Buckwheat-induced anaphylaxis: a case report.

Buckwheat (Fagopyrum schulentum) is not taxonomically related to wheat and other cereal grains. Buckwheat flour is used as a wheat substitute in breads, biscuits, pancakes, and crepes. Occupational exposure to buckwheat flour has been associated with rhinitis, conjunctivitis, contact urticaria, and occupational asthma. We present a patient who developed urticaria and hypotension after ingestion of buckwheat crepes. Skin testing by the prick technique revealed 3+ positive reaction to buckwheat with negative reactions to other foods including wheat, egg white, and milk. RAST for anti-buckwheat IgE was strongly positive. Buckwheat ingestion is a potential cause of food-related anaphylaxis. There does not appear to be cross-reactivity between buckwheat and wheat allergy.     

Buckwheat-induced anaphylaxis: a case report.

Buckwheat (Fagopyrum schulentum) is not taxonomically related to wheat and other cereal grains. Buckwheat flour is used as a wheat substitute in breads, biscuits, pancakes, and crepes. Occupational exposure to buckwheat flour has been associated with rhinitis, conjunctivitis, contact urticaria, and occupational asthma. We present a patient who developed urticaria and hypotension after ingestion of buckwheat crepes. Skin testing by the prick technique revealed 3+ positive reaction to buckwheat with negative reactions to other foods including wheat, egg white, and milk. RAST for anti-buckwheat IgE was strongly positive. Buckwheat ingestion is a potential cause of food-related anaphylaxis. There does not appear to be cross-reactivity between buckwheat and wheat allergy.     

Bakers' asthma

Bronchial provocation tests by ‘occupational’ exposure to flour provoked dual asthmatic reactions accompanied by rhinitis in two atopic bakers engaged in the manufacture of bread and pies. Ingestion tests with uncooked flour produced no reactions. Skin prick tests with aqueous extracts of flour produced positive immediate reactions in both bakers, and negative reactions in nine of ten atopic asthmatic control subjects with no occupational exposure to flour. Intracutaneous tests, performed in one precipitin negative baker, gave dual responses. Precipitating antibodies to an aqueous extract of flour were found in the unconcentrated serum of the other baker, and not in ten control subjects.     

Buckwheat Allergy: Health Food, an Inhalation Health Risk

Thirteen out of 28 persons (14 men and 14 women) employed in a company which imports, prepares and distributes plant products used in spices and as ingredients in so-called health food, had developed work-related symptoms in the form of rhinitis, conjunctivitis, asthma, itch or urticaria. The symptoms occurred in connection with specific work operations, especially in the grinding and packaging of buckwheat. Seven out of 25 examined persons (28%) had at least one positive allergy test (prick test or RAST) against buckwheat. Furthermore, one person had positive RAST against extract from castor-oil bean. The correlation between positive allergy tests and work-related symptoms is significant. Fourteen persons were also patch tested. All were negative except one person who had a positive patch test against nickel. The nickel allergy was diagnosed before this study was done and had no relation to the work. The levels of airborne dust in the breathing zones of the workers when they performed dust-forming work were around and below 5 mg/m3. When buckwheat flour was packaged, the airborne dust levels were about 1-2 mg/m3. Thus, exposure to comparatively low levels of buckwheat dust may induce a definite risk of rapidly ensuing allergy. It is also obvious that persons without atopic stigmata, such as an earlier history of allergy or the occurrence of allergic diseases in relatives, risk becoming allergic. A conclusion is that health food could be a danger, when it is inhaled.     

IgE-mediated occupational allergy to a spider mite

Two patients who suffered from allergic rhinitis, conjunctivitis and contact urticaria caused by the two-spotted spider mite (Tetranychus urticae, Koch) are described. Both patients worked in a greenhouse where they came in contact with both spider mites and predator mites living on bean leaves. Prick, Prausnitz-Küstner and RAST tests indicated type I allergy to spider mite but not to predator mite. Both patients had a high level (RAST score 4) of spider-mitE-specific IgE in their sera. Radioallergosorbent test (RAST) inhibition studies revealed no cross-reactivity between spider mite and house dust mite allergens. These results show that spider mites, which are herbivorous mites found in nature, in greenhouses and even in homes, can cause IgE-mediated allergy in man.     

