Substance Info: (and synonyms)

Background Info:

Family: Vitaceae.

Common name for edible fruit and of particular vines. European grape has been used for food since prehistoric times. Widely cultivated, many species and varieties. Red, green or purplish fruit which is smooth-skinned and fleshy. Eaten raw or dried (see Currants), and used extensively in wine making.

Fewer than a dozen varieties are grown for table grapes, the majority (90%) accounting for wine production.

Polyphenols and tannins present in red grapes may cause migraines. Main problem with grapes is contaminants on skin.

Source of potassium.


Adverse Reactions:


[ 1 / 43 ]

Anaphylaxis only to a home-made rose wine from a variety of grape. This study reports a case of anaphylaxis to a home-made wine and tolerance to other wines. patient experienced generalized pruritus, eyelid and face angioedema, urticaria and chest tightness within twenty minutes after having drunk a glass of home-made rose wine. He still ate different varieties of grapes, drank white and red wine as well as other alcoholic beverages without any reaction. SPT with commercial extract of grape was negative. Prick-to-prick tests were marginally positive to fresh white and red grape but strongly positive to the variety of rose grapes, so called cardinale, used in the culprit wine production. An SPT with this particular rose wine elicited a positive response even after it was boiled for 15 minutes. SPTs with undiluted white and red wines were negative. Grape specific serum IgE was negative.

Vovolis V, Delyargiris C, Tsiougkos N. Anaphylaxis only to a home-made rose wine from a variety of grape. Eur Ann Allergy Clin Immunol 2013 Aug;45(4):148-149

[ 2 / 43 ]

Anaphylaxis to grape, induced by prick-test to natural grapes, and a case of anaphylaxis to wine are reported. Both were induced by exercise. The first case was allergic to Artemisia and birch pollens. The second case has past multiple allergies to several other fruit and vegetable. Specific IgE to Pru p 3 and Art v 3 were present in both cases. In case 1, the inhibition test of Cap to grape by Bet v 1 was negative. A 95 % inhibition was observed by Art v 3, documenting the involvement of Vit v 1. A primary sensitization to fruit LTP is suggested in case 2. A primary sensitization to Art v 3 is highly probable in case 1. The great variability of the LTP syndrome is emphasized. Because the foods at risk are unpredictable, anti H1, corticosteroids and even self-injectable epinephrine should be prescribed in all the cases. (V. 2012 ref.28397 5)

V. Doyen, D.A. Moneret-Vautrin, M. Dron-Gonzalves Anaphylaxie sévère au vin et au raisin impliquant la LTP de raisin (Vit v 1) : à propos de deux cas / Severe anaphylaxis wine and grape grape involving LTP (Vit v 1): report of two cases Revue Française d'Allergologie 2012;52(7):480-483

[ 3 / 43 ]

Anaphylaxis to grape, induced by prick-test to natural grapes, and a case of anaphylaxis to wine are reported. Both were induced by exercise. The first case was allergic to Artemisia and birch pollens. The second case has past multiple allergies to several other fruit and vegetable. Specific IgE to Pru p 3 and Art v 3 were present in both cases. In case 1, the inhibition test of Cap to grape by Bet v 1 was negative. A 95 % inhibition was observed by Art v 3, documenting the involvement of Vit v 1. A primary sensitization to fruit LTP is suggested in case 2. A primary sensitization to Art v 3 is highly probable in case 1. The great variability of the LTP syndrome is underlined. Because the foods at risk are unpredictable, anti H1, corticosteroids and even self-injectable epinephrine should be prescribed in all the cases. (Doyen 2012 ref.28370 8)

Doyen V, Moneret-Vautrin DA, Dron-Gonzalves M. Severe anaphylaxis to wine and to grape induced by sensitization to grape lipid transfert protein (Vit v 1): Report of two cases. Rev Fr Allergol 2012(0):-

[ 4 / 43 ]

Vitis vinifera vitis (grape) cultivar Sultana is a causative agent of oral allergy syndrome (OAS) IgE-reactivity of sera from patients with history of OAS to grape and positive skin prick test (SPT) were evaluated. The purified 10 kDa allergen showed the highest immunoreactivity in component-resolved ELISA and the results were in correlation with SPT results. The patients sera were mostly reactive with 10, 28 and 60 kDa allergens; meanwhile, a 16 kDa protein can be considered as a novel marker for OAS to grape. The 24, 28 and 30 kDa allergens were identified as thaumatin-like protein, class IV chitinase and beta-1,3-glucanase, respectively. The Sultana cultivar showed a rather similar pattern of IgE reactivity with other cultivars. Several allergens play role in OAS to grapes, however, the 10 kD protein is the main allergen. (Falak 2012 ref.28278 7)

Falak R, Sankian M, Noorbakhsh R, Tehrani M, Assarehzadegan MA, Jabbari Azad F, Abolhasani A, Varasteh AR. Identification and characterisation of main allergic proteins in Vitis vinifera vitis. Food Agric Immunol 2012(0):- DOI:10.1080/09540105.2012.683167

[ 5 / 43 ]

