Anaphylaxis after ingestion of wheat flour contaminated with mites☆,☆☆,★

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Abstract

Background: Anaphylaxis after ingestion of flours contaminated with mites has been recently reported. Objective: The study was designed to determine whether flour-induced reactions in the absence of food sensitivity may result from mite contamination. Methods: Patients with systemic reactions after ingestion of foods containing wheat flour and without food sensitivities were included in a prospective study. The flours were examined microscopically, and major Dermatophagoides allergens were quantified by monoclonal antibody techniques. Skin prick tests and IgE determinations to mites and flours were performed. Single-blind, placebo-controlled oral challenges were also performed. Results: Sixteen patients were included in our protocol. They showed respiratory allergies to dust mites (100%) and intolerance to acetylsalicylic acid (87%). Microscopic examination of four flours implicated in allergic reactions revealed a high degree of mite contamination: Dermatophagoides farinae in one case and Thyreophagus entomophagus in three cases. Our patients' skin test and specific IgE responses to the flours implicated in the reactions were positive. A high level of Der 2 was found in the flour infested by D. farinae. Three of six food challenges with contaminated flours resulted in systemic reactions. Good tolerance to control flours was shown in our patients. Conclusion: Ingestion of foods contaminated with mites may induce systemic anaphylactic reactions in patients with respiratory allergy to mites. (J Allergy Clin Immunol 1997;99:308-13.)

Section snippets

Patients

A prospective protocol was designed to study subjects with a clinical history of immediate reactions to flour-based foods, suggestive of IgE-mediated hypersensitivity, and with no food allergies, who attended our outpatient clinic between 1992 and 1995. The following data were collected for all the patients: age, sex, medical history, and data related to the adverse reaction (food involved, elapsed time between ingestion and beginning of symptoms, clinical manifestations, and number of

RESULTS

Sixteen patients reporting anaphylactic food-induced reactions and without food hypersensitivities were included in our protocol. The clinical features of our patients are summarized in Table I. There were 12 women and 4 men, aged 22 ± 8 (mean ± SD) years, who shared the following three characteristics.

1. A food item made of wheat flour, either fried in batter or made into cakes, had been ingested from 5 minutes to 1 hour before the anaphylactic reaction.

2. All patients had a history of

DISCUSSION

This study was designed to investigate the clinical observation of a cluster of food-induced anaphylactic reactions in patients with respiratory allergies to dust mites. Some of these patients had been formerly diagnosed with idiopathic anaphylaxis because of the absence of food allergies. Common clinical features among these patients included the implication in the reactions of different foods made of wheat flour and the coexistence of respiratory allergy to dust mites with intolerance to ASA.

Acknowledgements

We would like to express our gratitude to nurses Teresa Martínez, Blanca González, Rosario Dávila, and Elisabeth Ugarte, and to auxiliary nurses Carmen Teresa Santana and Gloria Henríquez for their invaluable collaboration in this study.

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From aSection of Allergy, Hospital Universitario Nuestra Señora del Pino, Facultad de Ciencias Médicas y de la Salud, Las Palmas de Gran Canaria, Canary Islands; and bAlergia e Immunología Abelló, Madrid.

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Reprint requests: Carlos Blanco, MD, Sección de Alergia, Hospital Nuestra Señora del Pino, C/ Angel Guimerá N° 93, 35005, Las Palmas de Gran Canaria, Spain.

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