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vol. 14
Letter to the Editor

Dangerous anaphylactic reaction to mustard

Krzysztof Pałgan, Magdalena Żbikowska-Gotz, Zbigniew Bartuzi

Arch Med Sci 2018; 14, 2: 477–479
Online publish date: 2016/06/14
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Food allergy is an important health problem and affects between 2% and 10% of the general population. In Europe it ranges from 0.1–3.2% for adults and 0.1–5.7% for children. According to the epidemiological data the prevalence of food allergy is increasing. Most cases of food allergy are associated with cows’ milk, hens’ eggs, peanuts, tree nuts, soy, wheat, shellfish and fish [1]. The European list of potentially dangerous allergens contains: cereals containing gluten, crustaceans, mollusks, eggs, fish, peanuts, tree nuts, soybeans, milk, celery, mustard, sesame, lupin and sulfur dioxide [2]. Food allergy can be IgE-mediated or non-IgE-mediated. IgE-mediated reactions have a rapid onset, affecting the skin, respiratory tract, and gastrointestinal tract, and in some cases can lead to systemic anaphylaxis, whereas non-IgE-mediated food allergy usually is delayed and affects mainly the skin and the gastrointestinal tract [3].
We report the case of a patient who experienced a severe anaphylactic reaction immediately after the ingestion of mustard.
A 38-year-old Caucasian woman ate sausage with mustard sauce. Within minutes, she was feeling dizzy and rapidly developed dyspneic symptoms with tightness of her chest, wheezing, and nausea, and subsequently she became unconscious. Following that, she developed widespread urticaria with pruritus. The examination in the hospital confirmed tachycardia of 135/min and blood pressure of 65/45 mm Hg. After she had been treated with adrenaline i.m., intravenous saline hydration, anti-histamine antihistamines and steroids gradual improvement was observed.
Having performed examinations after recovery from anaphylactic shock, except for stomach inflammation detected by upper gastrointestinal (UGI) endoscopy, ECG and spirometry were normal. No abnormal findings were noted on the chest X-ray and paranasal sinuses.
The complete blood count revealed hemoglobin, 16.8 g/dl; hematocrit, 49.1%; leucocytes, 11.69 × 103 ml; neutrophils, 7.4 G/l; lymphocytes, 1.0 G/l; eosinophils, 0.03 G/l; monocytes 0.34 G/l and platelets, 367 000. She had no known food or drug allergies, but had seasonal allergic rhinitis in spring. Serum total IgE was 42.87 IU/ml and specific IgE determinations were remarkably positive to grass pollen (17.37 IU/l). Skin prick tests with common aeroallergens were positive to grass pollen. A strong skin prick test response was obtained with mustard allergens. Flow cytometry was...

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