Oral Mite Anaphylaxis Research Articles

Oral mite anaphylaxis (pancake syndrome) in Peru: an underestimated problem?

Oral mite anaphylaxis (pancake syndrome) in Peru: an underestimated problem?

Oral mite anaphylaxis (pancake syndrome) caused by storage mite Acarus siro and its treatment with allergen immunotherapy

A 10-year-old atopic patient with asthma, peanut, and house dust mite allergy developed frequent episodes with symptoms including abdominal pain, nausea, vomiting, dizziness, drop of blood pressure, and occasionally shortness of breath and wheezing. After detailed diagnostics including an ISAC test and several other specific IgE blood tests, which could not explain the symptoms, the patient tested positive for specific IgE to Acarus siro (flour mites) (9.2 kU/L). As no oral food challenge with Acarus siro was available, the patient's family implemented avoidance measures by storing food containing flour in the refrigerator, and the patient started subcutaneous immunotherapy (SCIT) with Depigoid Acarus siro. The implementation of avoidance measures led to an immediate improvement of symptoms, and after 3 years of treatment, products containing flour, stored at room temperature, are tolerated again.

Simultaneous oral mite anaphylaxis in siblings, identified by the saturated saline flotation method.

Simultaneous oral mite anaphylaxis in siblings, identified by the saturated saline flotation method.

P3‐15: Oral mite anaphylaxis after ingestion of Korean pancake

P3‐15: Oral mite anaphylaxis after ingestion of Korean pancake

Mititoxic properties of Cucurma longa against a major contributor of oral mite anaphylaxis, the grain mite Suidasia pontifica

ABSTRACT Current investigation aims to evaluate the mititoxic properties of turmeric crude extract (TCE) against Suidasia pontifica – a source of human allergens and major contributor of oral mite anaphylaxis (OMA) or pancake syndrome. Based on the response of S. pontifica, the estimated minimum effective concentration (MEC) of TCE to achieve complete mortality was 2.25–2.50 g/L. Twenty-three chemical components were identified in TCE based on GC-MS analysis. The four major compounds were as follows: aR-tumerone (50.63%), curlone (15.42%), α-curcumene (6.48%), and 3-octanol (5.88%). The TCE was relatively superior in terms of toxicity and volume concentration to control the population of S. pontifica. Further, it can be used as a complement or potential replacement to conventional synthetic acaricides on the market.

Oral mite anaphylaxis: who, when, and how?

To present an update on the recent advances in the understanding of the mechanisms and practical management of oral mite anaphylaxis (OMA, pancake syndrome). Among novel observations regarding OMA, this review highlights the increased prevalence of aspirin/NSAID hypersensitivity inpatients affected by OMA, the association of OMA with exercise-induced anaphylaxis, the presentation of OMA simulating acute asthma, the occurrence of OMA in childhood, the high severity and lethal potential of OMA, the contamination of other foods, such as oat and corn flour with mites, and the simultaneous induction of OMA symptoms in more than one individual exposed to the same food source. OMA is a severe, potentially lethal, acute allergic condition that should be suspected whenever symptoms begin soon after the intake of mite-contaminated foods. Physician awareness on this clinical picture is of paramount importance to establish a correct diagnosis and to implement adequate preventive measures to help patients at risk to avoid its occurrence.

The presence of aeroallergens in food products: a potential risk for the patient with allergic rhinitis

Abstract Clinical entities of food allergy in allergic rhinitis patients due to IgE-sensitization to cross-reactive aeroallergen and food allergen components are well described, but less data are available regarding allergic reactions to foods containing aeroallergens, either due to food contamination, such as oral mite anaphylaxis, or due to their natural presence in the edible products, such as pollen grains in honey and bee products. There are some potential risks for allergic rhinitis subjects due to ingestion of food products containing domestic mite, insect, fungal and pollen allergens. The knowledge of these risks is useful for the allergists and ENT specialists, especially in the context of climate changes with warmer periods facilitating mite growth in flours, and of increase use of phytotherapy and apitherapy products containing pollen grains.

