A case of mite-ingestion-associated exercise- induced anaphylaxis mimicking wheat-dependent exercise-induced anaphylaxis.
We present a case of mite-ingestion-associated exercise-induced anaphylaxis mimicking wheat-dependent exercise-induced anaphylaxis (WDEIA). A 17-year-old boy was referred for an episode of anaphylaxis while jogging, 1.5 h after having eaten okonomiyaki (a Japanese pancake). Laboratory measures revealed a slightly elevated specific immunoglobulin E (IgE) antibody against omega-5 gliadin (0.41 kUA/l) and a marked elevation of specific IgE antibody against house-dust mite, Dermatophagoides farinae (142 kUA/l). A detailed interview revealed that, in spite of the referring doctor's advice to discontinue postprandial exercises, he continued his jogging routine after consuming foods containing wheat and also that his younger brother, who had mild intermittent asthma, had suffered a mild asthma attack 2 h after eating the same food. We therefore examined the okonimiyaki mix, which had been stored for several months after opening the package until this episode, under a microscope, and we found an abundant number of live mites, D. farinae. Finally, a diagnosis of mite-ingestion-associated exercise-induced anaphylaxis was made. This clinical entity should be excluded when making a diagnosis of WDEIA.
Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan.
Yoko S
YS
Adachi
Toshiko
T
Itazawa
Yoshie
Y
Okabe
Osamu
O
Higuchi
Yasunori
Y
Ito
Yuichi
Y
Adachi
D000293:Adolescent; D000707:Anaphylaxis / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology*; D000818:Animals; D040001:Dermatophagoides farinae / Q000276:immunology*; D040002:Dermatophagoides pteronyssinus / Q000276:immunology*; D003937:Diagnosis, Differential; D004435:Eating; D015444:Exercise; D005433:Flour; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D021182:Wheat Hypersensitivity / Q000175:diagnosis / Q000276:immunology
D007073:Immunoglobulin E; D005903:Gliadin