ABSTRACT
Case report Background: We present a case of coconut allergy as a rare evolving food allergy among immigrants. Case presentation: A 3-year-old girl, on treatment for asthma, was referred to the allergy clinic due to possible reactions to salmon and coconut. Due to COVID restrictions, the initial consultation was conducted by telephone. Reportedly, she developed hives and wheeze after eating salmon and coconut products. During the face-to-face review, it was noted that the child's paternal side of the family was of ethnic minorities. The patient had cradle cap as a baby, and coconut oil was applied for treatment as advised by family back home. During a hospital-based coconut challenge, she developed puffy eyes, and on subsequent consumption of coconut macaroon, she developed hives. The child was diagnosed with coconut allergy. Face-to-face assessment and food cultural awareness are essential for clinical diagnosis. Discussion(s): Allergy is a multifactorial illness affected by epigenetic, environmental factors, eczema during infancy and food culture. Studies suggest that the risk of allergy can be highest in immigrants to culturally stable food, particularly with delayed early taste during weaning. The dual allergen hypothesis proposes that early cutaneous exposure to food protein through damaged skin barrier can lead to sensitisation and allergy and that early oral exposure to food induces tolerance. Conclusion(s): Further research on understanding the interaction between epigenetics of the allergic disease and the environment is needed as is an understanding of how the movement of populations and different culture habits can affect the incidence of food allergy. In the meantime, is promoting healthy skin barrier and early food introduction enough to prevent food allergies.