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Food allergy is estimated to affect around 5% to 10% of infants and young children in developed countries [1]. Allergic reactions to garlic are not common. In children they are exceptional. Garlic (Allium sativum) belongs to the Amaryllidaceae family and the onion (Allium) genus. It is closely related to shallot, leek, asparagus, and chive. It is widely used in cooking as a natural flavoring and as a natural medicine with many useful properties. Garlic is a respiratory sensitizer that can cause occupational allergy [2,3], a potent contact allergen [2], and a food allergen [4-6]. The only clinically relevant allergen identified to date is alliinase [4], although other proteins have been suggested as possible allergens [6]. We present a case of IgE-mediated allergy to garlic in an infant with results suggesting lectin as the relevant allergen. A 9-month-old infant experienced itchy erythema affecting the ear, trunk, and groin, along with cough (normal pulmonary auscultation) within minutes after the accidental intake of a homemade garlic sauce. She was still breastfeeding and had never eaten this food before (her mother had) or any other food belonging to the Amaryllidaceae family, with the exception of zucchini, which she tolerated well. The patient and her parents did not have atopic dermatitis or any additional atopic background. A raw garlic extract (GE) was prepared by homogenization in phosphate-buffered saline (16% wt/vol), dialyzation, and lyophilization (Roxall). The protein content of the extract (wt/wt) was 3% according to Bradford [7]. Skin prick tests to commercial common aeroallergens—pollens, dust mites, molds, dander, and peach and pollen profilin (Pho d 2) (ALK Allergologisk Laboratorium A/S)—were negative (wheal, <3 mm). The wheal produced by prick-by-prick testing with garlic was 10 mm. Prick-by-prick with onion, chive, leek, zucchini, and asparagus were all negative. Specific IgE (sIgE) (Thermo Fisher) to garlic was 3.15 kU/L (from a total IgE of 32 kU/L), and sIgE against both onion and asparagus was <0.1 kU/L. The garlic extract was analyzed using SDS-PAGE, which revealed protein bands ranging from 55 kDa to 4 kDa. SDS-PAGE IgE immunoblotting assays with the patients’ serum were performed under reducing and nonreducing conditions (with and without 2-mercaptoethanol, respectively) and revealed IgE-reactivity with an apparent molecular weight of approximately 8.5 kDa and 9 kDa under nonreducing conditions, and a faint band of approximately 9 kDa under reducing conditions (Figure). Both protein bands detected without 2-mercaptoethanol were manually excised from the gel, digested with trypsin, and analyzed by matrixassisted laser desorption/ionization time of flight and liquid chromatography coupled to tandem mass spectrometry (MC/

Allergy to a Garlic Lectin in an Infant After the First Intake: Difficulties Identifying the Route of Sensitization