title: Oral mite anaphylaxis caused by mite-contaminated okonomiyaki/ pancake-mix in Japan: 8 case reports and a review of 28 reported cases.
abstract: BACKGROUND
  Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital.
  
  
  METHODS
  In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan.
  
  
  RESULTS
  Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases.
  
  
  CONCLUSIONS
  Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Taniguchi
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Yuma
authors.initials: Y
authors.lastname: Fukutomi
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Sekiya
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Watai
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Mitsui
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Tanimoto
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Chiyako
authors.initials: C
authors.lastname: Oshikata
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuburai
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Tsurikisawa
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Minoguchi
authors.affiliation: Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Akiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology*; D000707:Anaphylaxis / Q000175:diagnosis / Q000276:immunology*; D000818:Animals; D000918:Antibody Specificity / Q000276:immunology; D039741:Antigens, Dermatophagoides / Q000276:immunology; D002648:Child; D005260:Female; D005433:Flour / Q000009:adverse effects; D005506:Food Contamination; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000276:immunology*; D016266:Food Parasitology; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D008875:Middle Aged; D039981:Pyroglyphidae; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000485:Allergens; D039741:Antigens, Dermatophagoides; D007073:Immunoglobulin E