Case 1
A female with a history of environmental allergies, eczema, and obesity was 11 years old at the time of her reaction. She sought care after an episode of lip swelling, nasal congestion and throat discomfort immediately after ingesting a Capri Sun® Pacific Cooler (pear, grape, and orange juice concentrates, pineapple and apple juice). Symptoms were treated at home with 50 mg of Benadryl, improved immediately, and resolved completely within a week. Her exam was notable only for a blood pressure of 138/62 and mild erythema of her oropharynx and nares. She began a 5-day course of prednisone, was prescribed an epinephrine pen, and was referred for further testing.  Two weeks later she received skin testing for apple, pineapple, grape, orange, pear, fresh orange, and Capri Sun®, all of which tested negative. She had large positive skin prick reactions to cat, mixed grass and one mold (Alternaria alternata ), and tested positive to penicillin.  An entire panel of environmental allergens, including dog, dust mite, trees, and weeds, tested negative, and she passed an oral pineapple challenge. It was concluded that the patient had likely reacted to a mold contaminant in the Capri Sun.