Management of Mango Allergy
The management of mango allergy requires complete avoidance of mango in all forms to prevent potentially life-threatening allergic reactions. 1
Diagnosis of Mango Allergy
Mango allergy can present in two distinct ways:
IgE-mediated (immediate) hypersensitivity reactions:
- Symptoms occur within minutes to hours after ingestion
- Can include urticaria, angioedema, respiratory symptoms, gastrointestinal distress, and anaphylaxis
- Diagnosis based on:
- Medical history of reactions after mango consumption
- Skin prick tests with mango extract
- Specific IgE testing
Non-IgE-mediated (delayed) hypersensitivity reactions:
- Typically presents as allergic contact dermatitis
- Mango can cause perioral dermatitis 1
- Diagnosis based on:
- Medical history
- Patch testing
- Resolution of symptoms with allergen elimination
Cross-Reactivity Concerns
Mango allergy often involves cross-reactivity with:
- Birch pollen (due to profilin similarity) 2
- Mugwort pollen (due to defensin Art v 1) 3, 2
- Other fruits and vegetables in the Anacardiaceae family (cashew, pistachio)
- Other foods including apple, peach, celery, carrot, and pear 3, 2
Management Recommendations
1. Complete Allergen Avoidance
- Strict avoidance of mango in all forms is the primary management strategy 1
- Avoid all products containing mango or mango derivatives
- Be cautious with foods that may have cross-contamination
- Read food labels carefully to identify mango ingredients
- Exercise caution with products that have precautionary labeling about potential cross-contamination 1
2. Emergency Preparedness
- Patients with history of mango-induced anaphylaxis should:
3. Medication Management
For acute allergic reactions to mango:
- First-line treatment for anaphylaxis: Epinephrine via intramuscular injection 1
- For milder reactions: H1 antihistamines may help manage symptoms like urticaria or mild angioedema 1
- After emergency treatment:
- H1 antihistamine (e.g., diphenhydramine every 6 hours for 2-3 days)
- H2 antihistamine (e.g., ranitidine twice daily for 2-3 days)
- Corticosteroids (e.g., prednisone daily for 2-3 days) 1
4. Education and Prevention
- Educate patients about:
- Identifying mango in all its forms in food products
- Cross-reactive foods to avoid based on individual sensitivity
- Restaurant precautions (informing staff about allergy)
- Reading ingredient labels carefully
- Recognizing early symptoms of allergic reactions
5. Follow-up Care
- Regular follow-up with an allergist/immunologist
- Nutritional counseling if needed to ensure adequate nutrition while avoiding mango
- Periodic reassessment of emergency action plan
Special Considerations
- For contact dermatitis reactions: Topical corticosteroids may help manage symptoms
- For patients with multiple food allergies: Consider broader testing for cross-reactive allergens
- For patients with history of anaphylaxis: More stringent avoidance measures are necessary
Common Pitfalls in Managing Mango Allergy
- Underestimating cross-reactivity: Patients may react to related fruits or pollens
- Relying on antihistamines alone: Epinephrine is the first-line treatment for anaphylaxis, not antihistamines 1
- Inconsistent avoidance: Even small amounts can trigger severe reactions in highly sensitive individuals
- Inadequate emergency preparation: Failure to carry epinephrine or have an action plan
- Misinterpreting sensitization: A positive test doesn't always correlate with clinical reactivity
Mango allergy can range from mild oral allergy syndrome to life-threatening anaphylaxis 4, 5. The cornerstone of management remains strict avoidance of the allergen, combined with emergency preparedness for accidental exposures.