Rare presentation of anaphylaxis: pancake syndrome

Area of Science:

• Allergy and Immunology
• Food Safety
• Environmental Health

Background:

• Foodborne anaphylaxis is a serious concern, often linked to common food allergens.
• Dust mite allergy is prevalent, but its role in food-induced anaphylaxis is less commonly recognized.
• Proper food storage is crucial to prevent contamination and potential allergic reactions.

Observation:

• A patient experienced acute anaphylactic symptoms including urticaria, angioedema, and respiratory distress after consuming a Japanese flour pancake.
• Analysis of the pancake's flour revealed a high concentration of Dermatophagoides farinae (dust mites).
• The patient demonstrated specific IgE antibodies to Dermatophagoides species, confirming dust mite allergy.

Findings:

• The patient's allergic reaction was directly attributed to the oral ingestion of Dermatophagoides farinae present in the contaminated flour.
• Specific IgE testing confirmed sensitization to dust mites (D. farinae and D. pteronyssinus), with no reactivity to other pancake ingredients.
• This case highlights the potential for dust mites in improperly stored food ingredients to act as a significant allergen.

Implications:

• Highlights the risk of anaphylaxis from consuming dust mite-contaminated food ingredients.
• Emphasizes the need for stringent food storage and handling practices to prevent dust mite proliferation.
• Suggests considering dust mite allergy in cases of unexplained food-induced anaphylaxis, particularly with flour-based products.