This study reports food-dependent exercise-induced anaphylaxis (FDEIA) where anaphylactic symptoms appeared not only after postprandial exercise, but also when the food allergen was ingested immediately after prolonged exercise.
A 27-year-old female experienced in the previous 12 years five incidents of FDEIA following ingestion of different fruits: plums, grapes, cranberries, peaches, blackberries and raspberries. In some episodes the fruits were eaten together, therefore the precise identification of culprit food was uncertain. The patient experienced two typical episodes of FDEIA. The first occurred 12 years previously after 30 minutes of intensive walking, preceded by eating blackberries. Symptoms included generalized urticaria, facial angioedema, nausea, vomiting and weakness. The second was precipitated 10 years ago by ingestion of raspberries and prolonged physical exercise started about 3 hours later. After 1 hour of dancing she developed anaphylactic symptoms which involved disseminated urticaria accompanied by facial angioedema and nausea.
The patient has experienced three unusual episodes of FDEIA:
Episode 1. Immediately after discontinuation of prolonged exercise lasting 2 hours, raspberries were ingested. About 20 minutes later she experienced generalized urticaria accompanied by angioedema localized on the face and upper limbs, vomiting and diarrhea.
Episode 2. During a hot and sunny day the patient did outdoor exercise for about 3 hours and a few minutes later ate peaches. About 10 minutes later she developed generalized urticaria, angioedema of the face, nausea and loss of consciousness requiring emergency room treatment.
Episode 3. Following a strenuous and prolonged exercise the patient ate the first meal that day - potatoes, chicken and cranberries. About 10 minutes later, disseminated urticaria localized on the neck and hands developed, which were partially reduced by 10 mg of cetirizine. Four hours later she ate white grapes and a shortly afterwards started dancing intensively. A few minutes later she developed a heavy anaphylactic reaction with the symptoms similar to those described in the episode 2.
Skin tests were positive to peach, raspberry, cranberry, nectarine, blackberry and black grape. Total serum IgE was 119 kU/L. Due to a possible lifethreatening systemic reaction, an exercise challenge after ingestion of food allergens was not performed. (Wolanczyk-Medrala 2010 ref.25801 5)

Wolanczyk-Medrala A, Barg W, Radlinska A, Panaszek B, Medrala W. Food-dependent exercise-induced anaphylaxis-sequence of causative factors might be reversed. Ann Agric Environ Med 2010 Dec;17(2):315-317

[ 6 / 43 ]

A 30-year-old LTP-sensitized Spanish woman with a history of severe anaphylactic reaction to grapes, apple and cauliflower in which the detection of specific IgE against the recombinant protein Pru p 3 led to the diagnosis. (Brans 2010 ref.25231 7)

Brans R, Merk HF. Component-based diagnostic approach. Detection of sensitization to lipid transfer proteins in food allergy. [German] Hautarzt 2010 May;61(5):382-385

[ 7 / 43 ]

A report of an individual with repeated severe anaphylaxis after consumption of grapes, wine, and raisins, as result of an IgE-mediated allergy against grape lipid-transfer protein, who was submitted to a specific oral tolerance induction (SOTI) with increasing doses starting from approximately 20 mg of grapes. Within 3 days the patient reached tolerance to the daily maintenance dose of 20 g of grapes (about 3 grape pieces) without anaphylaxis symptoms. Two months later, a controlled challenge with a total of 66.5 mL of white wine was tolerated. Grape-specific IgE stayed stable at 2.37 kU/L (class 2) and grape-specific IgG4 was first detectable 21 months after SOTI. Prick-to-prick skin tests continued to be positive to grapes, to raisins, and to white and red wine. The basophil activation test still showed strong IgE-mediated activation of basophils after stimulation with grape extract. Immunoblotting still detected IgE binding to a 8-kDa protein. (Schäd 2010 ref.24397 7)

Schäd SG, Trcka J, Lauer I, Scheurer S, Trautmann A. Wine allergy in a wine-growing district: tolerance induction in a patient with allergy to grape lipid-transfer protein. WAO Journal 2010;3(1):1-5

[ 8 / 43 ]

A child with anaphylaxis to grapes without reaction to grape seed oil. (Cardinale 2009 ref.24268 3)

Cardinale F, Berardi M, Chinellato I, Damiani E, Nettis E. A child with anaphylaxis to grapes without reaction to grape seed oil. Allergy 2009 Nov 2;

[ 9 / 43 ]

An 18-year-old woman presented with several anaphylactic reactions to a grape alcoholic drink. The first episode occurred 20 minutes after ingesting 12 grapes and one glass of champagne when she experienced generalized urticaria, facial angioedema, and nasal obstruction. The second episode, symptoms occurred after 10 mins and she experienced abdominal pain, vomiting, facial angioedema, and nasal obstruction. She was asymptomatic if she eats the grape alone but not if associated with alcoholic drinks. SPT with fresh grape and oral challenge with grapes and champagne together were positive. Grape-specific IgE was detected. Immunologic studies with the patient's sera and the sera of two other patients with grape allergy not alcohol-induced were performed to evaluate for differences. No different allergens to grape were identified when alcohol is a cofactor. (Alcoceba 2007 ref.20375 7)

Alcoceba BE, Botey FE, Gaig JP, Bartolome ZB. Alcohol-induced anaphylaxis to grape. Allergol Immunopathol (Madr ) 2007 Jul;35(4):159-161

[ 10 / 43 ]

Thirty seven patients with reported severe allergic reactions to grapes are described. Symptoms included generalized urticaria, asthma, atopic dermatitis, angiooedema, gastro-intestinal symptoms, hypotension, rhinitis, oral allergy symptoms. All subjects were polyallergic, sensitised and reactive to several additional foods and pollen. All patients were sensitised to grape LTP. A 28-kDa expansin, a 37.5-kDa polygalacturonase-inhibiting protein, a 39-kDa beta-1,3-glucanase and a 60-kDa protein were identified as minor grape allergens. Endochitinase and TLP did not play a role. Inhibition experiments revealed the possible cross-reactive role of LTP for clinical sensitivities to other LTP-containing plant foods, but also the involvement of cross-reactive carbohydrate determinants of minor allergens in IgE cross-reactivity. (Vassilopoulou 2007 ref.16320 7)

Vassilopoulou E, Zuidmeer L, Akkerdaas J, Tassios I, Rigby NR, Mills EN, van Ree R, Saxoni-Papageorgiou P, Papadopoulos NG. Severe immediate allergic reactions to grapes: part of a lipid transfer protein-associated clinical syndrome. Int Arch Allergy Immunol 2007 Jan 15;143(2):92-102

