title: Late-onset anaphylaxis after ingestion of Bacillus Subtilis-fermented soybeans (Natto): clinical review of 7 patients.
abstract: BACKGROUND
  Allergic reactions after ingestion of fermented soybeans have rarely been reported. Fermented soybeans were recently reported to be a causative food of IgE-mediated, late-onset anaphylaxis without early phase responses. The objectives of our study are to clarify the clinical and laboratory features and to characterize the allergens in allergy due to fermented soybeans.
  
  
  METHODS
  Seven patients with suspected hypersensitivity to fermented soybeans, from whom informed consent had been obtained, underwent skin prick-prick tests with fermented soybeans and challenge test with fermented soybeans. Additionally, specific IgE against fermented soybeans and the allergens of fermented soybeans were detected by ELISA and IgE-immunoblotting, respectively.
  
  
  RESULTS
  Seven male patients, aged 26 to 42 years (mean age, 33.1 years), participated. All patients reported generalized urticaria and dyspnea; 5, loss of consciousness; 2, collapse; 2, vomiting; and 2, diarrhea after fermented soybean ingestion. The interval between fermented soybean ingestion and onset of symptoms was 5 to 14 hours (mean, 9.6 hours). All patients were positive on skin prick-prick tests with fermented soybeans. In 2 patients, oral challenge with fermented soybeans was positive 5.5 and 13 hours after ingestion. In ELISA, all 5 patients tested showed elevated IgE levels to the fermented soybean extract. Furthermore, IgE-immunoblotting using 5 patients' sera showed six bands, of which three bands at 38, 28, and 26-kd were bound to sera from 4 patients.
  
  
  CONCLUSIONS
  Cases with hypersensitivity after ingestion of fermented soybeans most frequently correspond to IgE-mediated, late-onset anaphylactic reactions due to fermented soybeans.
authors.affiliation: Department of Dermatology, Yokohama City University Hospital, Yokohama, Japan. ninomata@med.yokohama-cu.ac.jp
authors.forename: Naoko
authors.initials: N
authors.lastname: Inomata
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Osuna
authors.forename: Katuyuki
authors.initials: K
authors.lastname: Kawano
authors.forename: Junko
authors.initials: J
authors.lastname: Yamaguchi
authors.forename: Masumi
authors.initials: M
authors.lastname: Yanagimachi
authors.forename: Setsuko
authors.initials: S
authors.lastname: Matsukura
authors.forename: Zenro
authors.initials: Z
authors.lastname: Ikezawa
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000382:microbiology*; D001412:Bacillus subtilis / Q000276:immunology*; D005285:Fermentation; D005512:Food Hypersensitivity / Q000276:immunology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000382:microbiology*; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D012882:Skin Tests; D045730:Soy Foods / Q000009:adverse effects*
chemical_list: D007073:Immunoglobulin E