Anaphylaxis after ingestion of beignets contaminated with Dermatophagoides farinae

A 48-year-old man was evaluated for anaphylaxis associated with ingestion of beignets prepared from a commercial mix. Microscopic examination of the patient's beignet mix revealed live Dermatophagoides farinae. Another unopened box from the same source was not infested. Skin test results to aeroallergens and foods, including all beignet mix ingredients, were positive only to D. farinae and D. pteronyssinus extracts. Skin prick test results to an infested mix extract (1:5 wt/vol) were also positive, but no reaction was observed with noninfested mix extract. ELISA inhibition studies demonstrated significant inhibition of the patient's serum binding to D. farinae strips by infected mix extract. Parallel inhibition curves were produced by the infested mix extract and a commercial D. farinae extract. Noninfested mix extract showed no inhibition. RAST analysis with beignet mix discs showed significant binding of the patient's serum IgE to infested mix discs but not to noninfested mix discs. RAST inhibition studies revealed more than 86% inhibition of binding of the patient's IgE to infested mix discs by infested mix extract and D. farinae extract. No inhibition was observed with noninfested mix or 5% fetal calf serum-phosphate-buffered saline. We conclude that the allergen to which the patient reacted was most likely D. farinae and that ingestion of D. farinae may cause anaphylaxis in sensitive persons.