[ 11 / 43 ]

An 18-year-old woman with alcohol- induced anaphylaxis to grape. She presented with her first episode at New Year with generalized urticaria, facial angioedema and nasal obstruction twenty minutes after ingesting grape and a glass of champagne. A year later, ten minutes after ingesting the same combination she developed abdominal pain, vomiting, facial angioedema and nasal obstruction. She remains asymptomatic if she eats the fruit alone but not if she associates the fruit with alcoholic drinks. Skin prick test with a commercial extract of white and red grape was negative. The prick-by-prick test was positive for red grape, white grape and negative for champagne. No grape-specific IgE could be demonstrated and oral challenge with grapes and champagne together were positive (negative for 1 grain grape and 5cc champagne but positive for 12 grains of grape and 50cc champagne. A further two patients with allergic reactions to grape are described: a woman who complained of angioedema on the lips and oral pruritus after eating grapes and a man with anaphylactic reactions after eating grapes. These two patients tolerated alcoholic drinks. The prick test with commercial grape extract was negative in both but the prick by prick was positive in both of them. Grape-specific IgE was 0.62 kU/l and 0.52 kU/l. (Alcoceba 2007 ref.22377 2)

Alcoceba Borràs E, Botey Faraudo E, Gaig Jané P, Bartolomé Zavala B. Alcohol-induced anaphylaxis to grapes. Allergol Immunopathol (Madr) 2007 Jul-Aug;35(4):159-61.

[ 12 / 43 ]

IgE-mediated type-I-allergy against red wine and grapes. a 66-year-old white man who developed an episode of anaphylaxis with swelling of the tongue and respiratory distress 2 h after consuming red wine. He previously tolerated red wine and grapes without any reactions. Other alcoholic beverages, i.e. beer, were tolerated without any symptoms. Prick-to-prick was positive for red wine, white wine and grapes. Serum specific IgE was found against birch, mugwort, egg, milk, codfish, wheat ?our, soy, peanut, apple, carrot, latex, grape (RAST Class 2), celery (RAST Class 5), cherry (RAST Class 2) and peach (RAST Class 2). Total IgE counted 607 kU/l. Potassium-metabisulfate was excluded by oral provocation. Western blot analysis of grape and red wine extracts revealed specific IgE reactivity to three allergens in grapes and red wine, previously identified as 30-kD-endochitinase 4A and 4B, 24-kD-thaumatin-like protein and the 9-kD-lipid transfer protein. (Sbornik 2007 ref.20382 5)

Sbornik M, Rakoski J, Mempel M, Ollert M, Ring J. IgE-mediated type-I-allergy against red wine and grapes. Allergy 2007 Nov;62(11):1339-40.

[ 13 / 43 ]

Sixty-one Greek patients, aged 14-52 years with a documented history of IgE-mediated reactions to grapes or its products (wine, juice, and wine vinegar) were included in this study. Patients reported 3.1 episodes/patient (range, 1-15 episodes) after consumption of grapes or its product. Forty-seven of 61 (77%) patients had presented oral allergy syndrome after eating grapes before the first reported reaction. The mean time for the onset of symptoms was 42 minutes (4-160 minutes). Forty-four of 61 (72.1%) patients reported more than one reaction. The observed prevalence of symptomatology according to the system involved was determined: skin, 57/61(93.4%) patients; respiratory, 46/61(75.4%) patients; cardiovascular, 27/61 (44.3%) patients; and gastrointestinal, 24/61(39.3%) patients. The main cosensitizations were identified (skin-prick tests): apples, 81.9%; peaches, 70.5%; cherries, 47.5%; strawberries, 32.8%; peanuts, 49.2%; walnuts, 42.6%; hazelnuts, 31.1%; almonds, 26.2%; and pistachios, 29.5%. The grape and its products may be the offending agent of IgE-mediated reactions in sensitized individuals. The high prevalence of concomitant reactivity to other fruits elicits the interest of clinical relevance of these findings among the grape-allergic population. (Kalogeromitros 2006 ref.13991 7)

Kalogeromitros DC, Makris MP, Gregoriou SG, Katoulis AC, Straurianeas NG. Sensitization to other foods in subjects with reported allergy to grapes. Allergy Asthma Proc 2006 Jan;27(1):68-71

[ 14 / 43 ]

An 18-year-old female student suffering from seasonal rhinoconjunctivitis with sensitization to pollens from vine and also from grass, olive, and Chenopodiaceae plants who had recently developed episodes of itching, maculopapular rash, and facial angioedema after eating grapes. Testing revealed positive reactions to vine pollen and grapes, and specific IgE were found for both allergens. Immunoblotting and inhibition assays revealed cross-reactivity between the allergenic structures of vine pollen and grape fruit and also among botanically unrelated pollens. (Mur 2006 ref.16684 5)

Mur P, Feo BF, Bartolome B, Galindo PA, Gomez E, Borja J, Alonso A. Simultaneous allergy to vine pollen and grape. J Investig Allergol Clin Immunol 2006;16(4):271-273

[ 15 / 43 ]

