Respiratory hypersensitivity reaction related to ingestion of raspberry

IF 1.1 Q4 ALLERGY
Yuki Akamatsu MD, Yoshio Kawakami MD, PhD, Shusaku Fujita MD, Tomoko Kawamoto MD, Tomoko Miyake MD, PhD, Yoji Hirai MD, PhD, Shin Morizane MD, PhD
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Multiple antigen simultaneous test (MAST)-36 (BML Inc) to examine allergen-specific IgE showed 15.2 lumicount (LC) (class 3) of cat dander and 4.89 LC (class 2) of dog dander, whereas the other results were negative. Specific IgE antibodies to strawberry, peach, apple, walnut, Jug r1, egg yolk, egg white, ovomucoid, gluten, ω-5 gliadin, birch pollen tested by CAP fluoro-enzyme immunoassay (CAP-FEIA) and prick-to-prick tests with ingredients of the cake and their related foods, including raspberry, strawberry, blackberry, blueberry, apple, walnut, almond, peanut, wheat, egg yolk, and egg white, were all negative. Then, an open oral provocation test was performed on admission initially with raspberry. Twenty minutes after eating 1.5 pieces of raspberry (about 4.5 g), she developed discomfort of the throat, dyspnea, repetitive cough, audible wheezing, and tachycardia (145 beats/min). Cutaneous symptoms were absent except for mild pruritus of the neck. Her blood pressure and percutaneous oxygen saturation (SpO2) levels were normal. She was treated with intravenous administration of 4 mg betamethasone and 5 mg chlorpheniramine, followed by an intramuscular injection of 0.3 mg adrenaline. Within 10 min, the patient's dyspnea and tachycardia subsided without sequelae. Further investigation with CD203c expression-based basophil activation test (BAT) to raspberry was negative. After avoiding raspberry and all the other berries, as well as still unchallenged walnuts, she has not experienced any episode of acute respiratory reactions for 3 years.</p><p>Raspberry (<i>Rubus idaeus</i>) is a small fruit belonging to the <i>Rosaceae</i> family: subfamily <i>Rosoideae</i> along with strawberry. 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引用次数: 0

Abstract

A 27-year-old woman developed dyspnea and wheezing within 10 min after eating a piece of raspberry walnut cake, and visited an emergency hospital. Based on a presumptive diagnosis of anaphylaxis, she was successfully treated with intravenous corticosteroid and intramuscular injection of adrenaline. She was referred for further investigation. Her medical history included mild asthma, cat allergy, and bipolar disorder, being treated with pranlukast, quetiapine, lamotrigine, and lorazepam. She could eat bread containing wheat and heated eggs without problem after this attack. Laboratory tests showed normal serum level of immunoglobulin (Ig) E 44 IU/mL. Multiple antigen simultaneous test (MAST)-36 (BML Inc) to examine allergen-specific IgE showed 15.2 lumicount (LC) (class 3) of cat dander and 4.89 LC (class 2) of dog dander, whereas the other results were negative. Specific IgE antibodies to strawberry, peach, apple, walnut, Jug r1, egg yolk, egg white, ovomucoid, gluten, ω-5 gliadin, birch pollen tested by CAP fluoro-enzyme immunoassay (CAP-FEIA) and prick-to-prick tests with ingredients of the cake and their related foods, including raspberry, strawberry, blackberry, blueberry, apple, walnut, almond, peanut, wheat, egg yolk, and egg white, were all negative. Then, an open oral provocation test was performed on admission initially with raspberry. Twenty minutes after eating 1.5 pieces of raspberry (about 4.5 g), she developed discomfort of the throat, dyspnea, repetitive cough, audible wheezing, and tachycardia (145 beats/min). Cutaneous symptoms were absent except for mild pruritus of the neck. Her blood pressure and percutaneous oxygen saturation (SpO2) levels were normal. She was treated with intravenous administration of 4 mg betamethasone and 5 mg chlorpheniramine, followed by an intramuscular injection of 0.3 mg adrenaline. Within 10 min, the patient's dyspnea and tachycardia subsided without sequelae. Further investigation with CD203c expression-based basophil activation test (BAT) to raspberry was negative. After avoiding raspberry and all the other berries, as well as still unchallenged walnuts, she has not experienced any episode of acute respiratory reactions for 3 years.

