A Patient with Carminic Acid-Induced Anaphylaxis; Usefulness of the Basophil Activation Test

Abstract

T U E S D A Y 769 A Patient with Carminic Acid-Induced Anaphylaxis; Usefulness of the Basophil Activation Test Naoya Sugimoto, Masao Yamaguchi, Yuko Nakase, Yusuke Tanaka, Hiroyuki Tashimo, Hidenori Arai, Hiroshi Akiyama, Hiroyuki Nagase, MD, PhD, Ken Ohta; Teikyo University School of Medicine, Tokyo, Japan, National Institute of Health Sciences, Tokyo, Japan, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. RATIONALE: In autumn, 2011, a 39-year-old female was referred for analysis of anaphylaxis that occurred following ingestion of a commercial bottled supplement. She had experienced anaphylactic shock with an itchy throat, generalized urticaria and low blood pressure after drinking the supplement every day for two months. Her anaphylaxis was associated with her menstrual period. METHODS: Skin tests and in vitro tests were performed. RESULTS: Her serum IgE concentration was slightly elevated (270 IU/ ml). An intradermal test showed a positive reaction to a 10-fold dilution of the drink. However, the solution also elicited skin reactions in four nonallergic volunteers, suggesting that the reaction was nonspecific. We then tried the in vitro basophil activation test (BAT), which analyzes activation marker CD203c expression on basophils. The drink itself and, among its constituents, only cochineal dye, gave positive results in BATusing the patient’s blood, but not nonallergic subjects’ blood. In addition, carminic acid (purity 97%), but not a protein extract of Coccus cacti, gave a positive BAT result. Furthermore, the patient’s basophils demonstrated a stronger BAT response to cochineal dye during the menstrual period, compared to the non-menstrual period. CONCLUSIONS: Cochineal dye is a highly safe material that is widely used as a food additive and cosmetic ingredient. To date, type I allergy due to the dye, including anaphylaxis, urticaria and occupational asthma, has been reported only occasionally. The present study shows the usefulness of in vitro BAT using peripheral blood for analyzing cochineal dye-induced allergy.