A 6 years old girl with a grass pollen allergy sensitised to group 1 and 5 allergens, and grass profilin, who presents and OAS to multiple fresh plant foods related to the profilin sensitisation. The girl presented with a mild atopic dermatitis and since the age of 3 years experencied rhinoconjunctival symptoms in spring. At 3.5 years she presented OAS after the intake of watermelon. Since then until the last visit she presented OAS with other plant foods including apple, kiwi, apricot, plum, peach, nectarine, pear, strawberry, grape, orange, tangerine, banana, tomato, cucumber and hazelnut. She tolerated processed fruits (juices, jam) and latex contact.
Skin prick tests to inhalants were positive to grass, olive, plane tree, mugwort, and plantain pollens. SPTs with commercial extracts of fruits were negative, but positive results were observed to some of them tested fresh (prick-prick). An oral challenge with fresh plum elicited oropharyngeal pruritus and labial angioedema. SPT and serum specific IgE to Pru p 3 were negative. SPT with nPho d 2 (date palm profilin) was positive. CAP to latex was 3.03 kU/L, with negative results to the recombinant latex allergens 1, 3, 5, 6.01 and 6.02. CAP inhibition assays of pollens, plant foods and latex were performed with rBet v 2 with the following inhibitions: > 85% to rBet v 2 and rPhl p 12, 40- 100% to watermelon, orange, apple, tomato, banana, 100% to latex, > 70% to mugwort, plane tree and olive pollens, no inhibition to grass and Phleum. (Rodriguez 2006 ref.23498 2)

Rodriguez del Rio P, Rodriguez-Jimenez B, Plaza A, Reig I, Sanchez-Lopez J, Vazquez-Cortes S, Martinez-Cocera C, Fernandez-Rivas M. Early onset of profilin sensitation. EAACI Congress, Vienna-Austria. 2006 Jun; Oral Abstract 1513.

[ 16 / 43 ]

Wine anaphylaxis in a German patient is described and IgE-mediated allergy against a lipid transfer protein of grapes confirmed. A 27-year-old woman had several episodes with palmoplantar pruritus, angioedema of the lips, eyelids and tongue, dyspnea, dysphagia and tachycardia 20–60 min after drinking red wine and champagne and eating fresh white grapes and raisins. Prick-to-prick tests were positive to fresh and cooked white and blue grapes, to raisins, to white and red wine, and to grape extract. Specific IgE against grapes was 2.43 kU/l. The BAT showed specific IgE-mediated activation of basophils after stimulation with grape extract. An protein allergen was isolated which completely inhibited by cherry LTP Pru av 3 and sequencing identified this 15-kDa protein as grape LTP Vit v 1. The study concludes that this data shows that sensitization to lipid transfer protein (LTP) can occur outside the Mediterranean area causing severe fruit allergy without association to pollinosis. (Schad 2005 ref.11097 3)

Schad SG, Trcka J, Vieths S, Scheurer S, Conti A, Brocker EB, Trautmann A. Wine anaphylaxis in a German patient: IgE-mediated allergy against a lipid transfer protein of grapes. Int Arch Allergy Immunol 2005 Jan 12;136(2):159-164

[ 17 / 43 ]

Eleven unrelated Greek patients, six men and five women (aged 16-44 years) were enrolled based on a documented history of IgE-mediated reactions to grapes, wine, or other grape products. Patients reported 35 grape-induced anaphylaxis episodes ranging from moderate to severe. A causative agent was identified: wine, 10/35 (28.6%); red grapes, 9/35 (25.7%); stuffed vine leaves, 8/35 (22.9%); raisins, 3/35 (8.6%); white grapes, 2/35 (5.7%); wine vinegar, 2/35 (5. 7%); and grape juice, 1/35 (2.9%). Other foods that induced anaphylaxis were apples (54.5%), cherries (18.6%), peaches (18.6%), and bananas (9.3%). The time between grape consumption and onset of symptoms varied from 1-140 mins. (Kalogeromitros 2005 ref.11597 7)

Kalogeromitros DC, Makris MP, Gregoriou SG, Mousatou VG, Lyris NG, Tarassi KE, Papasteriades CA. Grape anaphylaxis: a study of 11 adult onset cases. Allergy Asthma Proc 2005;26(1):53-8.

[ 18 / 43 ]

In 2002, 107 cases were reported to the French Allergy Vigilance Network of which 59.8 % were cases of anaphylactic shock (one being fatal), 18.7% systemic reaction, 15.9% laryngeal angio-edema, 5.6% serious acute asthma (one fatal). Adults represented 69% of cases (74 cases). The most frequent causal allergens were peanut (14), nuts (16), shellfish (9) latex group fruit (9 patients), and most often in-patients allergic to latex: avocado (4), kiwi (2), fig (2), and banana (1). Next came lupine flour (7), wheat flour (7), celery (5) and snails (5), sesame (4), milk (3), buckwheat (3), fish (3), peach (2), chicken (2). Single observations included sulfites, quinine (an additive in a tonic drink), mustard, lentils, kidneys, pork, melon, grapes, pears, chicory, artichokes, oranges and Anisakis simplex. Four patients had an immediate post-prandial shock and were reported as idiopathic shock. The allergen was present in a masked form in 13% of cases: peanut (6 - with one fatal), lupine (4), sesame (3), and hazelnut (1).
In 4 cases of which one lethal a severe anaphylactic reaction occurred after consumption of macaroon in which the almonds have been replaced by peanuts paste without an adequate labeling. Two cases of anaphylactic shocks in hospitalized children were due to chocolate drink containing lupine flour. Both children were allergic to peanuts and AS occurred by cross allergy. A case of food allergy to hazelnuts is due to a mislabeling on chocolate packaging at Halloween. Two cases of severe anaphylaxis by proxy are reported: the incriminated allergenic peanuts. The patient presented the allergic reaction by contact with another person eating peanuts. (Moneret-Vautrin 2004 ref.10176 0)

Moneret-Vautrin DA, Kanny G, Morisset M, Rance F, Fardeau MF, Beaudouin E. Severe food anaphylaxis: 107 cases registered in 2002 by the Allergy Vigilance Network. Allerg Immunol (Paris) 2004;36(2):46-51

[ 19 / 43 ]

