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Pancake Syndrome: Not a Wheat Allergy

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For some, like these dealing with a wheat allergy or celiac illness, pulling out a skillet to make contemporary pancakes is out of the query until particular care is taken to pick out a well-researched gluten-free flour.

However for people with no such restrictions, a contemporary, fluffy pancake can nonetheless imply a jab with an epinephrine auto-injector and a visit to the ER. How so?

We’re speaking about pancake syndrome, in any other case generally known as oral mite anaphylaxis (OMA). OMA is characterised by extreme allergic signs occurring instantly after consuming meals made with mite-contaminated wheat flour. The syndrome, extra prevalent in heat, humid environments, is commonly triggered by pancakes, therefore the moniker. (Quite a lot of this syndrome that happens throughout bodily train and is known as mud mite ingestion-associated exercise-induced anaphylaxis.)

As a result of cooked meals are in a position to induce the signs, heat-resistant allergens are suspected to be concerned.

A abstract of obtainable literature revealed in 2012 in The Journal of Allergy and Medical Immunology listed the precise species of mites which were linked to OMA, together with Dermatophagoides pteronyssinus, Dermatophagoides farina, Blomia tropicalis, Suidasia medanensisAleuroglyphus ovatus, Tyrophagus putrescientiae and Tyreophagus entomophagus.

Dermatophagoides pteronyssinus

Danger Components

The research recognized the next threat components for OMA:

  • earlier atopic illness;
  • mite sensitization;
  • NSAID hypersensitivity;
  • ingestion of pancakes or different meals containing wheat flour; and
  • ingestion of greater than 1 mg of mite allergen (>500 mites per gram of flour).

As solely a subset of sufferers will develop OMA, investigators have thought of different attainable underlying components predisposing these topics to react acutely to mite-contaminated meals. Presently, there isn’t a proof supporting any of the opposite normal susceptibility components for anaphylaxis, corresponding to mast cell activation syndrome, elevated oral/gastrointestinal mucosal permeability, or pre-existing mite-specific IgE ranges.

Analysis

OMA must be suspected in sufferers with acute signs throughout or instantly after consuming meals ready with wheat flour. Due to this, physicians usually dismiss the syndrome as wheat allergy.

Physicians are suggested to contemplate OMA in sufferers presenting with acute angioedema or laryngeal edema related to the ingestion of pancakes, notably if the occasion occurred in or the flour originated from tropical or subtropical climates.

The syndrome will be confirmed in sufferers assembly the next standards:

  • suitable signs occurring after consuming meals ready with wheat flour;
  • earlier historical past of rhinitis, bronchial asthma, atopic eczema, or meals allergy;
  • demonstration of mite-specific IgE in vivo (immediate-type pores and skin exams) or in vitro;
  • constructive pores and skin take a look at response induced by an extract of the incriminated flour;
  • damaging pores and skin take a look at response to business wheat extract and to an extract of uncontaminated flour;
  • tolerance to different meals made with uncontaminated wheat flour;
  • microscopic identification of mites within the suspected flour;
  • presence of mite allergens within the flour, as demonstrated via immunoassay; and
  • aspirin/NSAID hypersensitivity.

Prevention

Storing flour in sealed plastic or glass containers at low temperatures (corresponding to within the fridge, particularly in heat climates) will seemingly stop OMA.

Different environmental measures taken within the houses of sufferers recognized with OMA embody enhancing the air high quality utilizing air purifiers, lowering humidity, cleansing and disinfecting furnishings and flooring, and utilizing acaricides — pesticides used to kill ticks and mites.

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