Occupational IgE-mediated rhinitis caused by ninhydrin

Ninhydrin is a laboratory chemical used as a reagent in the detection of free amino and carboxyl groups in proteins and peptides. We present the case of a laboratory technician who developed symptoms of rhinitis when handling papers immersed in a solution containing ninhydrin. Prick tests for ninhydrin and ninhydrin RAST were positive. The inhalation provocation test in an exposure chamber gave an immediate nasal response. A positive prick test to ninhydrin, an elevated level of specific IgE antibodies to ninhydrin, and the RAST inhibition test confirmed an IgE-mediated type I allergic reaction. We are not aware of any other report of ninhydrin as a cause of IgE-mediated allergy.     

Clinical and immunological responses to enzymes of Bacillus subtilis in factory workers and consumers

Skin (prick) and serological tests were made with enzyme preparations of Bacillus subtilis in exposed factory workers and potential ‘consumers’. Prick tests with these materials at 10 mg/ml gave positive immediate reactions in twenty-six out of sixty-five factory workers. Eighteen of the factory workers were classified as atopic because of allergy to common allergens and fifteen gave positive reactions to the enzymes compared with eleven out of forty-seven non-atopic workers. A group of eleven of the factory workers had consistent ventilatory impairment on repeated examination; all were prick test positive and seven were atopic, and four non-atopic. Of 2500 patients attending for investigation of respiratory allergy, 40% were highly atopic, 40% moderately atopic and 20% non-atopic. 80% were consumers of biological detergents. Only two gave weak, not clinically relevant, prick test reactions to the enzyme preparations. In radioallergosorbent (RAST) tests for specific IgE antibody against the enzyme preparations, counts in the present investigation of 600/30 sec or more corresponded best with prick test positivity, such values being found in twelve of the fifteen prick test positive atopics and in eight of the eleven workers with ventilatory impairment. Comparison of the RAST counts on sera from cord blood and from the patients who included non, light and heavy consumers showed increasingly higher specific IgE counts in these groups, although these counts were almost all below the level of 600/30 sec, which corresponded with skin test reactions and clinical relevance. Radioimmunodiffusion (RID) and radioimmunoelectrophoretic (RIEP) tests with enzyme preparations gave positive reactions only in the factory workers, of whom forty-three had IgG and twenty-one IgA antibody, none having only IgE antibody.     

Multicolored Asian lady beetle hypersensitivity: a case series and allergist survey.

BACKGROUND: Multicolored Asian lady beetles (Harmonia axyridis) have been used as a biological control agent against crop-destroying aphids in the United States. Outside their natural habitat, H. axyridis seeks refuge in homes during fall and winter, leading to patient complaints and symptoms of rhinitis, wheezing, and urticaria on exposure to the beetles. OBJECTIVE: To gain a better understanding of the character and spectrum of allergic disease provoked by exposure to home-infesting lady beetles. METHODS: Eight patients with allergic symptoms suspected of being caused by H. axyridis and consistent with an IgE-mediated process were identified and interviewed. A whole-body extract from H. axyridis was prepared. Western blots using the patients' serum identified specific IgE antibodies in the extract. Through a novel technique, immunohistochemical analysis using beetle sections overlayed with patient serum was performed. A random survey of allergists from across the United States was also performed to evaluate experience with cases of lady beetle allergy. RESULTS: Western blots revealed IgE binding to 5 proteins with molecular weights of approximately 8.6, 21, 28, 31, and 75 kDa. Specific IgE bound to proteins localized in the beetle's mouth and leg areas. The allergist survey revealed positive responses in North Central, Mid-Atlantic and New England states. CONCLUSION: In 8 patients with allergic symptoms on exposure to high levels of lady beetles, specific IgE bound to proteins from H. axyridis. There was also an increased frequency of suspected cases of lady beetle allergy in endemic areas.     

