Department of Pediatrics and Neonatology, Guglielmo da Saliceto Hospital, Piacenza, Italy.
Department of Translational Medical Science - Pediatric Section, University "Federico II", Naples, Italy.
J Med Case Rep. 2021 May 14;15(1):235. doi: 10.1186/s13256-021-02823-4.
Honey is a rare cause of food allergy, especially in children, but it can cause severe systemic allergic reactions. In the pediatric age group, only a few cases have been reported in the literature. Honey allergy may be caused by pollen content or bee-derived proteins. A role for Compositae has been suggested among pollen allergens. Allergology workup of a patient with suspected honey allergy is not well defined. Here we describe a rare case of anaphylaxis in a 5-year-old boy, sensitized to Compositae pollen (ragweed and mugwort), after the ingestion of artisanal honey.
The Slavic patient was referred to our hospital emergency department for generalized urticaria and breathing impairment. All the symptoms occurred approximately 30 minutes after the ingestion of a meal containing salmon and artisanal honey. The allergology workup revealed that a skin prick-by-prick test with the implicated artisanal honey was positive, while a variety of different commercial honey and salmon products yielded negative results. Skin prick test and serum-specific immunoglobulin E (IgE) results were also positive for Compositae pollen (ragweed and mugwort). Patients sensitized to weed pollens who ingest bee products may experience an immediate allergic reaction because of the cross-reaction between weed pollens and Compositae bee product pollen. In this case, primary sensitization may be due to airborne Compositae pollen. Commercial honey is heavily processed due to pasteurization and filtration, which removes most of the pollen. These observations highlight the role of Compositae pollen in the observed allergic reaction and suggest that the different pollen content in the artisanal honey relative to commercial honey was responsible for the allergic reaction in our patient.
This is the first reported pediatric case of honey-induced anaphylaxis in a child under 6 years of age sensitized to Compositae pollen. Pediatricians should be aware of the potential risk of severe allergic reactions upon ingestion of honey and bee products, especially in patients sensitized to weed pollens. To diagnose honey allergy, obtaining a proper clinical history is essential. In addition, skin prick-by-prick tests are helpful, and may represent a simple method to screen for honey allergy in patients sensitized to Compositae pollen, in light of the potential risk.
蜂蜜是一种罕见的食物过敏原，尤其在儿童中，但它可引起严重的全身性过敏反应。在儿科年龄组中，文献中仅报道了少数几例。蜂蜜过敏可能是由花粉含量或源自蜜蜂的蛋白质引起的。花粉过敏原中已提出菊科植物的作用。疑似蜂蜜过敏患者的过敏症检查并未得到很好的定义。在这里，我们描述了一例 5 岁男孩的过敏反应病例，该患者对花粉（豚草和艾蒿）过敏，在摄入手工蜂蜜后发生了过敏反应。
这位斯拉夫患者因全身性荨麻疹和呼吸障碍被转诊到我们医院的急诊部门。所有症状大约在摄入含鲑鱼和手工蜂蜜的餐后 30 分钟后出现。过敏症检查显示，用可疑的手工蜂蜜进行皮内点刺试验呈阳性，而各种不同的商业蜂蜜和鲑鱼产品结果为阴性。皮内点刺试验和血清特异性免疫球蛋白 E（IgE）结果对花粉（豚草和艾蒿）也呈阳性。摄入蜂产品的杂草花粉致敏患者可能会因杂草花粉与菊科蜜蜂产品花粉之间的交叉反应而发生立即过敏反应。在这种情况下，初级致敏可能是由于空气中的花粉引起的。由于巴氏灭菌和过滤，商业蜂蜜经过了大量加工，从而去除了大部分花粉。这些观察结果突出了花粉在观察到的过敏反应中的作用，并表明与商业蜂蜜相比，手工蜂蜜中的花粉含量不同是导致我们患者过敏反应的原因。
这是首例报道的 6 岁以下儿童对花粉过敏的蜂蜜过敏引起的过敏反应病例。儿科医生应注意摄入蜂蜜和蜂产品后发生严重过敏反应的潜在风险，尤其是对杂草花粉过敏的患者。为了诊断蜂蜜过敏，获取适当的临床病史至关重要。此外，皮内点刺试验很有帮助，并且鉴于潜在风险，对于花粉过敏的患者，它可能是一种筛查蜂蜜过敏的简单方法。