A Spanish study of 14 children aged 4-16y who had suffered allergic reactions involving fresh grapes or grape juice. OAS was reported in 6, angiodema in 2, urticaria in 1, angioedema-urticaria in 1, and anaphylaxis in 3. Skin prick test (SPT) with commercial grape extract and with prick-prick technique were negative in five pollinic control subjects without grape allergy history. Open oral challenge was performed in two children with 'Muscat de Hamburg' grapes. The rest of parents refused. Sera from five children were assessed. An IgE-binding 94 kDa grape protein was recognized by patient no. 8 sera. Patient no. 9 IgE bind to 100, 60, 34, 28, 24 and 17 kDa protein bands, no. 12 to 31 and 24 kDa, no. 13 to a 34 kDa, and no. 14 to a 17 kDa band exclusively. (Rodriguez 2004 ref.9084 7)

Rodriguez A, Matheu V, Trujillo MJ, Martinez MI, Baeza ML, Barranco R, Frutos C, Zapatero L. Grape allergy in paediatric population. Allergy 2004;59(3):364

[ 20 / 43 ]

Fourteen patients, 10 women and 4 men (aged 23-47 years), were selected on the basis of a documented history of severe allergic reactions to grape (11 patients) or wine (3 patients). Of the patients with severe allergic reactions after eating grapes, in some, also reacted after drinking 2 particular kinds of red wine, namely Fragolino and the young wine vino novello. Because of the severe reactions, food challenges were not performed in any patient. Three patients with wine allergy experienced repeated reactions because they initially did not identify the relationship between symptoms and drinking young, new wine or Fragolino wine because they had not shown intolerance to other kinds of wine. One patient was a young woman with an oral allergy syndrome (OAS) for fresh grape, peach, and cherry who had anaphylactic shock 3 times after drinking a glass of young wine. Another, a young, nonatopic man who had anaphylactic reactions twice after drinking a glass of the red wine called Fragolino. One patient experienced an OAS to grape and young wine for 1 year and then suddenly experienced a risky laryngeal edema after drinking one glass of Fragolino. Because he tolerated other kinds of wine, he identified the culprit beverage only after a second, very severe reaction to Fragolino.SPTs with fresh grape provided positive results to both varieties in all 3 patients, although the patients reacted more strongly to the V labrusca grape. Patient no 13 had 3 episodes of exercise-induced anaphylaxis after eating large amounts of grapes before going dancing or swimming. He could tolerate traditionally prepared red wines, and the reactions started after a generalized reaction to acetylsalicylic acid. Patient 6 presented severe asthmatic reactions after eating grape. Other patients (nos. 1, 4, 5, 7, 10, and 11) reported many years of OAS for grape that had abruptly changed, causing laryngeal edema. Many of these patients reported previous allergic reactions to peach, cherry, or tree nuts. Only one patient (no. 7), a nurse, reported severe cutaneous and respiratory reactions to latex gloves. (Pastorello 2003 ref.7409 2)

Pastorello EA, Farioli L, Pravettoni V, Ortolani C, Fortunato D, Giuffrida MG, Perono Garoffo L, Calamari AM, Brenna O, Conti A. Identification of grape and wine allergens as an endochitinase 4, a lipid-transfer protein, and a thaumatin. J Allergy Clin Immunol 2003;111(2):350-9

[ 21 / 43 ]

A 28-year-old woman who presented with allergic systemic reaction after eating white grapes (Vitis vinifera). She complained of two severe episodes of anaphylaxis after eating grapes, with generalized pruritus, acute generalized urticaria, facial swelling, lip and oropharingeal angioedema, and dysphagia. She tolerated champagne. Skin prick tests with commercial extract of grapes provided a negative result, while prick by prick procedure performed with white grapes and white grape juice yielded a positive result. Grape-specific serum IgE were also detected. (Caiaffa 2003 ref.16705 7)

Caiaffa MF, Tursi A, Macchia L. Grape anaphylaxis. J Investig Allergol Clin Immunol 2003;13(3):211-212

[ 22 / 43 ]

Allergy to grape is rare. Only three cases in children and about 20 in adults have been reported. The presenting complaints are most often those of an oral allergy syndrome, although more severe manifestations, including asthma, exercise-induced anaphylaxis and anaphylactic shock, have been reported. We report a case of allergy to grape in a four-year old boy in which the clinical manifestation was limited to an oral allergy syndrome. The diagnosis was confirmed by a positive labial test to a fresh grape in addition to a positive prick test and positive specific IgE positive results. The patient was also allergic to house dust mites, grass pollen, egg, fish, coconut, kiwi, almond and latex. (Petrus 2002 ref.22376 5)

Petrus M, Malandain H. Food allergy to grape. A new observation in a four years old child. Rev Fr Allergol Immunol Clin 2002;42(8):806-809

[ 23 / 43 ]

Numerous reports of reactions to grapes or grape products have been reported in the literature, but no reports of sensitivities to grape skin extract or grape color extract were found. (Lucas 2001 ref.4719 3)

Lucas CD, Hallagan JB, Taylor SL. The role of natural color additives in food allergy. Adv Food Nutr Res 2001;43:195-216

[ 24 / 43 ]

Exercise-induced anaphylaxis. A 33-year-old woman, with allergic rhinoconjunctivitis due to Parietaria and mugwort, reported facial flushing, edema of the lips, and dyspnea after drinking white or red wine. She could eat fresh grapes. One month before, after eating white grapes and exercise, urticaria, facial, pharyngeal edema, abdominal pain, and dyspnea appeared and rapidly worsened followed by profound hypotension. Prick-to-prick tests with white and red grape juice were positive. Oral single-blind challenge with metabisulfite using increasing doses up to 75 mg was negative. An in vivo challenge was not performed. No grape-specific IgE could be demonstrated in the patient's serum by the CAP-RAST technique. But IgE reactivity of serum against grape extract was positive. The SDS-PAGE profile of grape extract showed a well-resolved band at about 67 kDa and a diffuse stain between 25 and 35 kDa. The patient's serum had IgE antibodies against one specific component of the extract (approx 30 kDa), whereas control sera also reacted to the 67-kDa band. (Senna 2001 ref.4720 7)

