Research Letter
Coconut anaphylaxis: Case report and review
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Michavila Gomez, M. Amat Bou, M.V. Gonzalez Cortés, L. Segura Navas, M.A. Moreno Palanques, B. Bartolomé" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Michavila Gomez" "email" => array:1 [ 0 => "amichavila@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Amat Bou" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.V." "apellidos" => "Gonzalez Cortés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Segura Navas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "M.A." "apellidos" => "Moreno Palanques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "B." "apellidos" => "Bartolomé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Pediatric Allergy Unit, Castellón General Hospital, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pediatric Service, Castellón General Hospital, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Research and Development Department, Bial-Aristegui, Bilbao, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1600 "Ancho" => 1018 "Tamanyo" => 67163 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">SDS-PAGE IgE immunoblotting result. (A) Fresh coconut extract. (B) Coconut milk extract. Lane P: patient serum. Lane C: control serum (pool of sera from non-atomic subject). Lane M: molecular mass marker.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The coconut (<span class="elsevierStyleItalic">Cocos nucifera</span>) is a monocotyledon plant belonging to the Aracaceae family. Although potentially severe, there are few allergic processes described that arise from ingestion of its fruit, although the majority of cases described to date have been anaphylactic reactions.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–7,10</span></a> The endosperm is the edible part of the fruit, and it is composed of 25% albumins and 75% globulins, the latter of which contains the proteins which have been implicated in allergic reactions, such as Coc n2, 7S globulin, and Coc n4, 11S globulin (known as cocosin). Under native conditions, molecular masses of the 7S and 11S globulins are 156<span class="elsevierStyleHsp" style=""></span>kDa and 326<span class="elsevierStyleHsp" style=""></span>kDa respectively, and the 7S globulin is composed of three protein subunits of 24<span class="elsevierStyleHsp" style=""></span>kDa, 22<span class="elsevierStyleHsp" style=""></span>kDa, and 16<span class="elsevierStyleHsp" style=""></span>kDa while the 11S globulin is composed of 55<span class="elsevierStyleHsp" style=""></span>kDa, 34<span class="elsevierStyleHsp" style=""></span>kDa, and 24<span class="elsevierStyleHsp" style=""></span>kDa subunits.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cross reactivity between coconuts, walnuts, hazelnuts and lentils has been described, and this is due to 7S and/or 11S globulins.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,6,7</span></a> Similarly, cases of monosensitization to coconut have been described.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Here we describe the case of a 12 and a half-year-old child with asthma and rhinitis caused by allergies which are being controlled with immunotherapy. The child is sensitized to <span class="elsevierStyleItalic">Dermatophagoides farinae</span> and <span class="elsevierStyleItalic">Dermatophagoides pteronyssinus</span>, <span class="elsevierStyleItalic">Alternaria</span> and dog and cat epitheliums, and has presented anaphylaxis from ingestion of crustaceans. At 12 years old, 10<span class="elsevierStyleHsp" style=""></span>min after ingesting a piece of coconut for the first time, the child presented an allergic reaction which lasted for an hour and consisted of spasmodic coughing, sneezing outbursts, rhinorrhea, vomiting, and difficulty in breathing with thoracic oppression and wheezing.</p><p id="par0020" class="elsevierStylePara elsevierViewall">To investigate this coconut allergy, skin prick tests were performed with commercial extracts and the following mean wheal diameters were found: coconut, 14<span class="elsevierStyleHsp" style=""></span>mm, walnut and hazelnut, 5<span class="elsevierStyleHsp" style=""></span>mm, sesame, 6<span class="elsevierStyleHsp" style=""></span>mm and date, 3<span class="elsevierStyleHsp" style=""></span>mm with erythema. The histamine dihydrochloride (10<span class="elsevierStyleHsp" style=""></span>mg/ml) value detected was 7<span class="elsevierStyleHsp" style=""></span>mm.