Watermelon

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Melon f87

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Code: f329
Latin name: Citrullus vulgaris/Citrullus lanatus
Source material: Fresh fruit
Family: Cucurbitaceae
Common names: Watermelon

See also Melon f87.

Food

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

Allergen Exposure

This food is widely grown in tropical and sub-tropical climates, and is an especially popular seasonal fruit in the southern United States. The plant has trailing vines and very large fruit (commonly up to half a metre long) with smooth, thick, green skin, and sometimes darker green stripes. The flesh is sweet, and pink, red or yellow in colour. It contains 95% water and has embedded brown or black seeds, although seedless varieties are available.

The fruit is commonly eaten in large slices, with the rind serving as a base, or in balls or cubes in fruit salads. The high water content makes the flesh impractical for cooking or preserving, but the rind is sometimes pickled.

Allergen Description

The following allergen(s) have been characterised:

Cit la 2, a 13 kDa protein, a profilin. (1, 2, 3, 4, 5)

Cit la MDH, a malate dehydrogenase. (4, 6, 7)

Cit la TPI, a triosephosphate isomerase. (4)

Seven trypsin inhibitors were isolated from the seeds of Cucurbitaceae plants: 2 from cucumber (Cucumis sativus) and red bryony (Bryonia diotica) and 1 from figleaf gourd (Cucurbita ficifolia), spaghetti squash (Cucurbita pepo var. vegetable spaghetti), and watermelon (Citrullus vulgaris). (8) Evaluation for allergenic potential was not conducted.

Potential Cross-Reactivity

Extensive cross-reactivity betwen the different individual species of the genus could be expected and has been reported. (9) Cross-reactivity was demonstrated between pumpkin, pumpkin seed, musk melon, watermelon, cucumber and zucchini. (10)

Cit la 2, a profilin, may result in cross-reactivity with other foods containing profilin. Profilins are cross-reactive allergens that bind IgE antibodies of almost 20% of plant-allergic patients. (1) Profilin has been identified as a major IgE-binding component of melon. Amino acid sequences of melon profilin compared with other profilins showed the most identity in the case of watermelon profilin. The melon profilin showed substantial cross-reactivity with profilin from tomato, peach, grape and Bermuda grass pollen. However, cantaloupe, watermelon, banana and Kentucky blue grass displayed no notable cross-inhibition. The study suggests that IgE reactivity to melon profilin strongly depends on the highly conserved conformational structure of the epitope, rather than on a high degree of amino acid sequence identity or even linear epitope identity. (1) An earlier study reported that, as in melon, the profilin of zucchini, cucumber, and watermelon extracts were strongly recognised by the IgE antibodies of the patients with melon allergy. (3)

Hypersensitivity to Bet v 2, a profilin, has been reported to be strongly associated with clinical allergy to citrus fruits (which occurs in 39% of patients monosensitised to Bet v 2, vs 4% of patients monosensitised to Bet v 1), melon or watermelon (67% vs 0%), banana (66% vs 8%), and tomato (33% vs 0%); whereas Bet v 1 sensitivity was associated with clinical allergy to apple (100% vs 39%) and hazelnut (56% vs 0%). A history of allergy to gourd fruits, citrus fruits, tomato, banana, or a combination thereof as a means to predict profilin-hypersensitive patients was 85% (41/48). The specificity of an allergy to any of these fruits exceeded 85%, with positive predictive values ranging between 68% and 91%. The conclusion drawn was that in clinical settings in which laboratory investigations are not easily accessible, allergy to melon, watermelon, citrus fruits, tomato, or banana can be used as a marker of profilin hypersensitivity once a sensitisation to natural rubber latex and lipid transfer protein is ruled out. (11)

In a subsequent study, 200 consecutive patients with pollen allergy underwent skin-prick tests with purified natural date palm profilin (Pho d 2). Sixty patients (30%) showed reactivity to this profilin. Thirty-four of 60 (57%) profilin reactors had food allergy; 21 of these were monosensitised to profilin, 11 were sensitised to both profilin and Bet v 1-homologous protein, 1 to both profilin and LTP, and 1 to all 3 allergens. The large majority of profilin-allergic patients reported oral allergy syndrome as the only food-induced symptom, and were able to tolerate the offending foods if they were cooked or otherwise processed. Twenty-eight of 34 reported reactivity to 2 or more plant-derived foods. Rosaceae, tree nuts, melon and watermelon, tomato, pineapple, citrus fruits and banana were the most frequently offending foods. The authors re-iterated that allergy to melon, watermelon, tomato, banana, pineapple or orange may be considered a marker of profilin hypersensitivity. (12)

In a study of the prevalence of and risk factors for latex hypersensitivity among healthcare workers (HCW) in an Italian general hospital, 24 of 672 who responded to the questionnaire, out of a potential total of 1 747 healthcare workers, reported oral allergy syndrome. It was most commonly related to kiwi, tomato, peach and melon/watermelon. Latex-specific IgE was found in 62 out of 1 747 HCW (3.6%). (13)

ELISA inhibition assays demonstrated allergenic similarity among celery, cucumber, carrot, and watermelon. Immunoblots of individual sera showed a 15 kDa protein band common to all 4 foods. The authors conclude that these foods possess shared antigens that may account for the clustering of allergies to them in patients. (14) Cit la 2, a profilin, may have been the allergen responsible.

