Food-induced anaphylaxis following skin prick testing: a case report and literature review

A case of legume-induced anaphylaxis following prick-to-prick (PtP) testing in a 2.5-year-old girl is described. Very few cases of food-induced anaphylaxis following skin prick testing are reported in the literature. Fish and nuts are the most commonly implicated allergens; however, milk, egg, legumes, and vegetables may also be involved. Some potential risk factors have been suggested, including young age, concomitant atopic dermatitis (AD) or asthma, large diameter of the skin test reaction, a history of previous anaphylaxis, and the use of fresh food allergens. The most convincing risk factor reported is the use of PtP testing with fresh, multiple, and often cross-reactive food allergens. When indicated, diagnostic testing should be performed in separate sessions, and the number of PtP tests with fresh foods should therefore be minimized. Physicians should be aware of the potential risk of severe reactions with PtP in certain diagnostic circumstances; therefore, emergency equipment and medications for the treatment of allergic reactions should always be available.