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Protein extracts, fresh coconut and coconut milk were prepared by homogenization in phosphate-buffered saline, dialization, and lyophilization. Serum specific immunoglobulin (Ig) E levels were measured using the enzyme allergosorbent technique (Specific IgE EIA kit HYTEC HYCOR Biomedical Ltd). Determination of serum specific IgE revealed the following values: fresh coconut, 0.6<span class="elsevierStyleHsp" style=""></span>kU<span class="elsevierStyleInf">A</span>/L, and coconut milk, 1<span class="elsevierStyleHsp" style=""></span>kU<span class="elsevierStyleInf">A</span>/L. Values detected against extracts from sesame, walnut and peanut were between 0.35 and 0<span class="elsevierStyleHsp" style=""></span>kU<span class="elsevierStyleInf">A</span>/L. Specific IgE against date extract was <0.35<span class="elsevierStyleHsp" style=""></span>kU<span class="elsevierStyleInf">A</span>/L.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) IgE immunoblotting revealed intense IgE binding bands at 27<span class="elsevierStyleHsp" style=""></span>kDa, 16<span class="elsevierStyleHsp" style=""></span>kDa, and a broad one between 20 and 25<span class="elsevierStyleHsp" style=""></span>kDa in both coconut extracts; some other faint bands were only detected in the fresh coconut extract at 80<span class="elsevierStyleHsp" style=""></span>kDa, 66<span class="elsevierStyleHsp" style=""></span>kDa, 39<span class="elsevierStyleHsp" style=""></span>kDa and 32/33<span class="elsevierStyleHsp" style=""></span>kDa (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, an open oral provocation test<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> against walnut, hazelnut, sesame and date (foods whose tolerance were not known and to which sensitization was demonstrated in skin tests) was performed, and the result was negative. A provocation test against coconut was not performed as there was the danger of an anaphylactic reaction and the family denied authorization to perform the test.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Nine cases of coconut allergy have been reported, all of which produce anaphylactic reactions,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–7,10</span></a> and four of which were in children.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,6,7</span></a> In four of the cases, the 11S globulin was identified as the principal agent responsible for the allergic process,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4</span></a> in two of the cases it was the 7S globulin,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and in one of the cases both proteins were implicated in the allergic reaction.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The molecular masses of the most intense bands detected in this study coincide with the molecular masses described for the 7S globulin protein subunits, and this suggests that this protein is involved in the allergic process of this patient. A less intense band of approximately 80<span class="elsevierStyleHsp" style=""></span>kDa was also detected, and one with a similar molecular mass has been described in some cases of monosensitization to coconut.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In this case it was verified that the patient could tolerate ingestion of tree nuts (walnuts and hazelnuts), sesame seeds and dates, all of which had produced sensitization, and thus this is the second case described where there is an allergic reaction (anaphylactic) caused exclusively by ingestion of coconut in a child. The first case was of a 3-year-old child.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The provocation results obtained, as well as low IgE specific values detected against walnut, sesame and date extracts lead us to believe that sensitization to these foods is due to cross reactive phenomena with coconut proteins, as has been shown in other cases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,6,7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the last few years, the presence of molecules derived from coconuts has increased significantly in the food industry due to the use of coconut oil. Similarly, oil from oil palm, <span class="elsevierStyleItalic">Elaeis guineensis</span>, is also used in industry and the 7S globulin from the oil palm fruit is homologous to the 7S globulin from coconuts.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Oils from both are also widely used in the cosmetic industry, where these oils can be found in 44–76% of skin products (protective creams, soaps, body lotions, shampoos, etc.).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">It has been suggested that sensitization to proteins from certain foods such as coconuts could be due to topical exposure through the skin. Whether it is through this route or the oral route by ingestion of foods containing products derived from coconuts, it is very probable that exposure to coconut proteins is now occurring from very early ages and thus the risk of sensitization to this fruit could facilitate an increase in allergic reactions to coconuts in the coming years.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In summary, we present a case of anaphylaxis in a child due to ingestion of coconut, and it is very probable that 7S globulin is the principal protein implicated in this allergic process.