Allergy to watermelon has been associated with other allergies, e.g. to melon and latex. In a study, the most common foods associated with melon allergy were avocado (n = 7), banana (n = 7), kiwi (n = 6), watermelon (n = 6), and peach (n = 5). (15)

An increased prevalence of food allergies in patients with latex allergy occurs. Among a group of these patients, foods responsible for reactions included banana (9, or 18.3%), avocado (8, or 16.3%), shellfish (6, or 12.2%), fish (4, or 8.1%), kiwi (6, or 12.2%), tomato (3, or 6.1%), watermelon, peach, carrot (2, or 4.1% each), and apple, chestnut, cherry, coconut, apricot, strawberry, and loquat (1, or 2.0% each). (16)

Over the last 3 decades, several authors have described an association between sensitivity to diverse pollens and sensitivity to diverse plant foods. An association between ragweed pollinosis and hypersensitivity to Cucurbitaceae foods (e.g. watermelon, melon, cucumber) and banana has been reported. (17) An association between grass pollinosis and sensitisation to tomato, potato, green pea, peanut, watermelon, melon, apple, orange and kiwi has been reported. (18)

Watermelon and ragweed have been proposed as having similar allergens. Between 28% and 50% of 120 patients whose sera contained specific IgE to ragweed also had specific IgE to 1 or more members of the gourd family studied (watermelon, cantaloupe, honeydew melon, zucchini, and cucumber). In an ELISA system, the extracts of watermelon and ragweed inhibited each other in a dose-dependent manner. (19)

Clinical Experience

IgE-mediated reactions

Watermelon may uncommonly induce symptoms of food allergy in sensitised individuals. Allergic reactions include oral allergy syndrome or oropharyngeal symptoms (itching and/or swelling of the lips, tongue, or throat), urticaria, dermatitis, angioedema, and dyspnoea. (20, 21)

In a study of 29 watermelon-sensitive patients, 6 were symptomatic. Only about 25% of patients with specific IgE to watermelon develop oropharyngeal symptoms. Symptoms include itching and/or swelling of the lips, tongue, or throat. Watermelon-specific IgE failed to predict an individual's symptoms, or differentiate asymptomatic from symptomatic individuals. (20)

In an Indian study of 24 children aged 3 to 15 years with documented deterioration in control of their perennial asthma during the months of August and September, it was reported that 19 (79%) were sensitised to watermelon. (22)

Contact urticaria from watermelon in a 45-year-old woman with pollen allergy has been reported. She developed urticaria and swelling of her lips on eating watermelon. Symptoms worsened every season and finally resulted in hospital admission following the onset of generalised urticaria, swelling of the lips and tongue, breathing difficulty, and hypotension. (23)

Other reactions

Intestinal obstruction and rectal bezoar by watermelon seed has been reported. (24, 25)

Watermelon seeds, found in 414 (38.7%) children who had aspirated foreign bodies, were the most common foreign bodies aspirated. (26)

