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

Erika de Arruda-Chaves; Yolanda Scavino Levy; Enrique Fernandez-Caldas; Mario Sánchez Borges(†)

doi:10.5935/2526-5393.20230042-en

Clinical and Experimental Communication

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

Anafilaxia por ingesta de ácaros (Síndrome da panqueca) no Peru: um problema subestimado?

Erika de Arruda-Chaves; Yolanda Scavino Levy; Enrique Fernandez-Caldas; Mario Sánchez Borges(†)

http://dx.doi.org/10.5935/2526-5393.20230042-en Arq Asma Alerg Imunol, vol.7, n3, p.292-297, 2023

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Abstract

Urticaria and angioedema are known to have different etiologies, as they can be allergic, infectious, autoimmune, or spontaneous in nature. In single or recurrent episodes, a hidden triggering allergen should be considered, such as house dust mites (HDMs). Several reports have demonstrated that flours contaminated with HDMs can cause urticaria and angioedema, including severe lifethreatening allergic reactions when ingested in large quantities from stored wheat flour. In this study, we report the clinical findings in 31 patients, including cases of anaphylaxis after the ingestion of mite-contaminated flour. We also found a relationship between a clinical history of hypersensitivity to nonsteroidal anti-inflammatory drugs and oral mite anaphylaxis syndrome in atopic patients, consistent with the theory of a “new aspirin triad,” as previously published, and now being described for the first time in Peru.

Keywords

Urticaria, angioedema, mites, anaphylaxis, flour.

Resumo

Sabe-se que a urticária e o angioedema apresentam diferentes etiologias, pois podem ser de natureza alérgica, infecciosa, autoimune ou espontânea. Em episódios únicos ou recorrentes, deve-se considerar um alérgeno desencadeante oculto, como os ácaros de poeira doméstica (APDs). Vários relatos demonstraram que farinhas contaminadas com APDs podem causar urticária e angioedema, incluindo reações alérgicas graves com risco de vida quando ingeridos em grandes quantidades provenientes de farinha de trigo armazenada. Neste estudo, relatamos os achados clínicos de 31 pacientes, incluindo casos de anafilaxia após ingestão de farinha contaminada com ácaros. Também encontramos uma relação entre uma história clínica de hipersensibilidade a anti-inflamatórios não esteroides e síndrome de anafilaxia por ingesta de ácaros em pacientes atópicos, consistente com a teoria de uma “nova tríade do ácido acetilsalicílico”, conforme publicado anteriormente, e agora sendo descrito pela primeira vez no Peru.

Palavras-chave

Urticária, angioedema, ácaros, anafilaxia, farinha.

References

1. Erben AM, Rodriguez JL, McCullough J, Ownby DR. Anaphylaxis after ingestion of beignets contaminated with Dermatophagoides farinae. J Allergy Clin Immunol. 1993 Dec;92(6):846-9.

2. Sánchez-Borges M, Fernandez-Caldas E. Hidden allergens and oral mite anaphylaxis: the pancake syndrome revisited. Curr Opin Allergy Clin Immunol. 2015 Aug;15(4):337-43.

3. Spieksma FT, Dieges PH. The history of the finding of the house dust mite. J Allergy Clin Immunol. 2004 Mar;113(3):573-6.

4. Sánchez-Borges M, Suárez-Chacón R, Capriles-Hulett A, CaballeroFonseca F. An update on oral anaphylaxis from mite ingestion. Ann Allergy Asthma Immunol. 2005 Feb;94(2):216-20.

5. Matsumoto T, Hisano T, Hamaguchi M, Miike T. Systemic anaphylaxis after eating storage-mite-contaminated food. Int Arch Allergy Immunol. 1996 Feb;109(2):197-200.

6. Blanco C, Quiralte J, Castillo R, Delgado J, Arteaga C, Barber D, Carrillo T. Anaphylaxis after ingestion of wheat flour contaminated with mites. J Allergy Clin Immunol. 1997 Mar;99(3):308-13.

7. Sánchez-Borges M, Suárez-Chacon R, Capriles-Hulett A, CaballeroFonseca F, Iraola V, Fernández-Caldas E. Pancake Syndrome (Oral Mite Anaphylaxis). World Allergy Organ J. 2009 May;2(5):91-6.

8. Kasti GL, Codina R, Ledford DR, Lockey RF. Mite contamination of food stuffs. J Allergy Clin Immunol. 1998;101:24-5.

9. Moreira MR, Mendonça MR, Gomes-Junior EA, Souza GG, Gervásio AM, Sopelete MC, et al. Sensibilização a alérgenos inaláveis domiciliares em pacientes asmáticos em Uberlândia, MG. Rev Bras Alergia Imunopatol. 2001;24:11-21.

10. Arruda-Chaves E. Nuevos aspectos en el tratamiento de la rinitis alérgica. Rev Peruana de Pediatria. 2002;55:100-4.

11. Spieksma FThM, Zuidema P, Leupen MJ. High Altitude and Housedust Mites. Br Med J. 1971 Jan 9;1(5740):82-4.

12. Valdivieso R, Iraola V, Estupiñán M, Fernández-Caldas E. Sensitization and exposure to house dust and storage mites in high-altitude areas of Ecuador. Ann Allergy Asthma Immunol. 2006 Oct;97(4):532-8.

13. Sanchez Medina M, Zarante I. Dust mites at high altitude in a tropical climate. J Allergy Clin Immunol. 1996;97:1t67-8.

14. Takahashi K, Taniguchi M, Fukutomi Y, Sekiya K, Watai K, Mitsui C, et al. Oral mite anaphylaxis caused by mite-contaminated okonomiyaki/ pancake-mix in Japan: 8 case reports and a review of 28 reported cases. Allergol Int. 2014 Mar;63(1):51-6.

15. Cain G, Elderfield AJ, Green R, Smillie FI, Chapman MD, Custovic A, et al. The effect of dry heat on mite, cat, and dog allergens. Allergy. 1998 Dec;53(12):1213-5.

16. Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bousquet J, et al. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA(#) and GA2LEN/HANNA*. Allergy. 2011 Jul;66(7):818-29.

17. Asero R. Intolerance to nonsteroidal anti-inflammatory drugs might precede by years the onset of chronic urticaria. J Allergy Clin Immunol.2003;111:1095-8.

18. Sánchez-Borges M, Fernández-Caldas E, Capriles-Hulett A, Caballero-Fonseca F. Mite-induced inflammation: More than allergy. Allergy Rhinol (Providence). 2012;3(1):e25-9.

Submitted date:
06/12/2023

Accepted date:
07/20/2023