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this article.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Data confidentiality</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no patient details appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Privacy rights and informed consent</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that no patient details appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">We declare that we do not have any financial or personal relationship with regard to the submitted publication.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Privacy rights and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1600 "Ancho" => 1018 "Tamanyo" => 67163 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">SDS-PAGE IgE immunoblotting result. (A) Fresh coconut extract. (B) Coconut milk extract. Lane P: patient serum. Lane C: control serum (pool of sera from non-atomic subject). Lane M: molecular mass marker.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic allergic reaction to coconut (<span class="elsevierStyleItalic">Cocos nucifera</span>) 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" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.S. Teuber" 1 => "W. Rich Peterson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "1999" "volumen" => "103" "paginaInicial" => "1180" "paginaFinal" => "1185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10359903" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anaphylaxis to coconut" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Rosado" 1 => "M. Fernandez Rivas" 2 => "E. Gonzalez Mancebo" 3 => "F. León" 4 => "C. Campos" 5 => "M.A. Tejedor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "2002" "volumen" => "57" "paginaInicial" => "182" "paginaFinal" => "183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11929430" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of coconut allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Tella" 1 => "P. Gaig" 2 => "M. Lombardero" 3 => "M.J. Paniagua" 4 => "P. Garcia-Ortega" 5 => "C. Richart" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "2003" "volumen" => "58" "paginaInicial" => "825" "paginaFinal" => "826" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12859570" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cross-reactivity between coconut and hazelnut proteins in a patient with coconut anaphylaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.A. Nguyen" 1 => "D.R. More" 2 => "B.A. Wishman" 3 => "L.L. Hagan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1081-1206(10)61562-1" "Revista" => array:6 [ "tituloSerie" => "Ann Allergy Asthma Immunol" "fecha" => "2004" "volumen" => "92" "paginaInicial" => "281" "paginaFinal" => "284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14989401" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monosensitization to coconut" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Martin" 1 => "P. Tornero" 2 => "M. De Barrio" 3 => "C.I. Perez" 4 => "J.M. Beitia" 5 => "M.L. Baeza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2004" "volumen" => "113" "numero" => "2 Suppl" "paginaInicial" => "S315" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of a 7S globulin as a novel coconut allergen" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Benito" 1 => "E. Gonzalez Mancebo" 2 => "M.D. Alonso Diaz de Durana" 3 => "R.M. Tolon" 4 => "M. Fernandez Rivas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Allergy Asthma Immunol" "fecha" => "2007" "volumen" => "98" "paginaInicial" => "580" "paginaFinal" => "584" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17601273" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cross-reactivity between coconut and lentil related to a 7S globulin and an 11S globulin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Manso" 1 => "C. Pastor" 2 => "M. Perez-Gordo" 3 => "B. Cases" 4 => "J. Sastre" 5 => "J. Cuesta-Herranz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1398-9995.2010.02370.x" "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "2010" "volumen" => "65" "paginaInicial" => "1487" "paginaFinal" => "1488" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20415717" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "11S and 7S globulins of coconut (<span class="elsevierStyleItalic">Cocos nucifera</span> L.): purification and characterization" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.N. Garcia" 1 => "R.V. Arocena" 2 => "A.C. Laurena" 3 => "E.M. Tecson-Mendoza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1021/jf0402173" "Revista" => array:6 [ "tituloSerie" => "J Agric Food Chem" "fecha" => "2005" "volumen" => "53" "paginaInicial" => "1734" "paginaFinal" => "1739" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15740067" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oral food challenges for diagnosis and management of food allergies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.H. Sicherer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "UpToDate" "fecha" => "2013" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterizing the relationship between sesame, coconut, and nut allergy in children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.M. Stutius" 1 => "W.J. Sheehan" 2 => "P. Rangsithienchai" 3 => "A. Bharmanee" 4 => "J.E. Scott" 5 => "M.C. Young" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-3038.2010.00997.