Senna G, Mistrello G, Roncarolo D, Crivellaro M, Bonadonna P, Schiappoli M, Passalacqua G. Exercise-induced anaphylaxis to grape. Allergy 2001;56(12):1235-1236

[ 25 / 43 ]

This study reports on 11 patients presenting with anaphylactic reactions following grape. The reported symptoms were: anaphylactic shock in 4 cases, of which 2 following grape ingestion and 2 following young wine consumption, severe asthma in 1 case, glottic oedema and angioedema in 4 cases, glottis oedema and urticaria in 2 cases, gastrointestinal symptoms and hypotension in 1 case. In 2 cases symptoms followed exercise. (Pravettoni 2001 ref.4047 0)

Pravettoni V, Conti A, Farioli L, Rivolta F, Calamari AM, et al. Identification of the major allergens of grape [Poster] 8th International Symposium on Problems of Food Allergy, Venice. 2001, March 11-13.

[ 26 / 43 ]

A 5-year-old child who suffered an oral allergy syndrome and lip angiedema after eating grapes. Prick test with commercial grape extract and a prick-by-prick test with pulp and peel of fresh white grape (Moscatel variety) and pulp and peel of blue grape were all positive. A 94 kDa antigenic band was detected. Lip open challenge was positive. (Rodriguez 2001 ref.4717 7)

Rodriguez A, Trujillo MJ, Matheu V, et al. Allergy to grape. A case report. Pediatr Allergy Immunol 2001;12:289-290

[ 27 / 43 ]

A 38-year-old developed an itchy nose and palate while eating a bowl of Raisin Bran cereal. He developed repeated bouts of sneezing, facial flushing, and periorbital angioedema. He was skin test positive to commercial grape extract. He was diagnosed allergic to latex a year earlier based on skin and serum specific IgE. (MacLean 2000 ref.20671 2)

MacLean J. Allergy to grapes.. Ann Allergy Asthma Immunol 2000 Feb;84(2):265-6.

[ 28 / 43 ]

A 39-year-old female described the onset of acute urticaria, angioedema, shortness of breath, wheezing and dry cough after eating mulberry for the first time. Previously she described reactions which occurred after eating white grapes and on another occasion, white grapes and apricots. The reactions appeared immediately after eating mulberry and within 2 hours with the other foods. Reactions were life threatening requiring emergency room visits. Skin tests were positive to, among other, maize, peanut, orange and green bean. Serum specific IgE was 0.59 for apricot and 1.15 kU/L for grape. (Karakaya 2000 ref.20670 7)

Karakaya G, Kalyoncu AF. Allergy to grapes. Ann Allergy Asthma Immunol 2000 Feb;84(2):265.

[ 29 / 43 ]

Four unusual clinical cases of rare allergy to foods in patients affected by allergic rhinitis and asthma: Grapes, lupine seeds, black mulberry and artichoke. This is the first time allergy to ingested artichoke has been described. (Romano 2000 ref.4809 5)

Romano C, Ferrara A, Falagiani P. A case of allergy to globe artichoke and other clinical cases of rare food allergy. J Investig Allergol Clin Immunol 2000;10(2):102-4

[ 30 / 43 ]

Adult onset hypersensitivity to grapes has not been previously reported. A 28-year-old woman experienced generalized urticaria, facial/oropharyngeal angioedema, and dizziness after eating a bunch of white grapes. She became dyspneic and hypotensive. Previously, she had experienced two similar episodes after eating white grapes. The grape prick skin tests were strongly positive forming a pseudopod type reaction. The total serum IgE was 1918 ng/mL. The grape-specific serum IgE was weakly positive by the modified RAST and negative in the ImmunoCap System. (Vaswani 1999 ref.20669 7)

Vaswani SK, Chang BW, Carey RN, Hamilton RG. Adult onset grape hypersensitivity causing life threatening anaphylaxis. Ann Allergy Asthma Immunol 1999 Jul;83(1):25-6.

[ 31 / 43 ]

Several anaphylactic reactions in one patient selectively sensitized to the Americana grape (Vitis labrusca). Grape allergy may be specific to a certain grape variety with tolerance to others. (Bircher 1999 ref.4124 0)

Bircher AJ, Bigliardi P, Yilmaz B. Anaphylaxis resulting from selective sensitization to Americana grapes. J Allergy Clin Immunol 1999;104(5):1111-3

[ 32 / 43 ]

The author points out contrary to the claims of Giannoccaro et al. (Giannoccaro 1998 ref.2756 2) that "the first case of a patient with OAS after eating grapes", that 2 such cases were previously presented and published. (Guinnepain 1997 ref.22387 2) The two patients first developed OAS to grapes, one subsequently experienced anaphylactic shock. The second patient, a short time after eating grapes, developed exercise-induced anaphylaxis. Prick by prick tests were positive with red grapes and specific IgE were 1.06 and 9.80 kU/1. Both were also sensitized to pollens (mugwort and birch, respectively) and to the Rosaceae family (peach and apple, respectively). (Guinnepain 1998 ref.22373 8)

Guinnepain MT, Rassemont R, Claude MF, Laurent J. Oral allergy syndrome (OAS) to grapes. Allergy 1998 Dec;53(12):1225.