Pancake syndrome – oral mite anaphylaxis

Oral mite anaphylaxis (OMA), known also as pancake syndrome, is characterized by a severe, possibly life-threatening allergic reaction occurring in atopic patients after the consumption of food made with mite-contaminated wheat flour. Mite proliferation can be prevented by storing wheat flour at low temperatures. Affected patients usually have a history of rhinitis, asthma or both. The most common symptoms are breathlessness, face and/or laryngeal angioedema, wheezing, rhinorrhea, cough, dysphagia, and urticaria. OMA should be suspected when the patient presents with a severe allergic reaction associated with the ingestion of wheat flour-based foods. Increased physician awareness is required for early diagnosis and treatment.

A Case of Oral Mite Anaphylaxis Caused by Okonomiyaki mix Contaminated with <i>Dermatophagoides Siboney</i>

A Case of Oral Mite Anaphylaxis Caused by Okonomiyaki mix Contaminated with <i>Dermatophagoides Siboney</i>

Hidden allergens and oral mite anaphylaxis: the pancake syndrome revisited.

To present currently available information on oral mite anaphylaxis. Oral mite anaphylaxis (pancake syndrome) is a new syndrome characterized by severe symptoms triggered by the intake of foods containing mites and their allergens. Breathlessness, face and/or laryngeal angioedema, wheezing, rhinorrhea, cough, dysphagia, and wheals are the most frequent clinical manifestations. Pancake syndrome can occur in individuals at any age and in any geographical location. Foods made with wheat and corn flour, especially pancakes, are the most common inducers of the clinical picture. Both, domestic and storage mites have been incriminated. Increased physician awareness is required for early diagnosis and treatment, and for the prevention of future episodes in predisposed individuals.

Anafilaxia oral por ingestión de alimentos contaminados con ácaros en Ciudad de Panamá, 2011-2014

Antecedentes: la anafilaxia oral por ácaros, o síndrome de las panquecas, ocurre cuando individuos atópicos ingieren alimentos elaborados con harina de trigo contaminada con ácaros, lo que induce reacciones alérgicas moderadas o severas, incluso fatales. Los reportes provienen de ambientes tropicales y subtropicales, donde las condiciones para la proliferación de ácaros domésticos son favorables. Se ha encontrado una asociación importante con la hipersensibilidad a ácido acetilsalicílico (AAS)-antiinflamatorios no esteroides (AINES) y el ejercicio físico. Objetivo: documentar el estudio clínico y descriptivo de casos de anafilaxia oral por ácaros atendidos en Ciudad de Panamá durante los años 2011 a 2014.Material y método: estudio clínico descriptivo y retrospectivo, que incluyó pruebas cutáneas de punción para cinco especies de ácaros domésticos. La identificación taxonómica de los ácaros se realizó bajo microscopio y se calculó la densidad de ácaros por gramo de alimento en tres casos.Resultados: se estudiaron 10 casos compatibles con anafilaxia oral por ácaros, la panqueca fue el alimento implicado con más frecuencia. Los primeros síntomas aparecieron entre 25 y 60 minutos después de la ingestión del alimento. Todos los pacientes fueron adultos jóvenes atópicos, cuatro con hipersensibilidad a AAS-AINES. Los pacientes resultaron positivos a las pruebas cutáneas de punción para los ácaros: Blomia tropicalis, Dermatophagoides pteronyssinus y Suidasia pontifica. Tres muestras de harina de trigo estudiadas motraron altas densidades de ácaros.Conclusiones: la panqueca fue el alimento implicado con más frecuencia en los casos de anafilaxia oral por ácaros. Suidasia pontifica y Blomia tropicalis parecen ser los ácaros más importantes relacionados con este síndrome en nuestro país.

Dust mite infestation in cooking flour: experimental observations and practical recommendations

The first documented case of oral mite anaphylaxis has recently been reported in Thailand, with mites possibly originating from cooking flour. Our study was designed to assess the effects of cooking flours enhancement and storage conditions on mite proliferation and to provide practical recommendations to prevent mite anaphylaxis. In a factorial experiment, six commercial brands of cooking flours were selected and either inoculated or set free of mites and stored in one of the four containers chosen for the study: original package, plastic bag, plastic box and glass bottle. The resulting experimental units where then stored at either room temperature or in a refrigerator (+4C). In order to determine levels of Der f 1 allergen, 0.1 gram of flour was sampled from each experimental unit and tested by ELISA. Sampling was carried out immediately after inoculation and subsequently at week 2, 4, 6, 8, 10, 12, 16 and 20. Levels of Der f 1 allergen in the inoculated samples increased significantly in all conditions 6 weeks after inoculation (p <0.001) and reached the highest levels at week 8. While experimental units left at room temperature showed higher levels of mite growth (p <0.001), no statistical differences were found among types of containers. The highest amount of Der f 1 was observed for Gogi, followed by Gold Label, tempura flour, corn flour, wheat flour and tapioca starch, respectively (p <0.01). In the context of our experiment, mites preferably grew in cooking flours containing high amounts of wheat at room temperature, particularly after 8 week of storage. According to our results, we thus advise to keep household cooking flour refrigerated and while the type of container does not matter, storage should not exceed 20 weeks.

