A Case of Mite-Ingestion-Associated Exercise- Induced Anaphylaxis Mimicking Wheat-Dependent Exercise-Induced Anaphylaxis

Abstract

We present a case of mite-ingestion-associated exercise-induced anaphylaxis mimicking wheat-dependent exercise-induced anaphylaxis (WDEIA). A 17-year-old boy was referred for an episode of anaphylaxis while jogging, 1.5 h after having eaten okonomiyaki (a Japanese pancake). Laboratory measures revealed a slightly elevated specific immunoglobulin E (IgE) antibody against omega-5 gliadin (0.41 kU_A/l) and a marked elevation of specific IgE antibody against house-dust mite, Dermatophagoides farinae (142 kU_A/l). A detailed interview revealed that, in spite of the referring doctor's advice to discontinue postprandial exercises, he continued his jogging routine after consuming foods containing wheat and also that his younger brother, who had mild intermittent asthma, had suffered a mild asthma attack 2 h after eating the same food. We therefore examined the okonimiyaki mix, which had been stored for several months after opening the package until this episode, under a microscope, and we found an abundant number of live mites, D. farinae. Finally, a diagnosis of mite-ingestion-associated exercise-induced anaphylaxis was made. This clinical entity should be excluded when making a diagnosis of WDEIA.

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“…The association of OMA with exercise-induced anaphylaxis has been reported by two groups of investigators, and this clinical pattern has been designated as dust mite ingestion-associated exerciseinduced anaphylaxis [20,21].…”

Food allergen‐sensitized CCR9+ lymphocytes enhance airways allergic inflammation in mice

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“…Later reports have described similar findings [48–54]. The name Pancake Syndrome derives from the commonality of patients being infected by mite-contaminated flour products.…”