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Should we modify the allergic rhinitis and its impact on asthma dichotomic classification of severity?

apparent molecular weight from 16 to 34 kDa for coconut extract were obtained (Fig. 1, Section B). Cross-reactivity between lentil and coconut was investigated. An immunoblotting inhibition assay showed a total inhibition of the IgE binding bands when coconut extract and patient serum preincubated with coconut extract (data not shown) and lentil extract (Fig. 1, Section C), at 100 lg/ml concentration, were used. Partial inhibition was obtained when inhibition assays were performed with lentil extract and serum preincubated with coconut (Fig. 1, Section C). Specific IgE-binding bands were extracted from the gel, digested with trypsin, and the proteins were identified by mass spectrometry (MS), as previously described (3). The aminoacid sequences obtained were identified using Mascot Program software (http://www.matrixscience.com). Some IgE-binding bands contained in coconut extract were identified as two seedstorage proteins, a 7S globulin (‘b’ in Fig. 1) and an 11S globulin (‘a’ and ‘c’ in Fig. 1), expressed as 2 subunits under reducing conditions. Both proteins were involved in cross-reactivity between coconut and lentil (1, 4). In summary, we report a case of a child with lentil and coconut allergy in which IgE mechanism has been demonstrated. Our patient tolerated all other legumes and, in contrast to other reports (4, 5), has not presented clinical crossreactivity with nuts. This is the first time that cross-reactivity between coconut and lentil has been described. Results of the immunological studies provided evidence that both allergens, 7S and 11S globulin, were involved in this crossreactivity. In addition, this case report support the claim that coconut allergy is as a new cause of hidden food allergy that should be kept in mind when evaluating patients with idiopathic anaphylaxis. Further studies including more coconut allergic patients are necessary to elucidate the possible cross-reactivity between coconut and other legumes. Editorial assistance was kindly provided by Oliver Shaw. Identification of proteins by MS was performed by the Proteomics Service of the Universidad Complutense de Madrid (UCM), a member of the ProteoRed Network.