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f36 Coconut

Code f36
LOINC LP16955-4
Family Arecaceae
Genus Cocos
Species Nucifera
Route of Exposure Ingestion and Topical
Source Material Fresh coconut meat
Latin Name Cocos nucifera
Other Names Common Coconut
Categories Food Of Plant Origin, Seeds & Nuts

Summary

Coconut (Cocos nucifera) belongs to the genus Cocos and Arecaceae family. It is a synoicous plant that can grow around 72 ft and is found commonly along the tropical, subtropical, and coastal areas worldwide. Coconut plant comes from the tropical regions of Latin America, Africa, and the Asia-Pacific region. Coconut is used worldwide for various purposes like for cooking, as a medicine, for dermatology products, and for making handicrafts. Coconut contains multiple allergens such as Coc n 1 (7S globulin), Coc n 2 and Coc n 4 (11S globulin) protein. Coconut allergy is a rare phenomenon, but it can lead to conditions such as bronchial asthma, contact dermatitis, allergic conjunctivitis, and anaphylaxis. Immunotherapy is effective in reducing symptoms of coconut allergy. Cross-reactivity is observed between coconut and macadamia, almond, walnuts, hazelnuts and lentils, latex, and this is mainly due to allergens such as 7S and 11S globulins.

Allergen

Nature

Coconut (Cocos nucifera) is easily identified by its crown of feather-like fronds and clusters of large fruits carried on the top of long slender stems. It grows up to 65-72 ft in 40 years. (1). The fruit of the coconut palm tree is identified as a drupe and not as nuts. The outer layer is made up of green-yellow leathery exocarp color. Underneath is a fibrous mesocarp, and the seed is covered by a woody endocarp (2). The coconut is a synoicous plant with both male and female flowers on the same plant (1).  The typical amount of coconut pollen produced in a single flower ranges from 0.11 million to 0.22 million grains per anther (3). It is mainly used for staple food, woodwork, handicrafts etc. (1). Various components of coconut, such as oil and milk, are utilized for cooking and frying. They are also used in creating soaps, cosmetics and other dermatology products (4).

Habitat

Coconut palm can be seen along the tropical and subtropical regions and primarily observed along the coasts around the world. Its inherent habitat is coastal areas and sandy soil but can adapt to various types of soil. It is a non-invasive plant. Thus, humans’ use can be considered a significant factor for its spread inland from its natural habitat. It survives under humid and warm conditions and can also endure short-term exposure to low temperatures (1).

Taxonomy

Taxonomic tree of Coconut  (5)  
Domain Eukaryota
Kingdom Plantae
Phylum Spermatophyta
Subphylum Angiospermae
Class Monocotyledonae 
Order Arecales
Family Arecaceae
Genus Cocos
Species Cocos nucifera

 

Tissue

A typical coconut pollen grain has a single furrow (monocolpate). It ranges from 65 to 69µm in length and 28 to 30 µm in diameter (3).  

Epidemiology

Worldwide distribution

Only some case reports of a severe allergy to coconut have been reported to date in the literature. In an Australian survey, including 5000 patients suspected of food allergy, nine had suffered anaphylaxis reaction, and 26 had milder IgE-mediated allergy from coconut ingestion(6).

A study was conducted in the United States to know the prevalence of coconut allergy in children suspected of tree nut and peanut allergy. A total of 37 children were tested for coconut skin prick test (SPT). The results showed that out of 37 children, 21.6% were sensitized to coconut, and 24% were diagnosed with coconut allergy. Coconut allergy increment in tree-nut or peanut-allergic children was not observed in the study.(7).

In another study, 5843 children’s food IgE data was used to derive patients questioned for coconut IgE in the US. Among these, 298 patients underwent coconut IgE testing, where 30.2% were observed to have positive coconut sIgE testing results. Significant correlation between coconut, and two tree nuts that are macadamia and almond, was observed. While in all other nuts, the relation was observed to be not statistically significant. Anaphylaxis reactions and oral allergy syndrome were also observed in patients allergic to coconut with a walnut allergy history (8).   