Immediate and delayed allergy to nickel with contact urticaria, rhinitis, asthma and contact dermatitis

A 27-year-old woman had for 2 years performed manual grinding of metal castings that contained nickel. She had previously had allergic contact dermatitis from nickel but started to get contact urticaria, rhinitis and asthmatic attacks at work. The symptoms disappeared at weekends and on holiday. Scratch chamber tests, open tests, specific IgE determinations (RAST), and RAST-inhibition test indicated that she had developed an IgE-mediated allergy to nickel; the bronchial provocation reaction with NiSO₄ was, however, a late one. Patch tests confirmed her allergic contact dermatitis to be caused by nickel. This is the first patient, to the best of our knowledge, reported to have developed allergic contact dermatitis, allergic contact urticaria, rhinitis and asthma from nickel.     

Occupational allergy caused by spathe flower (Spathiphyllum wallisii)

Occupational allergy caused by plants is seldom reported although it is probably relatively common. We report on a 22-year-old male atopic caretaker of plants who developed IgE-mediated allergic rhinitis, laryngitis, pharyngitis, and contact and generalized urticaria caused by exposure to spathe flower (Spathiphyllum wallisii) while he was working for a firm that supplied plants to offices. He also had an asthmatic attack at work, but in bronchial provocation tests conducted 8 months after he had stopped doing the work in question, he developed rhinoconjunctivitis, pharyngitis, and laryngitis, but exhibited neither bronchial reaction nor fall in PEF values. Prick tests with spathe flower gave 3 + reactions for exudates from the flower, pollen, stem, and leaves. He also had several positive reactions to fruits, vegetables, and spices, but not to natural rubber latex. The radioallergosorbent test with spathe flower was positive (3.4 PRU/ml, close to class 3). In protein staining with SDS—PAGE, one heavy band was detected at about 14 kDa, and other faint bands were visible on both sides. Six faint bands were detected at the mol. mass range of 30–67 kDa. In IgE immunoblotting, one heavy band was detected at about 14 kDa. The patient became symptomless after he had ceased working with plants.     

Pharyngeal edema caused by occupational exposure to cellulase enzyme

Enzymes can cause allergic asthma and rhinitis. Although patients sometimes complain of symptoms in their throat, we have not been able to find any published report of pharyngeal edema caused by exposure to enzymes. We present the case of a maintenance foreman who worked in a factory producing enzymes, and who had pharyngeal edema, asthma, and rhinitis at work. Prick tests for cellulase enzyme and cellulase RAST were positive. The causal association between his pharyngeal symptoms and cellulase was demonstrated with inhalation provocation tests in an exposure chamber.     

Coffee Worker''s Allergy

Workers in the coffee industry were investigated. Study I comprised 50 selected cases of whom 25 had work-related symptoms and 25 had not. Prick tests and RAST investigations with different factory dust extracts were performed. Study II was a cross-sectional study comprising 129 workers who were prick-tested with one factory dust extract and with castor bean (CB). More than 40% described occupationally related asthma, rhinitis, conjunctivitis or pruritus, and in about half of these cases sensitization with one or two allergens was found. One allergen comes from coffee beans and is found in the factory dust, mainly where the raw coffee is handled. This allergen is destroyed in the roasting process. The other allergen is identical with the allergen from castor bean and its presumed to enter the plant via the sacks. Predisposing factors to developing sensitization were atopic status, degree and length of exposure, and smoking habits.     

Anaphylaxis to raw potato.

BACKGROUND: Potato allergy has been described rarely, generally in relation to the Oral Allergy Syndrome (OAS). Adults with seasonal allergic rhinitis have been reported in whom peeling of raw potatoes causes oculonasal symptoms, wheezing, and contact urticaria. Skin testing with fresh fruits and vegetables has been recommended in cases of OAS, although the sensitivity of commercial potato extract is reportedly equal to that of fresh potato. CASE REPORT: This report describes a 4-year-old with raw potato-induced anaphylaxis. He rapidly developed urticaria, angioedema, respiratory distress, vomiting and diarrhea after biting into a raw potato that was being used for painting in preschool. Review of systems is significant for viral-induced wheezing, but no symptoms suggestive of seasonal allergic rhinitis were evident. His mother has a history of seasonal allergic rhinitis and contact urticaria with raw potato. Skin testing to commercial potato extract was negative and skin testing to fresh potato by the prick + prick method was markedly positive. Skin testing to birch tree was negative. An open challenge to a small amount of cooked potato was negative. Food challenge to raw potato was not considered indicated in this case of immediate anaphylaxis to a single food. CONCLUSIONS: This patient had clinical and skin test reactivity to raw and uncooked potato in the absence of OAS. The patient will be followed for the development of seasonal allergic rhinitis.     

