Allergic reaction after eating alpha-amylase (Asp o 2)-containing bread. A case report

A 29-year-old female bakery shop assistant was occupationally sensitized to flour allergens and Aspergillus alpha-amylase (Asp o 2). The latter represents a strongly allergenic component of routinely used baking additives. The patient had repeatedly responded to the consumption of white bread with rhinitis, conjunctivitis, and, occasionally, wheal and flare reactions. She underwent allergologic investigations including oral challenge tests with commercially available bread loaves. Elevated specific IgE antibodies against bread extracts, Asp o 2, and flour allergens were detectable in her serum. The provocation test with bread resulted in a running nose together with a strong increase in nasal resistance. All symptoms subsided about 3 h after the challenge. None of the above symptoms could be observed when bread free of Aspergillus alpha-amylase was administered. This outcome provides evidence of a clinically relevant persistent allergenicity to Asp o 2 in bread.