We report the case of a 55-year-old woman without a history of atopic disease or drug allergy who developed a maculopapular symmetric exanthematous rash about 2 days after taking throat lozenges containing papaya juice. Patch tests gave negative reactions to the European standard series but were positive for papaya juice. A solution of 1% papain in water showed a weak and probably irritant reaction, while a 0.1% solution was negative. To our knowledge this is the first case report of systemic contact dermatitis to papaya without papain hypersensitivity.
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Iliev et al. (2009) studied this question.