Orga-Dumitriu Dan, Harris Dana M, Porr Corina
Internal Medicine Department, Faculty of Medicine, Lucian Blaga University, 550169 Sibiu, Romania.
Internal Medicine Department, Mayo Clinic, Jacksonville, FL 32224, USA.
J Clin Med. 2024 Sep 4;13(17):5243. doi: 10.3390/jcm13175243.
: Urticaria is a common disease with a marked influence on quality of life. The key cell involved is the mast cell, which can be activated by a vast variety of stimuli, and the major mediator is histamine. Allergic urticaria is a disorder with a large variety of causes: food, drugs, insect venom, skin contact with allergens, and physical exercise. Buckwheat consumption has increased in European countries and the USA because it is gluten-free. It can trigger anaphylactic shock if ingested, inhaled, or handled with the hands. Five common buckwheat allergens named Fag e1 to 5 (Fag e1, 2, and 3 are considered the major allergens) and two tartary buckwheat allergens named Fag t1 and Fag t2 have been described. : We present the case of a patient who experienced two anaphylactic shocks and in whom the etiological factor was buckwheat. The patient presented to the Allergology department for the evaluation of two episodes of severe allergic reactions that required emergency therapy, episodes that involved the loss of consciousness and were of major severity. At each anaphylactic shock, an ambulance was requested, and emergency therapy was administered, leading to the patient's recovery within a few hours. : Since each episode occurred a few minutes after eating, the diagnosis was established based on a detailed anamnesis and prick skin tests, followed by specific IgE dosages. Other foods consumed by the patient, assessed by prick skin testing and specific IgE dosages of suspected foods, were excluded as the etiological cause. Increased levels of buckwheat-specific immunoglobulin E were highlighted, thus identifying the etiological agent. The treatment of anaphylactic shock was performed urgently by the ambulance crew with adrenaline, infusion solutions, cortisone preparations, and antihistamines. : Following the treatment that was initiated, there was a partial remission of the lesions after a few hours. : Buckwheat allergy is rare, but it produces symptoms that affect the skin, gastrointestinal tract, and respiratory tract, as well as anaphylaxis. In a professional environment, it can trigger allergic rhinitis, asthma, and hives. Although buckwheat allergens have been described, their clinical relevance has only been studied in a small number cases. In current practice, the only commercially available allergen is Beech e2 per the ImmunoCAP ISAC microarray. Diagnosis can be difficult in clinical practice. This reported case suggests the need for a thorough anamnesis, since buckwheat is consumed as a hidden allergen, and in Europe, it is not necessary to label foods containing this allergen.
荨麻疹是一种对生活质量有显著影响的常见疾病。其中关键的细胞是肥大细胞,它可被多种刺激激活,主要介质是组胺。过敏性荨麻疹病因多样:食物、药物、昆虫毒液、皮肤接触过敏原以及体育锻炼等。在欧洲国家和美国,荞麦的消费量有所增加,因为它不含麸质。如果摄入、吸入或用手接触,它可能引发过敏性休克。已描述了五种常见的荞麦过敏原,命名为Fag e1至5(Fag e1、2和3被认为是主要过敏原)以及两种苦荞麦过敏原,命名为Fag t1和Fag t2。
我们报告一例患者,该患者经历了两次过敏性休克,病因是荞麦。患者前往过敏科评估两次严重过敏反应发作情况,这两次发作均需紧急治疗,发作时伴有意识丧失且病情严重。每次过敏性休克发作时,都呼叫了救护车并进行了紧急治疗,患者在数小时内康复。
由于每次发作都在进食后几分钟内出现,诊断基于详细的病史采集和点刺皮肤试验,随后进行特异性IgE检测。通过点刺皮肤试验和对可疑食物进行特异性IgE检测,排除了患者食用的其他食物作为病因。检测发现荞麦特异性免疫球蛋白E水平升高,从而确定了病因。救护车工作人员紧急使用肾上腺素、输液溶液、皮质激素制剂和抗组胺药对过敏性休克进行了治疗。
在开始治疗后,数小时内皮损有部分缓解。
荞麦过敏较为罕见,但会产生影响皮肤、胃肠道和呼吸道的症状,以及过敏性反应。在职业环境中,它可引发过敏性鼻炎、哮喘和荨麻疹。尽管已描述了荞麦过敏原,但仅在少数病例中研究了它们的临床相关性。在当前实践中,根据ImmunoCAP ISAC微阵列,唯一可商购的过敏原是山毛榉e2。在临床实践中诊断可能困难。本报告病例表明需要进行全面的病史采集,因为荞麦是一种隐藏的过敏原,在欧洲,含有这种过敏原的食品无需标注。