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Pancake Syndrome

It may sound like something delicious ... having a syndrome of something as good as pancakes. But the name comes from something far from rich ...

Oral anaphylaxis due to mites, or pancake syndrome, occurs when atopic people (hypersensitivity to some foods or substances) ingest food made with wheat flour contaminated with mites, which induces moderate or severe allergic reactions, even fatal.

The reports come from tropical and subtropical environments, where the conditions for the proliferation of house mites are favorable. An important association has been found with hypersensitivity to acetylsalicylic acid (ASA) -nonsteroidal anti-inflammatory drugs (NSAIDs) and physical exercise.

House mites have allergens that cause different types of diseases, such as allergic rhinitis, bronchial asthma and atopic dermatitis, which are of great relevance throughout the world. These clinical manifestations are caused by contact between humans and mites or their feces, either through the skin or through the respiratory tract.

1) Likewise, it has been determined that ingestion of food contaminated with house mites can trigger a moderate or severe allergic response (anaphylaxis) in susceptible people.

2) The symptoms are usually: urticaria, angioedema, cough, dyspnea and hypotension. The allergic reaction began between 25 and 60 minutes after ingestion, with an average of 41.5 minutes.

Other incriminated foods include cakes, pizza, pasta, bread, chicken fillets (made with contaminated bread), and white sauce. But without a doubt, pancakes are the food that involves the most cases. Likewise, other foods that have been identified as containing mites since they have been stored at room temperature are: salami, cheeses, nuts, ham and sausages.

In conclusion, the experts' recommendation is that wheat flour be stored in the refrigerator in sealed packages, since mites do not survive or reproduce at low temperatures.

References: Colloff MJ. Dust mites. CSIRO Publishing, Australia, 2009.

2. Erben AM, Rodríguez JL, McCullough J, Ownby DR. Anaphylaxis after ingestion of beignets contaminated with Dermatophagoides farinae. J Allergy Clin Immunol 1993; 92: 846-849.

3. Blanco C, Quiralte J, Castillo R, et al. Anaphylaxis after ingestion of wheat flour contaminated with mites. J Allergy Clin Immunol 1997; 99: 308-313.

4. Sánchez-Borges M, Capriles-Hulett A, Fernández-Caldas E, et al. Mite contaminated foods as a cause of anaphylaxis. J Allergy Clin Immunol 1997; 99: 738-743.

5. Sánchez-Borges M, Suarez-Chacón R, Capriles-Hulett A, et al. Anaphylaxis from ingestion of mites: Pancake anaphylaxis. J Allergy Clin Immunol 2013; 131: 31-35.

6. Sánchez-Borges M, Suarez-Chacón R, Capriles-Hulett A, et al. Pancake syndrome (oral mite anaphylaxis). WAO J 2009; 2: 91-96.

7. Barrier OM, Murgas I, Miranda RJ. First report of anaphylactic shock caused by the ingestion of mite-infested flour in Panama. Proceedings XXII World Allergy Congress. World Allergy Organization. Cancun, Mexico, December 4-8, 2011.

8. Wen DC, Shyur SD, Ho CM. Systemic anaphylaxis after the ingestion of pancake contaminated with the storage mite Blomia freemani. Ann Allergy Asthma Immunol 2005; 95: 612-614.

9. Miranda RJ, Quintero AD, Almanza A. House dust mite from urban and rural house on the lowland Pacific slopes of Panama. Syst Appl Acarol 2002; 7: 23-30.

10. Mariana A, Ho TM, Gendeh GM, et al. First report on sensitization to allergens of a house dust mite, Suidasia pontifica (Acari: Saproglyphidae). Southeast Asian J Trop Med Public Health 2000; 31: 722-723

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