A study was conducted in Southern India on individuals (n=2219) diagnosed with asthma and allergic rhinitis. Among these, 9.4% (209/2219) showed positive skin prick test results to coconut (9). 

Environmental Characteristics

Worldwide distribution

Coconut may have originated from Southeast Asia’s, Indo-Malayan parts. Coconut plant is widely distributed in the tropical regions of Latin America, Africa and the Asia-Pacific region (10). It is found in the coastal areas of South-east Asian countries such as Malaysia, Indonesia, and the Philippines, Melanesia, Polynesia, and Micronesia. It is also found in India, Sri Lanka and East Africa, and tropical islands like Seychelles, Andaman and Mauritius (1).

Coconut is used for different purposes like cooking, medicine, dermatology, and making ropes and mats for many centuries. It is grown in other parts of the world since the 19th century. It is currently recognized as one of the world’s most significant palm species (2).

Route of Exposure

Main

The main route of exposure for coconut pollen is through ingestion (6).

Secondary

Allergic patients may suffer from skin reactions due to coconut exposure through cutaneous pathways, like applying oil to the skin(4).

Coconut Pollen can be inhaled by an individual and lead to an allergic reaction (11).  

Detection

Coconut allergy is an infrequent clinical entity. In the small number of cases that have been reported, most of them are associated with anaphylaxis. Other symptoms observed are urticaria, dermatitis, asthma and rhinorrhea.

Studies have shown that exposure to coconut and its allergens may facilitate the risk of coconut sensitization from a young age even after tolerance to coconut in initial years. This exposure may also lead to an increment in allergic reactions with aging in allergic patients(4, 12).

Anaphylaxis

In Spain’s published literature, around nine allergy cases to coconut with anaphylactic reaction have been reported. Among these, four of them occurred in children. The patients may suffer from allergic reactions such as rhinorrhea, sneezing outbursts, spasmodic coughing, vomiting and breathing difficulty (12).

A boy (age three years) suffered from, oral allergy syndrome, vomiting, sudden abdominal pain and eyelids’ edema after ingesting a small portion of fresh coconut. No other food allergies were present. A skin prick test with coconut showed a strong positive response. Testing with sIgE to coconut was also positive (13). 

Contact Urticaria

A literature published case report on mono-sensitization to coconut in a 64-years-old female patient suffering from hypertension and thyroiditis. The patient developed generalized urticaria, facial and uvula edema, dysphagia and dyspnea. Another episode followed where hypoxemia (low oxygen levels), hypotension (low blood pressure), and bronchoconstriction reactions were observed (14).

Atopic Dermatitis

Coconut fatty acids diethanolamine is a by-product of coconut oil. In a study conducted on a total of 2572 subjects with occupational allergic contact dermatitis, around 1 percent had allergic dermatitis due to coconut products (15).

Allergic conjunctivitis

A case of occupational allergic conjunctivitis due to coconut fiber dust was reported. A 46-year-old male had been working for about ten years in the factory of coconut fibre mattress. He developed conjunctivitis in the last few years, usually appearing 20 to 30 minutes after tufting of coconut fibre mattress. On the application of the coconut fibre test, he developed symptoms of allergic conjunctivitis. The signs were seen up to 24 hours after the test. An increase in eosinophil count was also found in tear fluid from the patient (16).

Asthma

In a study done in India in 975 individuals, about 2% of patients with coconut sensitivity had asthma and allergic rhinitis. A positive result was found in seven out of a total of eight patients in a test of bronchial provocation (17).

Prevention and Therapy

Allergen immunotherapy

In a placebo-controlled study conducted in 96 coconut allergic patients for a 6 to 12 months period, the results showed a statistically significant (p< 0.005) reduction in symptoms and drug use in the immunotherapy group as compared to placebo (18).

