Anaphylaxis to Agaricus bisporus ingestion

Inês Machado Cunha,Maria Luís Marques,Borja Bartolomé,Carmo Abreu,Eva Gomes

doi:10.31744/einstein_journal/2020rc5478

Abstract

ABSTRACTA 33-year-old male with house dust mite allergic rhinitis and asthma reported an episode of facial and lip angioedema, dyspnea, cough and dysphagia at the age of 25, minutes after eating a mushroom ( Agaricus bisporus ) pizza. He denied any drug intake, hymenoptera stings or other possible triggers, and no identifiable cofactors were present. Since then he avoided all types of mushrooms, however an accidental contact occurred with mushroom sauce that resulted in angioedema of the lip within minutes. The allergy workup included measurements of total IgE and specific IgE to mushroom, and skin prick test to aeroallergens sources, possible food allergen sources and mushroom extract, a prick to prick test with raw and cooked A. bisporus , in addition to a SDS-PAGE and immunoblotting assay. The study revealed a specific IgE to mushroom of 0.76kUA/L positive skin prick test to mushroom extract, and prick to prick test positive to white and brown A. bisporus (raw and cooked). The immunoblotting identified two IgE binding proteins with 10kDa and 27kDa. We report a case of A. bisporus anaphylaxis probably due to primary mushroom sensitization. We detected two IgE-reactive proteins with 10kDa and 27kDa as possible culprit allergens.

Highlights

Anaphylaxis is a serious allergic reaction with a rapid onset and potentially fatal outcome.[1]einstein (São Paulo). 2020;18:1-4Cunha IM, Marques ML, Abreu C, Bartolomé B, Gomes EIn adults the main anaphylaxis triggers are food, insect stings and drugs.[2]Concerning food allergens, the main identified triggers are peanut, fish, shellfish, tree nut and fresh fruits, especially in pollen allergic patients; we must be aware that the implicated allergens can change with different eating patterns.[3,4] In a suspected food allergy, a clinical history with a food diary is extremely important to identify unusual food allergens.Species in the Fungi kingdom can cause different types of allergic symptoms
We report a case of anaphylaxis to A. bisporus in a patient without any other sensitization to molds, in which ingestion appears to be the primary route of sensitization
The immunoblotting assay with A. bisporus extract revealed two main IgE binding bands of approximately 10kDa and 27kDa (Figure 2)

Summary

Introduction

Anaphylaxis is a serious allergic reaction with a rapid onset and potentially fatal outcome.[1]einstein (São Paulo). 2020;18:1-4Cunha IM, Marques ML, Abreu C, Bartolomé B, Gomes EIn adults the main anaphylaxis triggers are food, insect stings and drugs.[2]Concerning food allergens, the main identified triggers are peanut, fish, shellfish, tree nut and fresh fruits, especially in pollen allergic patients; we must be aware that the implicated allergens can change with different eating patterns.[3,4] In a suspected food allergy, a clinical history with a food diary is extremely important to identify unusual food allergens.Species in the Fungi kingdom can cause different types of allergic symptoms. We report a case of anaphylaxis to A. bisporus in a patient without any other sensitization to molds, in which ingestion appears to be the primary route of sensitization. A 33-year-old man with allergic rhinitis and asthma under treatment with inhaled and nasal corticosteroids, and with a known allergy to Dermatophagoides pteronyssinus and Dermatophagoides farinae. He experienced an anaphylactic reaction at the age of 25 years, with facial and lip angioedema, dyspnea, cough and dysphagia minutes after ingestion of a mushroom pizza. No other suspected triggers were present, such as drug intake or stings He denied physical exercise or alcohol intake in the hours before the episode.

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Discussion

Conclusion