[ 33 / 43 ]

Food allergy induced by grapes. (Romano 1998 ref.20854 5)

Romano C, Ferrara A. Food allergy induced by grapes. [Abstract] Allergy 1998;53(suppl):93

[ 34 / 43 ]

Patients may not tolerate any grape species, wine or raisins. (Giannoccaro 1998 ref.2756 8)

Giannoccaro F, Munno G, Riva G, Pugliese S, Paradiso MT, Ferrannini A. Oral allergy syndrome to grapes. Allergy 1998;53(4):451-2

[ 35 / 43 ]

Oral Allergy Syndrome. A 24-year-old man presented with springtime oculorhinitis. About 6 years earlier, 15 min after drinking white wine, he had suffered for the first time from flushing of the face and neck, followed by local itchy skin rash, itching and edema of the oral and peroral mucosa, and moderate dyspnea. Similar reactions arose every time he drank wine - even red wine. A similar clinical picture (flushing of the face and neck with itchy skin rash, edema of the oral and peroral mucosa, and dyspnea) arose 10 mm after he ate fresh grapes. Recently, itchy labial edema, skin rash on the face and neck, and slight respiratory difficulties 30 min after eating a confection containing sultanas was described. He also reported oropharyngeal pruritus after eating cherries. SPT with commercial food extracts were positive for cherry and plum. The prick by prick test with three fresh fruits was highly positive. Serum specific IgE was 2.88 for grape. The RAST result was positive only when the polyphenols were chemically removed from the grapes (Norgaard 1992 ref.22385 5), since they can affect diagnostic results. (Giannoccaro 1998 ref.2756 8)

Giannoccaro F, Munno G, Riva G, Pugliese S, Paradiso MT, Ferrannini A. Oral allergy syndrome to grapes. Allergy 1998;53(4):451-2

[ 36 / 43 ]

Anaphylactic reaction to Americana grapes. (Yilmaz 1998 ref.20853 5)

Yilmaz B, Courvoisier S, Bircher AJ. Anaphylactic reaction to Americana grapes. [Abstract] Allergy 1998;53(suppl):92

[ 37 / 43 ]

Anaphylaxis described in 3 patients, after the ingestion of fresh grapes. Positive skin prick test and specific IgE determination. An unidentified protein of approximately 30 kd bound IgE antibodies from all three. (Anton 1997 ref.4896 3)

Anton E, Jimenez I, Polo F, Picans, I, Sanchez I, Jerez J. Immediate hypersensitivity to grape: Study of cross-reactivity with other fruits. Allergy 1997;52(37 Suppl):119

[ 38 / 43 ]

A patient allergic to grape and peach. (Guinnepain 1997 ref.22380 4)

Guinnepain M-T, Rassemont R, Laurent J. Le raisin est aussi un trophoallergène. Rev Fr Allergol 1997;37:400.

[ 39 / 43 ]

Eleven Japanese patients with food-dependent, exercise-induced anaphylaxis were studied. Seven patients experienced anaphylactic symptoms only after eating certain foods, such as shellfish, wheat, and grape before exercise. In the remaining four patients, no specific food could be identified, but the act of eating itself predisposed to anaphylaxis. Six patients had increased serum IgE levels, and IgE antibodies against the causative food allergens were detected by the skin prick test or RAST in four cases. In contrast, patients who developed the symptoms after 30 years of age (N = 4) appeared to have a less atopic background, and IgE levels were within normal range except in one case. Three of four patients in the latter group developed symptoms after ingesting food made of wheat followed by exercise. All patients were sensitive to wheat as determined by the skin prick test. Only one individual reported symptoms for abalone, resulting in pruritis with exercise. Although various foods have been reported as allergens, including wheat, shellfish, vegetables, nuts and fish, wheat is the most frequent causative food in Japan. (Dohi 1991 ref.451 89)

Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Juji F, Okudaira H, Sano Y, Ito K, Miyamoto T. Food-dependent, exercise-induced anaphylaxis: a study on 11 Japanese cases. J Allergy Clin Immunol 1991;87:34-40

[ 40 / 43 ]

Food-dependant exercise-induced anaphylaxis. (Kidd 1983 ref.332 14) (Sheffer 1984 ref.6603 3)

Sheffer AL, Austen KF. Exercise-induced anaphylaxis . J Allergy Clin Immunol 1984;73:699-703

[ 41 / 43 ]

Food-dependant exercise-induced anaphylaxis. (Buchbinder 1983 ref.530 72) (David 1984 ref.530 82)

Buchbinder EM, Bloch KJ, Moss J, Guiney TE. Food-dependant exercise-induced anaphylaxis. J Am Med Assoc 1983;250:2973-2974

[ 42 / 43 ]

A thirty-one year old Catholic priest presented with sneezing, nasal stenosis, with a watery coryza, perennial, with seasonal exacerbations, for six years. Attacks occurred at any time. Skin tests were negative for the common inhalants and foods except for Timothy. He was placed on a very restricted diet for a period of three weeks. During this time he could continue saying Mass, and taking small quantities of wheat and grape wine. There was neither exacerbation nor amelioration of symptoms, excepting for a change in the pattern of reaction, all occurring simultaneously, being worse each morning about ten minutes after Mass. Grape wine fell under suspicion. Intradermal testing for grape and raisin resulted in very positive reactions. Two weeks later the patient was given two ounces of wine to drink. Within ten minutes he had a violent reaction, with injected conjunctivae and epiphora, sneezing and coryza, cough, wheeze, and generalized angioneurotic edema and urticaria. Two weeks later, a grain alcohol challenge was negative. Beer and whiskey caused no symptoms. The patient did no say Mass for two weeks: within fifty-six hours all symptoms cleared. On one occasion the ingestion of wine caused symptoms, arising in fifteen minutes and lasting three days. Limiting the wine to 5 drops, to which was added one drop of water, once daily, resulted in milder symptoms, but were otherwise continuously present. Repeat tests with grape seed extract were positive. Oral desensitization was unsuccessful. Passive transfer to grape, grape seed, commercial grape juice, lemon, lime, orange and grapefruit, showed the following reactions: all were moderately positive in the test sites; completely negative in the recipient's skin.