Compiled by Dr Harris Steinman, harris@allergyadvisor.com

References

  1. Sankian M, Varasteh A, Pazouki N, Mahmoudi M. Sequence homology: A poor predictive value for profilins cross-reactivity. Clin Mol Allergy 2005;3(1):13.
  2. Gil F, Pastor C, Cases B, Cuesta J, Vivanco F. Cloning and expression of watermelon (Citrillus lanatus) profilin. EMBL/GenBank/DDBJ databases http://www.uniprot.org/uniprot/Q5XWE. Accessed August 2004.
  3. Rodriguez-Perez R, Crespo JF, Rodriguez J, Salcedo G. Profilin is a relevant melon allergen susceptible to pepsin digestion in patients with oral allergy syndrome. J Allergy Clin Immunol. 2003;111(3):634-9.
  4. Pastor C, Cuesta-Herranz J, Cases B, Pérez-Gordo M, Figueredo E, de las Heras M, Vivanco F. Identification of major allergens in watermelon. Int Arch Allergy Immunol 2009;149(4):291-8.
  5. Cases B, Pastor-Vargas C, Gil DF, Perez-Gordo M, Maroto AS, de Las HM, Vivanco F, Cuesta-Herranz J. Watermelon profilin: characterization of a major allergen as a model for plant-derived food profilins. Int Arch Allergy Immunol 2010 May 18;153(3):215-22.
  6. Gietl C, Lehnerer M, Olsen O. Mitochondrial malate dehydrogenase from watermelon: sequence of cDNA clones and primary structure of the higher-plant precursor protein. Plant Mol Biol 1990;14(6):1019-30.
  7. Gonzalez-Mancebo E, Lopez-Torrejon G, Gonzalez de OD, Santos S, Gandolfo-Cano M, Melendez A, Salcedo G, Cuesta-Herranz J, Vivanco F, Pastor-Vargas C. Identification of potential allergens involved in systemic reactions to melon and watermelon. Ann Allergy Asthma Immunol 2010;104(3):271-2.
  8. Polanowski A, Cieslar E, Otlewski J, Nienartowicz B, Wilimowska-Pelc A, Wilusz T. Protein inhibitors of trypsin from the seeds of Cucurbitaceae plants. Acta Biochim Pol 1987;34(4):395-406.
  9. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09.
  10. Figueredo E, Cuesta-Herranz J, Minguez A, Vidarte L, et al. Allergy to pumpkin and cross-reactivity to other Cucurbitaceae fruits. J Allergy Clin Immunol 2000;106(2):402-3.
  11. Asero R, Mistrello G, Roncarolo D, Amato S, Zanoni D, Barocci F, Caldironi G. Detection of clinical markers of sensitization to profilin in patients allergic to plant-derived foods. J Allergy Clin Immunol. 2003;112(2):427-32.
  12. Asero R, Monsalve R, Barber D. Profilin sensitization detected in the office by skin prick test: a study of prevalence and clinical relevance of profilin as a plant food allergen. Clin Exp Allergy 2008;38(6):1033-7.
  13. Suli C, Parziale M, Lorini M, De Silva E, Miadonna A, Tedeschi A. Prevalence and risk factors for latex allergy: a cross sectional study on health-care workers of an Italian hospital. J Investig Allergol Clin Immunol 2004;14(1):64-9.
  14. Jordan-Wagner DL, Whisman BA, Goetz DW. Cross-allergenicity among celery, cucumber, carrot, and watermelon. Ann Allergy. 1993;71(1):70-9.
  15. Rodriguez J, Crespo JF, Burks W, Rivas-Plata C, Fernandez-Anaya S, Vives R, Daroca P. Randomized, double-blind, crossover challenge study in 53 subjects reporting adverse reactions to melon (Cucumis melo). J Allergy Clin Immunol. 2000;106(5):968-72.
  16. Kim KT, Hussain H. Prevalence of food allergy in 137 latex-allergic patients. Allergy Asthma Proc. 1999;20(2):95-7.
  17. Caballero T, Martin-Esteban M. Association between pollen hypersensitivity and edible vegetable allergy: a review. J Investig Allergol Clin Immunol. 1998;8(1):6-16.
  18. Ortolani C, Ispano M, Pastorello E, Bigi A, Ansaloni R. The oral allergy syndrome. Ann Allergy. 1988;61(6 Pt 2):47-52.
  19. Enberg RN, Leickly FE, McCullough J, Bailey J, Ownby DR. Watermelon and ragweed share allergens. J Allergy Clin Immunol. 1987;79(6):867-75.
  20. Enberg RN, McCullough J, Ownby DR. Antibody responses in watermelon sensitivity. J Allergy Clin Immunol. 1988;82(5 Pt 1):795-800.
  21. Yamamoto T, Asakura K, Shirasaki H, Himi T. Clustering of food causing oral allergy syndrome in patients with birch pollen allergy. [Japanese] Nippon Jibiinkoka Gakkai Kaiho 2008;111(8):588-93.
  22. Agarkhedkar SR, Bapat HB, Bapat BN. Avoidance of food allergens in childhood asthma. Indian Pediatr. 2005;42(4):362-6.
  23. Temesvari E, Becker K. Contact urticaria from watermelon in a patient with pollen allergy. Contact Dermatitis. 1993;28(3):185-6.
  24. Grannis FW, Lee RA. Intestinal obstruction by a watermelon seed. Minn Med. 1974;57(6):457-8.
  25. Britton PN, Polon M. A case of impacted watermelon seed rectal bezoar in a 12-year-old girl. J Paediatr Child Health 2011;47(1-2):68-9.
  26. Eren S, Balci AE, Dikici B, Doblan M, Eren MN. Foreign body aspiration in children: experience of 1160 cases. Ann Trop Paediatr. 2003;23(1):31-7.

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