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Allergy Immunol" "fecha" => "2010" "volumen" => "21" "paginaInicial" => "1114" "paginaFinal" => "1118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21073539" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presence of common food allergens in commercially available pediatric skin care products" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.K. Newhall" 1 => "L.S. Amoruso" 2 => "J.M. Sinacore" 3 => "J.A. Pongracic" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2004" "volumen" => "113" "paginaInicial" => "S235" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004300000002/v2_201503200840/S0301054613002449/v2_201503200840/en/main.assets" "Apartado" => array:4 [ "identificador" => "5550" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Research letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004300000002/v2_201503200840/S0301054613002449/v2_201503200840/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054613002449?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 4 | 12 |
| 2024 October | 82 | 22 | 104 |
| 2024 September | 85 | 17 | 102 |
| 2024 August | 76 | 7 | 83 |
| 2024 July | 90 | 10 | 100 |
| 2024 June | 93 | 13 | 106 |
| 2024 May | 82 | 27 | 109 |
| 2024 April | 121 | 12 | 133 |
| 2024 March | 124 | 9 | 133 |
| 2024 February | 112 | 8 | 120 |
| 2024 January | 127 | 17 | 144 |
| 2023 December | 120 | 18 | 138 |
| 2023 November | 134 | 19 | 153 |
| 2023 October | 142 | 22 | 164 |
| 2023 September | 95 | 13 | 108 |
| 2023 August | 83 | 10 | 93 |
| 2023 July | 146 | 14 | 160 |
| 2023 June | 110 | 13 | 123 |
| 2023 May | 133 | 25 | 158 |
| 2023 April | 115 | 22 | 137 |
| 2023 March | 81 | 13 | 94 |
| 2023 February | 66 | 26 | 92 |
| 2023 January | 78 | 19 | 97 |
| 2022 December | 76 | 33 | 109 |
| 2022 November | 87 | 19 | 106 |
| 2022 October | 66 | 24 | 90 |
| 2022 September | 62 | 24 | 86 |
| 2022 August | 99 | 25 | 124 |
| 2022 July | 55 | 31 | 86 |
| 2022 June | 111 | 18 | 129 |
| 2022 May | 73 | 15 | 88 |
| 2022 April | 69 | 32 | 101 |
| 2022 March | 101 | 23 | 124 |
| 2022 February | 45 | 19 | 64 |
| 2022 January | 42 | 25 | 67 |
| 2021 December | 55 | 58 | 113 |
| 2021 November | 38 | 44 | 82 |
| 2021 October | 46 | 43 | 89 |
| 2021 September | 27 | 46 | 73 |
| 2021 August | 19 | 21 | 40 |
| 2021 July | 26 | 21 | 47 |
| 2021 June | 20 | 22 | 42 |
| 2021 May | 37 | 22 | 59 |
| 2021 April | 45 | 50 | 95 |
| 2021 March | 34 | 48 | 82 |
| 2021 February | 20 | 50 | 70 |
| 2021 January | 36 | 32 | 68 |
| 2020 December | 3 | 23 | 26 |
| 2020 November | 0 | 22 | 22 |
| 2020 October | 1 | 19 | 20 |
| 2020 September | 0 | 9 | 9 |
| 2020 August | 0 | 17 | 17 |
| 2020 July | 0 | 12 | 12 |
| 2020 June | 0 | 7 | 7 |
| 2020 May | 0 | 14 | 14 |
| 2020 April | 0 | 6 | 6 |
| 2020 March | 0 | 13 | 13 |
| 2020 February | 0 | 23 | 23 |
| 2020 January | 0 | 12 | 12 |
| 2019 December | 0 | 23 | 23 |
| 2019 November | 0 | 10 | 10 |
| 2019 October | 0 | 12 | 12 |
| 2019 September | 0 | 17 | 17 |
| 2019 August | 0 | 5 | 5 |
| 2019 July | 0 | 15 | 15 |
| 2019 June | 0 | 16 | 16 |
| 2019 May | 0 | 21 | 21 |
| 2019 April | 0 | 17 | 17 |
| 2019 March | 0 | 5 | 5 |
| 2019 February | 0 | 7 | 7 |
| 2019 January | 0 | 7 | 7 |
| 2018 December | 0 | 7 | 7 |
| 2018 November | 0 | 5 | 5 |
| 2018 February | 23 | 10 | 33 |
| 2018 January | 10 | 7 | 17 |
| 2017 December | 25 | 7 | 32 |
| 2017 November | 9 | 6 | 15 |
| 2017 October | 18 | 7 | 25 |
| 2017 September | 20 | 10 | 30 |
| 2017 August | 37 | 16 | 53 |
| 2017 July | 29 | 9 | 38 |
| 2017 June | 32 | 19 | 51 |
| 2017 May | 35 | 13 | 48 |
| 2017 April | 37 | 6 | 43 |
| 2017 March | 28 | 19 | 47 |
| 2017 February | 31 | 12 | 43 |
| 2017 January | 36 | 7 | 43 |
| 2016 December | 18 | 13 | 31 |
| 2016 November | 47 | 11 | 58 |
| 2016 October | 53 | 21 | 74 |
| 2016 September | 21 | 11 | 32 |
| 2016 August | 24 | 10 | 34 |
| 2016 July | 10 | 5 | 15 |
| 2016 June | 17 | 21 | 38 |
| 2016 May | 30 | 12 | 42 |
| 2016 April | 21 | 14 | 35 |
| 2016 March | 22 | 14 | 36 |
| 2015 December | 1 | 1 | 2 |
| 2015 November | 1 | 1 | 2 |
| 2015 October | 0 | 1 | 1 |
| 2015 July | 2 | 1 | 3 |
| 2015 June | 0 | 2 | 2 |
| 2015 May | 4 | 6 | 10 |
| 2015 April | 12 | 10 | 22 |
| 2015 March | 3 | 6 | 9 |
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