Q:

I recently saw a child who had hives from ingestion of pomegranate; are there any cross-reactivities to be concerned about? Any data regarding the natural history of pomegranate allergy? Thanks.

A:

Thank you for your recent inquiry.

Pomegranate has been known to produce allergic reactions for many years, and there are several case reports in the literature (1-3). The allergens of pomegranate have also been studied. One of these is a lipid transfer protein. Lipid transfer proteins have been found to be major allergens in fruits belonging to the Rosaceae family (4). Patients allergic to pomegranate have shown symptoms after eating other fruits such as peaches (4). The lipid transfer proteins in pomegranates have also been shown to cross react with hazelnut and peanut (5), and patients allergic to pomegranates have also reacted to walnuts (4). 

Unfortunately, I could find no information about the natural history of pomegranate allergy.

In summary, there is potential cross reactivity between pomegranate and other fruits and nuts as described in the references noted below. Unfortunately there is little known about the natural history of pomegranate history.

Thank you again for your inquiry and we hope this response is helpful to you.

References:
Gaig, et al. Allergy to pomegranate. Allergy 1999; 54(3):287-288.
Gaig, et al. Allergy to pomegranate (punica granatum). Journal of Investigative Allergology Clin Immunol 1992; 2:216-218.
Igga J, et al. Adverse reaction to pomegranate ingestion. Allergy 1991; 46(supplement s11):472-474.
Damiani G, et al. Pomegranate (punica granatum) allergy: Clinical and immunologic findings. Annals of Allergy, Asthma, and Immunology 2009 (August); Volume 103, Issue 2, Pages 178-180.
Enrique E, et al. Allergy to lipid transfer proteins; cross-reactivity among pomegranate, hazelnut, and peanut. Annals of Allergy, Asthma, and Immunology 2006; 96(1):122-123.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology