DANGERS AT THE DINNER TABLE – A REPORT OF ANAPHYLAXIS TO LION'S MANE MUSHROOM

Abstract

<h3>Introduction</h3> We report the first case of anaphylaxis after ingestion of Lion's Mane Mushroom, <i>Hericium erinaceus</i>, a mushroom with increasing culinary popularity. <h3>Case Description</h3> A 43-year-old male experienced abdominal pain, diarrhea, hives and swelling within minutes of consuming the Lion's Mane Mushroom, <i>H. erinaceus</i>. Brussel sprouts, bok choy, and an alcoholic beverage made with pineapple juice were also consumed. After taking Benadryl, symptoms resolved over 24 hours. These foods and other mushroom varieties were previously eaten without allergic symptoms and also tolerated since the incident, with the exception of <i>H. erinaceus</i>. The remainder of history and physical examination were unremarkable. Extract skin prick testing wheel/flare (mm): positive control (histamine) 4/5, negative control (normal saline) 0/0, and fresh food testing using <i>H. erinaceus</i> was 3/3, in duplicate. Skin testing using mushroom extract was negative. Based on positive skin testing to <i>H. erinaceus</i> and history consistent with anaphylaxis, we report the first known case of Lion's Mane Mushroom allergy. The patient was diagnosed with allergy to <i>H. erinaceus</i>, advised to strictly avoid <i>H. erinaceus</i> containing foods, and prescribed an epinephrine auto-injector. <h3>Discussion</h3> Expanding culinary interest and incorporation of mushrooms into dishes, including meat substitutes at vegan restaurants, will expose more patients to the Lion's Mane Mushroom. We report the first case of Lion's Mane Mushroom Allergy.