Prevention strategies

Avoidance

Allergic reactions to coconut can be prevented by avoiding the allergenic food made by coconut and products created in the near vicinity of coconut products (2).

Molecular Aspects

Allergenic molecules

Coconut contains allergens such as Coc n 1(7S globulin) Coc n 2 and Coc n 4 (11S globulin) protein. The Coc n 1, 7S globulin is a vicilin-like protein (2, 4). Coc n 4, cocosin globulin is an allergen with a hexamer structure and a molecular weight of about 300 kDa. This unit has 54 kDa subunit with disulfide bond connecting acid and essential chains (10). Coconut allergens are identified with a different molecular weight, such as 35 kDa, 36.5 kDa and 55 kDa (19).

In a study report of a male patient (age 28 years), an anaphylactic reaction occurred due to coconut ice-cream intake. In this patient, protein bands for the molecular weights of 15, 20, 35, 45 and 200 kDa were shown. Also, IgE immunoblot showed strong reactivity to a protein of 78 kDa and weak for bands 15–20, 22 and 30 kDa (20).

 Among these identified allergens, only Coc n 1 has been listed in the WHO/IUIS list (21).

Allergen

Biochemical Name

Molecular Weight

Allergenicity

Coc n 1

vicilin-like protein

53 kDa

Vicilin-like protein was identified as a major coconut allergen using cluster analysis on patient sera, which was tested for allergenicity(11)

 

Biomarkers of severity

Coc n 1, a vicilin-like protein, has been recognized as a major allergen (11). 

Cross-reactivity

Cross-reactivity has been found between coconut and tree nuts such as walnuts, hazelnuts and lentils, and this is mainly due to allergens such as 7S and 11S globulins (12). The coconut’s decreased protein at 35 kDa of coconut 11S globulin is thought to be soy glycinin, a legumin type of seed storage protein (19). In a study of two subjects with an allergy to coconut, the clinical reactivity was found due to cross-reactivity of IgE antibodies for Walnut (19). 7S globulin, which has been described as a major allergen in walnut (Jug n 2, Jug r 2) and hazelnut (Cor a 11), is also identified in coconut (10).

Though in general correlation between patients sensitized or allergic to tree-nut or peanuts with sensitization to coconut has not been observed(7, 8). One study in the children population reported high significant coconut co-sensitization rates with 71% for macadamia and 69% for almond. In another case report, two patients, who had a history of anaphylactic reaction to walnut, developed an anaphylactic reaction to coconut, signifying co-sensitization (8).

There also exists cross-reactivity between latex and coconut. In a study done in patients with type I latex allergy, about 21.1% of them had a food allergy. Out of these, about 2% had coconut allergy (22).

A study has discovered strong cross-reactivity between buckwheat and coconut. This cross-reaction may be due to Coc n 2 of molecular weight 29 kDa in coconut and Fag e 3 of 19 kDa in buckwheat, known as vicilin-like allergens (23). 

Compiled By

Author: Turacoz Healthcare Solutions

Reviewer: Dr. Fabio Iachetti

 