Conditions Affect Dust Mite Infestation Of Flour Samples In Tropical Area

RationaleOral mite anaphylaxis is caused by ingestion of dust mite-contaminated flour in sensitized subjects. The type of flour, storage temperature and relative humidity influence mite propagation. The study aimed to investigate conditions affected the development of mite in order to provide appropriate flour storage instruction in a tropical country.MethodsDermatophagoides farinae(Der f) were inoculated in six types of cooking flour; two types of self-rising flour, plain wheat flour, tempura batter mix containing wheat flour, corn flour and tapioca starch. The samples were stored in different containers and kept in two conditions; at room temperature (mean temperature=26.6;range 25-28.9°C,mean relative humidity=69.6; range 60-77.3%) and in a refrigerator (mean temperature=8.2; range 2-12.2°C, mean relative humidity=36.7; range 22-51.4%) for 20 weeks. The analysis of Der f1 allergen levels was performed every 2 weeks by ELISA assay.ResultsDer f1 allergen levels at 6 weeks were significantly higher than baseline in both storage conditions regardless of container types(P<0.001). The maximum levels of Derf1 were found at 8 weeks. Comparing between the two storage conditions, room temperature storage enhanced growth of dust mites in all types of flour(P<0.001). Different types of flour had different influence on mite propagation. Self-rising flours yielded the highest numbers of mites followed by tempura batter mix containing wheat flour, plain wheat flour, corn flour and tapioca starch respectively (P<0.01).ConclusionsBoth storage conditions and types of flour affect dust mite infestation. In tropical regions, cooking flour should be kept refrigerate for no longer than 6 weeks in order to prevent significant mite propagation. RationaleOral mite anaphylaxis is caused by ingestion of dust mite-contaminated flour in sensitized subjects. The type of flour, storage temperature and relative humidity influence mite propagation. The study aimed to investigate conditions affected the development of mite in order to provide appropriate flour storage instruction in a tropical country. Oral mite anaphylaxis is caused by ingestion of dust mite-contaminated flour in sensitized subjects. The type of flour, storage temperature and relative humidity influence mite propagation. The study aimed to investigate conditions affected the development of mite in order to provide appropriate flour storage instruction in a tropical country. MethodsDermatophagoides farinae(Der f) were inoculated in six types of cooking flour; two types of self-rising flour, plain wheat flour, tempura batter mix containing wheat flour, corn flour and tapioca starch. The samples were stored in different containers and kept in two conditions; at room temperature (mean temperature=26.6;range 25-28.9°C,mean relative humidity=69.6; range 60-77.3%) and in a refrigerator (mean temperature=8.2; range 2-12.2°C, mean relative humidity=36.7; range 22-51.4%) for 20 weeks. The analysis of Der f1 allergen levels was performed every 2 weeks by ELISA assay. Dermatophagoides farinae(Der f) were inoculated in six types of cooking flour; two types of self-rising flour, plain wheat flour, tempura batter mix containing wheat flour, corn flour and tapioca starch. The samples were stored in different containers and kept in two conditions; at room temperature (mean temperature=26.6;range 25-28.9°C,mean relative humidity=69.6; range 60-77.3%) and in a refrigerator (mean temperature=8.2; range 2-12.2°C, mean relative humidity=36.7; range 22-51.4%) for 20 weeks. The analysis of Der f1 allergen levels was performed every 2 weeks by ELISA assay. ResultsDer f1 allergen levels at 6 weeks were significantly higher than baseline in both storage conditions regardless of container types(P<0.001). The maximum levels of Derf1 were found at 8 weeks. Comparing between the two storage conditions, room temperature storage enhanced growth of dust mites in all types of flour(P<0.001). Different types of flour had different influence on mite propagation. Self-rising flours yielded the highest numbers of mites followed by tempura batter mix containing wheat flour, plain wheat flour, corn flour and tapioca starch respectively (P<0.01). Der f1 allergen levels at 6 weeks were significantly higher than baseline in both storage conditions regardless of container types(P<0.001). The maximum levels of Derf1 were found at 8 weeks. Comparing between the two storage conditions, room temperature storage enhanced growth of dust mites in all types of flour(P<0.001). Different types of flour had different influence on mite propagation. Self-rising flours yielded the highest numbers of mites followed by tempura batter mix containing wheat flour, plain wheat flour, corn flour and tapioca starch respectively (P<0.01). ConclusionsBoth storage conditions and types of flour affect dust mite infestation. In tropical regions, cooking flour should be kept refrigerate for no longer than 6 weeks in order to prevent significant mite propagation. Both storage conditions and types of flour affect dust mite infestation. In tropical regions, cooking flour should be kept refrigerate for no longer than 6 weeks in order to prevent significant mite propagation.

