Jujube

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Code: f336
Latin name: Ziziphus jujuba
Source material: Fresh fruit
Family: Rhamnaceae (Buckthorn)
Common names: Jujube fruit, Azufaifa fruit, Chinese date, Chinese jujube, Chinese red date, Common jujube, Cottony jujube, Indian jujube

Terminological confusion exists between the related species Ziziphus zizyphus and Ziziphus mauritiana. Some sources give the common name jujube, red date, or Chinese date for Ziziphus zizyphus (the species used primarily for its fruit); and Indian jujube, Chinese apple or cottony jujube for Ziziphus mauritiana.

Food

A food, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Jujubes originated in China, where they have been cultivated for more than 4 000 years, and where there are over 400 cultivars. The spiny trees travelled beyond Asia centuries ago, and today are grown to some extent in Russia, northern Africa, southern Europe, the Middle East and the south-western United States.

The fruit is a drupe, varying from round to elongated and from cherry-size to plum-size, depending on the cultivar. It has a thin, edible, dark-red skin surrounding whitish flesh of a sweet, agreeable flavour. The single hard stone contains 2 seeds. Confusingly, Jujube is also the name of a tiny fruit-flavoured sweet or candy with a hard, gelatinous texture, but the name is the only connection between the 2 foods.

The naturally drooping tree is graceful and ornamental, and it is grown in gardens as well as in orchards. The fruit can be eaten out of hand or in a variety of desserts, but is not readily available in the West. Oil is extracted from the seeds. Some tests indicate very high vitamin C content.

The fruit has been used medicinally for millennia by many cultures. One of its most popular uses is as a tea for sore throat. The aqueous extract from the leaves of the related Zizyphus mauritiana Lam has been used in traditional medicine. It has been shown to have anti-diabetic activity, resulting in a decrease in blood glucose. (1)

Allergen Description

No allergens from this plant have yet been characterised.

Proteins of 15 to 60 kDa were detected, but on immunoblotting studies with a patient’s serum, only a single band of around 30 kDa was found. The authors postulated that this protein may represent a chitinase panallergen, but this could not be confirmed. (2)

A more recent report describes the isolation of a 42 kDa Latex protein and a 42 kDa Indian jujube protein from 2 jujube- and latex-allergic subjects. In addition, IgE from 1 subject bound to a 30 kDa Indian jujube protein. (3) The study reported Indian jujube as Zizyphus mauritiana, whereas other sources regard Indian jujube as Ziziphus jujube.

Ziz m 1, a Class 3 chitinase, has been characterised in the close relative Ziziphus mauritiana. (4, 5)

Potential Cross-Reactivity

An extensive cross-reactivity among the different individual species of the genus could be expected. (6)

In a study of 2 subjects, both allergic to jujube and latex, cross-reactivity between latex and jujube was demonstrated. The authors suggest that jujube is therefore part of ‘latex-fruit syndrome’. (3)

Clinical Experience

IgE-mediated reactions

Anecdotal evidence suggests that Jujube may induce symptoms of food allergy such as urticaria, angioedema, rhinoconjunctivitis, dyspnoea, and wheezing in sensitised individuals; however, few studies have been reported to date. (2, 3, 7)

Two patients described were jujube- and latex-allergic. Both patients had positive skin-test responses and specific IgE assays to Indian jujube and latex extracts. Jujube was shown to be cross-reactive with latex. (3)

Urticaria, angioedema, rhinoconjunctivitis, dyspnoea, wheezing, abdominal pain, and diarrhoea were reported in a 38-year-old latex- and food-allergic nurse after she ate jujube fruit. Her prior food allergy was to banana, chestnut, kiwi and avocado. (2) This co-sensitisation is typical of ‘latex-fruit syndrome’.

Other reactions

The seeds and leaves of Ziziphus spinosa exert an inhibiting effect on central nervous system function, while the fruits have a synergism with pentobarbitol sodium and thiopental sodium on prolongation of sleep and sedation, and also decrease coordinated action. Jujuboside A exerts no inhibiting effect, but has a synergistic effect with phenylalanine on central nervous system function. (8) Whether a similar effect may occur with Ziziphus jujuba was not assessed.

Perforation of the small bowel due to the pointed pit of the jujube fruit has been described. (9)

Compiled by Dr Harris Steinman, harris@allergyadvisor.com

References

  1. Cisse A, Ndiaye A, Lopez-Sall P, Seck F, Faye B, Faye B. Antidiabetic activity of Zizyphus mauritiana Lam (Rhamnaceae). [French] Dakar Med 2000;45(2):105-7.
  2. Alvarado MI, Moneo I, Gonzalo MA, Alvarez-Eire M, Diaz-Perales A. Allergy to azufaifa fruit and latex. Allergy. 2002;57(5):460-1.
  3. Lee MF, Chen YH, Lan JL, Tseng CY, Wu CH. Allergenic Components of Indian Jujube (Zizyphus mauritiana) Show IgE Cross-Reactivity with Latex Allergen. Int Arch Allergy Immunol 2004;133(3):211-6.
  4. Lee MF, Hwang GY, Chen YH, Lin HC, Wu CH. Molecular cloning of Indian jujube (Zizyphus mauritiana) allergen Ziz m 1 with sequence similarity to plant class III chitinases. Mol Immunol 2006;43:1144-51.
  5. Lee MF, Tsai JJ, Hwang GY, Lin SJ, Chen YH. Identification of immunoglobulin E (IgE)-binding epitopes and recombinant IgE reactivities of a latex cross-reacting Indian jujube Ziz m 1 allergen. Clin Exp Immunol 2008;152(3):464-71.
  6. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09.
  7. Alcantara M, Bartolome E, Pagan JA, et al. Allergy to azufaifo (Ziziphus jujuba) a case of hypersensitivity infrequent. [Abstract] Allergy 2002;55:228.
  8. Wu SX, Zhang JX, Xu T, Li LF, Zhao SY, Lan MY. Effects of seeds, leaves and fruits of Ziziphus spinosa and jujuboside A on central nervous system function. [Chinese] Zhongguo Zhong Yao Za Zhi 1993;18(11):685-7, 703-4.
  9. Lavers GD, Feldmayer JE. Jujube. A case of perforated bowel. Calif Med 1964;101:206-7.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.