Brown EA. Sensitivity to grape and grape products, including wine; case report. Ann Allergy 1953 Sep-Oct;11(5):590-3.

[ 43 / 43 ]

See also: Vine Pollen.

Editor Comment Editorial comment, common knowledge, or still to add - -

Non-Immune reactions

[ 1 ]

Some patients complain of abdominal distention and excessive flatus after ingesting certain fruits such as mango, persimmon, and grapes but not after eating apricots and melon. Breath hydrogen, flatus passage and bloating after 20 g fructose in 8 patients with history of fruit intolerance was assessed. The patients with fruit intolerance produced breath hydrogen 1745.2+/-7.8 parts per million, passed flatus 13.8+/-0.3 times, and had bloating score of 5.7+/-0.1. The healthy controls produced breath hydrogen 712.5+/-5.8 parts per million in 8 hours, passed flatus 7.2+/-0.5 time, and had bloating score of 2.7+/-0.2. After 20 g fructose, patients with history of fruit intolerance produce more Fructose-induced breath hydrogen, pass flatus more frequently, and have a higher bloating score compared with healthy controls. (Mann 2008 ref.22339 7)

Mann NS, Cheung EC. Fructose-induced breath hydrogen in patients with fruit intolerance. J Clin Gastroenterol 2008 Feb;42(2):157-9.

Occupational reactions

[ 1 ]

A cross-sectional study of 120 grape farmers and 100 controls at the Malevisi region in Northern Crete was conducted. Grape farmers who used pesticides had higher prevalence rates of allergic rhinitis symptoms compared with grape farmers who reported no current use of pesticides, and control subjects. Logistic regression models showed that 6 of the 12 predefined groups of major pesticides were significantly related to allergic rhinitis symptoms. The highest risks were observed for paraquat and other bipyridyl herbicides, dithiocarbamate fungicides and carbamate insecticides. The most common factor was that of multiple pesticide use that included 9 pesticides and was significantly associated with allergic rhinitis. (Chatzi 2007 ref.20175 3)

Chatzi L, Alegakis A, Tzanakis N, Siafakas N, Kogevinas M, Lionis C. Association of allergic rhinitis with pesticide use among grape farmers in Crete, Greece. Occup Environ Med 2007 Jun;64(6):417-421

[ 2 ]

Grape farmers are exposed to a variety of agents capable of inducing occupational skin disease. This study measured the prevalence of skin symptoms and work-related skin symptoms among 120 grape farmers in a region of Crete. Self-reported itchy rash within the last 12 months, and work-related itchy rash were significantly higher in grape farmers than in controls. Sensitization to pollens and allergic rhinitis were found to be significantly associated with self-reported itchy rash in the grape farmers group. Further studies are needed to evaluate the impact of specific occupational agents on skin diseases among grape farmers. (Chatzi 2006 ref.22379 0)

Chatzi L, Alegakis A, Krüger-Krasagakis S, Lionis C. Skin symptoms and work-related skin symptoms among grape farmers in Crete, Greece. Am J Ind Med 2006 Feb;49(2):77-84.

[ 3 ]

The study mainly demonstrated the high prevalence (45.8%) of allergic rhinitis and work-related respiratory symptoms in grape farmers compared to control subjects. It also suggested that grape farming is possibly associated with increased allergic sensitization to specific pollens, low baseline FEV1, and increased bronchial hyper-responsiveness. (Chatzi 2005 ref.22375 5)

Chatzi L, Prokopakis E, Tzanakis N, Alegakis A, Bizakis I, Siafakas N, Lionis C. Allergic rhinitis, asthma, and atopy among grape farmers in a rural population in Crete, Greece. Chest 2005 Jan;127(1):372-8.

[ 4 ]

In 120 subjects enrolled in each of four groups: grape harvesters, winery workers in selection of grapes, winery workers operating de-stemming/crushing/pressing machines, and administrative personnel, sensitisation to grapes was examined by skin prick-to-prick tests with fresh fruit and juice. Eight harvesters and five workers in grape selection had positive reaction to the grapes tested. No machine operators or administrative personnel had positive tests. Asymptomatic sensitisation to grapes was detected only in workers handling the fruit, suggesting that sensitisation is more likely to occur through cutaneous exposure and/or minor wounding than through the gastrointestinal tract. Prevalence rates were high and the clinical impact needs to be further investigated. (Kalogeromitros 2004 ref.9805 3)

Kalogeromitros D, Rigopoulos D, Gregoriou S, Mousatou V, Lyris N, Papaioannou D, Katsarou-Katsari A. Asymptomatic sensitisation to grapes in a sample of workers in the wine industry. Occup Environ Med 2004;61(8):709-11

[ 5 ]

To estimate the prevalence of dermatitis and risk factors for skin disease in California farm workers, a cross-sectional survey was conducted among grape, citrus, and tomato workers. The prevalence of contact dermatitis was 2% and lichenified hand dermatitis was 13%. Grape workers were more likely to report rashes in the last 12 months than were tomato workers or citrus workers. Grape workers were more likely to have contact dermatitis and lichenified hand dermatitis than were citrus or tomato workers. (Gamsky 1992 ref.22386 6)

Gamsky TE, McCurdy SA, Wiggins P, Samuels SJ, Berman B, Shenker MB. Epidemiology of dermatitis among California farm workers. J Occup Med 1992 Mar;34(3):304-10.

[ 6 ]

Occupational contact dermatitis from grape bud. (Yamasaki 1985 ref.2044 6)

Yamasaki R, Dekio S, Jidoi J. Contact dermatitis from grape bud. Contact Dermatitis 1985;12(4):226-7

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