Last reviewed: November  2020

References
  1. Chan E, Elevitch CR. Cocos nucifera (coconut). 2006.
  2. Wrage J, Kleyner O, Rohn S, Kuballa J. Development of a DNA-Based Detection Method for Cocos Nucifera Using TaqMan™ Real-Time PCR. Foods [Internet]. 2020 2020/03//; 9(3). Available from: https://doi.org/10.3390/foods9030332
  3. Manthriratna M. Coconut pollen. 1965.
  4. Anagnostou K. Coconut Allergy Revisited. Children (Basel). 2017;4(10):85.
  5. CABI. Invasive Species Compendium 2020 [17-11-2020]. Available from: https://www.cabi.org/isc/datasheet/11788.
  6. Pathmanandavel K, Kaur N, Joshi P, Ford LS. Anaphylaxis and allergy to coconut: An Australian pediatric case series. The Journal of Allergy and Clinical Immunology: In Practice. 2020.
  7. Rangsithienchai P, Sheehan W, Stutius L, Schneider L, Phipatanakul W. Prevalence of coconut allergy in children with tree nut and peanut allergies. Journal of Allergy and Clinical Immunology. 2009;123(2):S26.
  8. Polk BI, Dinakarpandian D, Nanda M, Barnes C, Dinakar C. Association of tree nut and coconut sensitizations. Annals of Allergy, Asthma & Immunology. 2016;117(4):412-6.
  9. Chogtu B, Magaji N, Magazine R, Acharya PR. Pattern of allergen sensitivity among patients with bronchial asthma and/or allergic rhinosinusitis in a tertiary care centre of Southern India. Journal of clinical and diagnostic research: JCDR. 2017;11(8):OC01.
  10. Benito C, González-Mancebo E, de Durana MDAD, Tolón RM, Fernández-Rivas M. Identification of a 7S globulin as a novel coconut allergen. Annals of Allergy, Asthma & Immunology. 2007;98(6):580-4.
  11. Saha B, Sircar G, Pandey N, Gupta Bhattacharya S. Mining novel allergens from coconut pollen employing manual de novo sequencing and homology-driven proteomics. Journal of proteome research. 2015;14(11):4823-33.
  12. Michavila GA, Amat BM, Gonzalez CM, Segura NL, Moreno PM, Bartolomé B. Coconut anaphylaxis: Case report and review. Allergologia et immunopathologia. 2015;43(2):219.
  13. Tella R, Gaig P, Lombardero M, Paniagua M, García‐Ortega P, Richart C. A case of coconut allergy. Allergy. 2003;58(8):825-6.
  14. Martin E, Tornero P, De Barrio M, Pérez CI, Beitia JM, Baeza ML. Monosensitization to coconut. Journal of Allergy and Clinical Immunology. 2004;113(2):S315.
  15. Aalto-Korte K, Pesonen M, Kuuliala O, Suuronen K. Occupational allergic contact dermatitis caused by coconut fatty acids diethanolamide. Contact Dermatitis. 2014;70(3):169-74.
  16. Wittczak T, Pas-Wyroslak A, Palczynski C. Occupational allergic conjunctivitis due to coconut fibre dust. Allergy. 2005;60(7):970-1.
  17. Karmakar PR, Chatterjee BP. Cocos nucifera pollen inducing allergy: sensitivity test and immunological study. Indian J Exp Biol. 1995;33(7):489-96.
  18. Karmakar PR, Das A, Chatterjee BP. Placebo-controlled immunotherapy with Cocos nucifera pollen extract. Int Arch Allergy Immunol. 1994;103(2):194-201.
  19. Teuber SS, Peterson WR. Systemic allergic reaction to coconut (Cocos nucifera) in 2 subjects with hypersensitivity to tree nut and demonstration of cross-reactivity to legumin-like seed storage proteins: new coconut and walnut food allergens. J Allergy Clin Immunol. 1999;103(6):1180-5.
  20. Rosado A, Fernández-Rivas M, González-Mancebo E, León F, Campos C, Tejedor MA. Anaphylaxis to coconut. Allergy. 2002;57(2):182-3.
  21. Allergen-Nomenclature. Coc n 1 2016 [17-11-2020]. Available from: http://www.allergen.org/viewallergen.php?aid=866.
  22. Kim KT, Hussain H. Prevalence of food allergy in 137 latex-allergic patients. Allergy Asthma Proc. 1999;20(2):95-7.
  23. Cifuentes L, Mistrello G, Amato S, Kolbinger A, Ziai M, Ollert M, et al. Identification of cross-reactivity between buckwheat and coconut. Annals of Allergy, Asthma & Immunology. 2015;115(6):530-2.