The relationship of respiratory allergy, skin test reactivity, and serum IgE in a community population sample.

The relationship between prick and intradermal skin test reactivity and serum levels of total and specific IgE was evaluated in 311 subjects selected from a general population. Test results were related to the historical allergy status of the subjects. Prick test reactivity to 14 common local allergens correlated with the presence of allergy symptoms. Similarly, mean total serum IgE (PRIST) levels were significantly higher (p < 0.02) in allergic (187.9 IU) than in nonallergic subjects (107 IU) and were found to be positively correlated with the degree of prick test reactivity. Conversely, intradermal reactions following a negative prick test for that allergen showed no correlation with either the clinical allergy status or the level of total serum IgE. Bermuda-specific IgE was found to correlate closely with prick reactivity to that allergen as an overall agreement of 89.2% was observed. In contrast, only 2 of 12 positive Bermuda intradermal tests ≥5 mm and none of 38 smaller reactions following a negative prick response were associated with positive RASTs. The results strongly suggest that prick test reactivity correlates with both total and specific IgE and allergic symptomatology, but intradermal reactions in the absence of prick reactivity do not correlate with either clinical or immunologic evidence of allergy.     

Skin and serologic testing in the diagnosis of latex allergy

Background: Latex hypersensitivity is associated with occupational allergy contact urticaria, rhinitis, asthma, and anaphylaxis. However, standardized sensitive and specific latex extract for skin prick or serologic testing is not available in the United States.Methods: We investigated the reliability of two latex extracts in 118 consecutive skin tests in patients with spina bifida, health care workers, and other patients with symptoms of latex allergy, and 10 control subjects.Results: Forty-two of 86 patients with spina bifida, 11 of 15 health care workers with symptoms of latex allergy, 6 of 7 patients with symptoms of latex allergy, and 0 of 10 control subjects had demonstrable immediate wheal and flare responses to latex prick testing. In addition, 95 patients and 10 control subjects were tested concurrently for latex-specific IgE by ELISA. Of 55 patients with positive skin prick test results, 48 were reactive as determined by ELISA for IgE-specific latex antibody (sensitivity = 87%). Latex ELISA titers were significantly higher in patients with positive skin prick test results with a history of anaphylaxis to latex and in individuals without symptoms of latex allergy who had positive skin prick test results when compared with patients with negative skin prick test results. During the skin test procedure, nine patients had adverse reactions, including anaphylactic reactions in four.Conclusions: Skin prick and serum testing are reliable methods of diagnosing latex allergy. Serologic evaluation may be more desirable until allergen standardization is available.     

Occupational type I allergy to Christmas cactus (Schlumbergera)

The study aimed to determine whether occupational contact urticaria and symptoms of mucous membranes, reported by five workers in a cactus nursery, were due to IgE-mediated allergy to Schlumbergera cacti. The five persons had positive skin prick tests to the plants as is and positive histamine-release tests, and in three of them specific IgE to the cacti could be demonstrated by Maxisorp RAST and immunoblotting. Four of the patients were atopic, and the fifth had a positive skin prick test to cat dander, indicating latent atopy. Skin prick tests with cacti were negative in most atopic volunteers, and all had negative histamine-release tests. The results suggest a true IgE-mediated allergy to the cacti, and both genetic predisposition and close contact with the plants at work seem to be important factors in the emergence of this new occupational allergy.     