Oral Mite Anaphylaxis Caused by Mite-Contaminated Okonomiyaki/Pancake-Mix in Japan: 8 Case Reports and a Review of 28 Reported Cases

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.In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan.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.Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

Pancake syndrome induced by ingestion of tempura

Funding sources: none. Conflicts of interest: none declared. Dear Editor, Pancake syndrome is oral mite anaphylaxis caused by eating food prepared with wheat flour contaminated with mites. More than 135 cases occurring in various countries located in tropical and subtropical areas have been reported.1 The most common culprit food is a pancake, although various foods containing flour have reportedly been causative. In cases of this disease in Japan, the causative foods have been confined to okonomiyaki and takoyaki, both of which are popular in the Kansai region of Japan.2 To our knowledge, this is the first report of pancake syndrome induced by ingestion of tempura, a well‐known Japanese dish. A 16‐year‐old girl suddenly felt obstruction of the throat and developed facial oedema 2 min after ingestion of shrimp tempura, and was transferred by ambulance to the emergency outpatient service of our hospital. She had mild atopic eczema but no history of anaphylaxis or allergic reaction to seafood. Her level of consciousness was slightly depressed at that time. Her systolic/diastolic blood pressures were 101/76 mmHg and her pulse rate was 100 beats per minute. Oxygen saturation was 93%. Her face was markedly swollen but no weals were observed. Laboratory tests (haemogram and blood chemistry) showed no abnormal findings. A diagnosis of anaphylaxis was made, and she received an infusion of extracellular fluid and an antihistamine with quick relief of symptoms.

Anaphylaxis from ingestion of mites: Pancake anaphylaxis

Oral mite anaphylaxis is a new syndrome characterized by severe allergic symptoms occurring immediately after eating foods made with mite-contaminated wheat flour. This syndrome, which is more prevalent in tropical environments, is triggered more often by pancakes, and for that reason, it has been designated "the pancake syndrome." Because cooked foods are able to induce the symptoms, it has been suggested that thermoresistant allergens are involved in its pathogenesis. A variety of this syndrome can occur during physical exercise (dust mite ingestion-associated exercise-induced anaphylaxis).

