L) and D pteronyssinus (3.14 kU/L), but not to carrot, apple, kiwi, celery, melon, peach, timothy grass, mugwort, alder, birch, beech, oak, or Alternaria. Serum specifi c-immunoglobulin (Ig) E for rBet v1 or rBet v2 was not detected. Sodium dodecyl sulfate polyacrylamide gel electrophoresis immunoblotting with kaki extracts revealed bands corresponding to apparent molecular masses of 27 kDa, 30 kDa, 60 kDa, and 70 kDa (Figure). The immunoblotting study with the patient’s serum indicated IgE-binding proteins at positions corresponding to molecular masses of approximately 30 kDa 250 150