Raspberry (Rubus idaeus) is a small fruit belonging to the Rosaceae family: subfamily Rosoideae along with strawberry. To the best of our knowledge, there have been only five reported cases of hypersensitivity reactions related to raspberry including our case (Table 1).1-4 Three cases had evidence of cross-reactivities with other fruits belonging to Rosaceae family, such as strawberry (n = 2), and/or rPru p 3 (n = 2) from peach.2-4 Our case demonstrated negative results on the skin-prick test, which is reliable but not infallible, exhibiting an 85% sensitivity rate.5 Despite a lack of cutaneous or mucosal involvement, our case demonstrated the acute onset of laryngeal involvement after exposure to a probable allergen and fulfilled one of the amended criteria for the diagnosis of anaphylaxis.6 Anaphylaxis often involves isolated respiratory or cardiovascular symptoms.7 In our case, the specific IgE to birch was negative, and no symptoms of tingling or edema of the oral mucosa were observed before the respiratory symptoms developed. Therefore, our case is more likely to be classified as class 1 food allergy, which is sensitized through the gastrointestinal tract, rather than classified as oral allergy syndrome.8

The authors declare no conflicts of interest.

Approval of the research protocol: No human participant was involved in this study.

Informed Consent: N/A.

Registry and the Registration No. of the study/trial: N/A.

Animal Studies: N/A.

与摄入树莓有关的呼吸道超敏反应
一名27岁的女性在吃了一块覆盆子核桃蛋糕后10分钟内出现呼吸困难和喘息,并前往急救医院。基于过敏反应的推定诊断,她成功地通过静脉注射皮质类固醇和肌肉注射肾上腺素治疗。她被转介接受进一步调查。病史包括轻度哮喘、猫过敏和双相情感障碍,曾用普鲁卡斯特、喹硫平、拉莫三嗪和劳拉西泮治疗。这次发作后,她可以吃含小麦的面包和热鸡蛋了。实验室检查显示血清免疫球蛋白(Ig) E水平正常,为44 IU/mL。多抗原同时检测(MAST)-36 (BML Inc .)检测过敏原特异性IgE的结果显示,猫皮屑的lumicount (LC)(3类)为15.2,狗皮屑的lumicount(2类)为4.89,其他结果均为阴性。用CAP荧光酶免疫法(CAP- feia)检测草莓、桃子、苹果、核桃、Jug r1、蛋黄、蛋清、卵泡样蛋白、面筋、ω-5麦胶蛋白、桦树花粉的特异性IgE抗体,并用覆盆子、草莓、黑莓、蓝莓、苹果、核桃、杏仁、花生、小麦、蛋黄、蛋清等原料进行刺点试验,均为阴性。然后,在入院时进行开放的口腔激发试验,最初使用覆盆子。进食1.5片覆盆子(约4.5 g) 20分钟后,患者出现咽喉不适、呼吸困难、反复咳嗽、可闻喘息、心动过速(145次/分)。除颈部轻微瘙痒外,无皮肤症状。她的血压和经皮氧饱和度(SpO2)水平正常。静脉给予倍他米松4mg、氯苯那敏5mg,随后肌内注射肾上腺素0.3 mg。10分钟内,患者呼吸困难和心动过速消退,无后遗症。进一步研究基于CD203c表达的嗜碱性粒细胞激活试验(BAT)对覆盆子的影响为阴性。在不吃覆盆子和所有其他浆果,以及仍然没有挑战的核桃之后,她3年来没有出现任何急性呼吸反应。树莓(Rubus idaeus)是一种小型水果,属于蔷薇科:与草莓一起属于蔷薇亚科。据我们所知,只有5例与覆盆子相关的过敏反应报告,包括我们的病例(表1)。1-4例与蔷薇科的其他水果有交叉反应的证据,如草莓(n = 2)和/或来自桃子的rPru p3 (n = 2)。2-4本病例的皮肤点刺试验结果为阴性,这是可靠的,但并非绝对正确,敏感性为85%尽管没有皮肤或粘膜受累,我们的病例显示,暴露于可能的过敏原后,急性发作的喉部受累,符合过敏反应诊断的修订标准之一过敏反应通常包括孤立的呼吸道或心血管症状在我们的病例中,桦树的特异性IgE为阴性,在呼吸道症状出现之前,没有观察到口腔粘膜刺痛或水肿症状。因此,我们的病例更有可能被归类为通过胃肠道致敏的1类食物过敏,而不是被归类为口腔过敏综合征。作者声明无利益冲突。批准研究方案:本研究未涉及人类受试者。知情同意:无。注册处及注册编号研究/试验:无。动物研究:无。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.60
自引率
10.00%
发文量
69
审稿时长
12 weeks
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