Comparison of immunologic tests in the diagnosis of occupational asthma and rhinitis

In this study, three immunologic tests, skin prick test, RAST, and basophil histamine-release test (BHRT), were compared by provocation in the diagnosis of occupational asthma and rhinitis. Twenty-three positive bronchial or nasal challenges were performed on 16 patients (six farmers, six bakery workers, and four food industry workers) and asthma or rhinitis was diagnosed as caused by cereal flour or grain, cow epithelium, storage mites, garlic, or soy dust. A control group consisted of 12 patients, of whom four (two bakery workers, one food industry worker, and one farmer) were challenge-negative, and the rest suffered from pollen allergy and seasonal rhinitis and were not challenged. The sensitivity and specificity of the prick test, RAST, BHRT, and a panel of them were as follows: 74 and 89%, 57 and 86%, 78 and 93%, and 91 and 71%, respectively. The overall concordance among these three type I allergy tests or between immunologic tests and challenge was relatively good.     

A baker''s occupational allergy to flour moth (Ephestia kuehniella)

BACKGROUND: Allergy to insects is common. However, few reports cover occupational sensitization to flour moth (Ephestia [syn. Anagasta] kuehniella). We describe a baker who suffered from IgE-mediated occupational respiratory allergy to flour moth. METHODS: The skin prick test (SPT) and serum IgE tests were used to evaluate the patient's sensitivity to flour moth. Allergen cross-reactivity with mites was evaluated in IgE-inhibition studies. Clinical sensitivity was evaluated by nasal challenge test. Pulmonary function tests were repeatedly monitored. RESULTS: SPT with flour moth gave a 6-mm wheal, and an elevated level of flour moth-specific IgE was measured in the patient's serum (1.9 PRU/ml, RAST class 2). Immunoblotting with the patient's serum revealed at least seven heavy IgE-binding bands with molecular masses of 22, 35, 43, 53, 65, 77, and >86 kDa in the extract of flour moth. Allergen cross-reactivity with mites was demonstrated in inhibition studies. Immediate-type allergy to flour moth was confirmed by nasal challenge. Increased daily variability of PEF values was observed during workplace exposure. CONCLUSION: A baker's occupational respiratory allergy to flour moth was confirmed.     

Anaphylaxis to wheat beer.

BACKGROUND: Despite its worldwide and abundant consumption, beer has rarely been found to cause anaphylaxis. Barley malt contained in lager beers seems to be an important elicitor. OBJECTIVE: To report the unusual case of severe anaphylaxis following the ingestion of wheat beer. METHODS: A 59-year-old man experienced angioedema, generalized urticaria, and unconsciousness after ingestion of wheat beer. He tolerated lager beer well. For diagnostic evaluation, skin prick tests, oral challenge tests, and identification of specific IgE antibodies were performed. RESULTS: Skin prick test results with standard series of common aeroallergens and food allergens were negative with the exception of a 1 + reaction to wheat flour. The results of skin prick tests with native materials were positive for 2 brands of wheat beer and wheat malt shred but negative for baker's yeast, hops, and a brand of lager beer. Oral challenges with wheat beer or wheat flour elicited urticaria. By CAP-FEIA, specific IgE antibodies to wheat and barley flour but not to hops or baker's yeast were found in serum. Immunoblot analysis revealed that patient's IgE was bound to a protein of approximately 35 kDa in wheat extract. CONCLUSIONS: This is the first report, to our knowledge, on anaphylaxis to beer attributable to wheat allergy.     

The significance of hypersensitivity to nuts in patients with birch pollen allergy

This study was performed in patients with allergic rhinitis/conjunctivitis to birch pollen to determine whether patients with additional hypersensitivity to nuts and apples differed from patients without such hypersensitivity; the determination was in terms of results of skin prick test (SPT), specific IgE antibodies (RAST), and symptoms during the pollen season. Forty-seven patients with birch pollen allergy were investigated by RAST against birch and hazel pollen and by SPT. They were treated in a randomized, double-blind, placebo-controlled study with fluticasone propionate aqueous nasal spray or placebo. The area of the SPTs was larger and the specific IgE values higher in patients with hypersensitivity to nuts and apples. These patients also had more symptoms during the pollen season. We conclude that hypersensitivity to nuts is an indication of a more severe allergy in patients with birch pollen allergic rhinitis.