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 Allergy Advisor Digest - May 2014
Editor: Dr. Harris A. Steinman

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This is a monthly digest of interesting information that is being added to Allergy Advisor. While we add a great deal of information every month, here we highlight some of the more interesting articles.
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Read Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-alpha-1,3-galactose.

Abstracts shared in May 2014 Advisor Digest Newsletter

Read Italian study on buckwheat allergy: prevalence and clinical features of buckwheat-sensitized patients in Italy.
Read Anaphylaxis to weaver ant eggs: a case report.

Allergy and Intolerance Abstracts
Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-alpha-1,3-galactose.
In a recent study, Mullins et al detected alpha-Gal in meat-derived gelatin, correlating gelatin skin testing and anti alpha-Gal IgE with a strong relationship to red meat anaphylaxis. It was hypothesized that alpha-Gal is one of the targets of reactivity to gelatin. In this case report, a 58-year-old hunter with a 10-year history of episodes of anaphylaxis (?ush, urticaria, hypotension, diarrhea) during night time after consuming meat and entrails from beef, pork, and game. The most severe reactions started <3 hours after eating entrails. Symptoms started 3 to 8 hours after eating and was brought on by exercise. Prick-to-prick skin testing of pork meat, pork kidney, and beef kidney was positive. Total IgE was 595 kUA/L and speci?c IgE to pork 4 kUA/L, to beef 4.3 kUA/L, and alpha-Gal 29.2 kUA/L. Tryptase was elevated. Oral challenge with cooked pork kidney (12 g and 36 g separated by 2 hours) elicited a severe allergic reaction that included diarrhea and urticaria lasting for 8 hours within 1.5 hours after the last portion of pork kidney. Consumption of grilled beef (350 g), resulted in mild self-limiting, generalized urticaria occurring 7.5 hours later. In contrast, grilled pork (350 g) resulted in no allergic symptoms. However, provocation tests with grilled pork (350 g) in combination with physical exercise 60 minutes after eating elicited urticaria 5 hours later. The patient also complained of recurring dizziness, abdominal pain, and diarrhea with delayed onset after ingestion of his favored sweets (gums with pork-derived gelatin - Haribo). Prick-to-prick skin testing of gelatin-containing gums and bovine gelatin-derived colloid was not reactive. Speci?c IgE to gelatin was 0.04 kUA/L. An oral challenge test was performed: ingestion of 250 g of gelatin-containing Haribo gums (corresponding to about 30 g of gelatin) followed by physical exercise 60 minutes later. About 10 hours after eating, ?atulence and abdominal cramps began, which were followed by ?ushing, tachycardia, and diarrhea after 11.5 hours. Physical exercise on its own was always tolerated by the patient.

The authors conclude that gelatin-containing sweets can elicit type I allergic symptoms in patients sensitized to alpha-Gal. (In contrast, non-gastrointestinal application, anaphylaxis will not be delayed, but rather occur within minutes). The authors suggest that that minimal amounts of gelatin in food or in medical products, for example, in capsules or pills, are unlikely to cause severe allergic reactions, but further analys

Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-alpha-1,3-galactose.  
Caponetto P, Fischer J, Biedermann T.
J Allergy Clin Immunol Pract 2013 May;1(3):302-303

Index

Allergen-, Food allergy-, Intolerance-related articles

Remission of wheat-dependent exercise-induced anaphylaxis after the cessation of hydrolysed wheat-containing soap usage.  
Ishii K, Hiragun M, Matsuo H, Hiragun T, Hide M.
Acta Derm Venereol 2012 Sep;92(5):490-491

Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-alpha-1,3-galactose.  
Caponetto P, Fischer J, Biedermann T.
J Allergy Clin Immunol Pract 2013 May;1(3):302-303


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