402 Oral Mite Anaphylaxis is Caused by Mite-contaminated Okonomiyaki Mix in Japan

BackgroundAnaphylaxis after the ingestion of foods contaminated with mites has recently been reported. It is an immediate and potentially life-threatening reaction in patients with previous allergic rhinitis and/or asthma following the ingestion of mite-contaminated foods. 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 encountered 8 cases of oral mite anaphylaxis in our hospital not caused by mite-contaminated wheat flour but by mite-contaminated okonomiyaki mix.MethodsTo review the current literature, in addition to our patients, we performed a MEDLINE search of articles on oral mite anaphylaxis in Japan up to June 2011 and collected patient characteristics, interview contents, results on specific IgE against mites, wheat, and pollen and other antigens, results of skin prick tests including those using extracts from mites and/or culprit flours, and microscopic examination results.ResultsWe found thirty oral mite anaphylaxis patients in Japan twenty-eight (93.3%) of whom ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki mix (24 patients) or takoyaki mix (4 patients), respectively, which was previously opened and stored for months at ambient temperature. Takoyaki mix is similar to okonomiyaki mix, which is composed of flour, dried scallop, bonito, and mackerel. The other 2 patients ingested pancake mix. Microscopic examination of thirteen patients’ mixes revealed contaminating mites. Thyreophagus putrescentiae, Dermatophagoides pteronyssinus, Dermatophagoides farinae were found in mix samples of 4, 3, and 3 patients, respectively. The specific IgE against each mite is generally upregulated, which might be affected by cross-reactivities to other mites. Especially, the specific IgEs to Dermatophagoides pteronyssinus and Dermatophagoides farina were more than class 2 in all cases. It is suggested that mites are attracted to the flavors of okonomiyaki and takoyaki mixes and invade from a crack in a flour sack, and proliferate under favorable conditions.ConclusionsMite-contaminated flavored mix is a major cause of oral mite anaphylaxis in Japan.

Mite-induced Inflammation: More than Allergy

Clinical observations have suggested that there is an association of atopic conditions with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). This relationship has been especially present in patients allergic to mites. This study was designed to review clinical and experimental evidence linking atopy, mite allergy, and hypersensitivity to aspirin and NSAIDs and discuss the possible mechanisms explaining this association. A review of the medical literature concerning the association of atopic diseases, mite hypersensitivity, and intolerance to NSAIDs using PubMed and other relevant articles is presented. NSAID-sensitive patients are frequently atopic and allergic to mites, and patients who develop oral mite anaphylaxis (OMA) show an increased prevalence of NSAID hypersensitivity. The study of atopic, mite-sensitive patients, who experience urticaria and angioedema when exposed to NSAIDs and patients with OMA suggests an interesting interaction between atopic allergy and disorders of leukotriene synthesis or metabolism. Various mechanisms that could be involved in this interaction are presented, including genetic factors, inhibition of cyclooxygenase-1, and other effects (not related to IgE sensitization) of mite constituents on the immune system. The association of mite hypersensitivity with aspirin/NSAIDs intolerance has been confirmed and provides additional clues to various nonallergic pathways that may contribute to the acute and chronic inflammatory process observed in atopic, mite-allergic, individuals. The clinical relevance of these observations is presently under investigation.

Pancake Syndrome (Oral Mite Anaphylaxis)

Oral mite anaphylaxis is a new syndrome characterized by severe allergic manifestations occurring in atopic patients shortly after the intake of foods made with mite-contaminated wheat flour. This clinical entity, observed more frequently in tropical/subtropical environments, is more often triggered by pancakes and for that reason it has been designated "pancake syndrome". Because cooked foods are able to induce the symptoms, it has been proposed that thermoresistant allergens are involved in its production. A novel variety of this syndrome occurs during physical exercise and therefore has been named dust mite ingestion-associated exercise-induced anaphylaxis. To prevent mite proliferation and the production of anaphylaxis, it has been recommended that wheat flour be stored at low temperatures in the refrigerator.

An update on oral anaphylaxis from mite ingestion

To review systemic reactions due to the oral ingestion of mites. We performed a MEDLINE search of peer-reviewed research articles published between 1993 and 2004 relevant to the subject of anaphylactic reactions to mite-contaminated foods. Recent studies that emphasized the potentially life-threatening nature of anaphylactic reactions, responsible foodstuffs and mites, populations at risk, and pathogenesis were selected for inclusion in this review. Although relatively few new cases of oral mite anaphylaxis are reported in the literature, we speculate that this clinical condition is occurring more frequently than realized in many geographic locations, and only the suspicion of an informed physician can contribute to its diagnosis and prevention. Oral anaphylaxis from mite-contaminated foods may be lethal if not promptly recognized and treated, and some preventive measures may be helpful for individuals at risk. Frequent cross-reactions among domestic, storage, and phytophagous mites explain the increased risk of oral mite anaphylaxis in sensitive patients living in both urban and rural areas. The enzymatic activity of some mite allergens contributes to the pathogenesis of this syndrome by means of mucosal damage and enhanced allergen absorption through the oral route. Oral mite anaphylaxis is a severe, potentially lethal allergic condition that occurs in many countries and is frequently undiagnosed. Early recognition may lead to the implementation of simple prophylactic measures in at-risk populations of allergic patients.