267 Recurrent Aanaphylaxis in Cow Milk Allergy: What Is Wrong?

266 First Report of Anaphylactic Shock Caused by the Ingestion of Mite-Infested Flour in Panama Olga Melcina Barrera de Pino, MD, Ingrid Murgas Entomologist, 2 and Roberto J. Miranda. Institute of Pneumology and Allergy, San Fernando Hospital, Panama City, Panama; Gorgas Memorial Institute, Panama City, Panama. Background: To report the first case of an anaphylactic shock, almost lethal, in the Republic of Panama, produced by ingestion of pancakes contaminated by mites. Methods: A 21 year-old male patient was evaluated due to an anaphylactic shock after the ingestion of pancakes, eggs and milk. The patient had a background of a moderate allergic rhinitis. Not asthma. Skin prick test was performed on the patient with standardized extract of mites and food items, including, flour, milk and egg. After twenty minutes the results were read and considered positive since the wheal was 2 mm larger than the control (histamine 1 mg/mL). The Total IgE was determined by the chemiluminescence method. The determination of the specific IgE for mites and food was performed by the enzyme immunoassay technique. The counting and identification of the mites in the pancake samples that were eaten by the patient were placed in a microscopic slide using a Hoyer medium and analyzed in a stereomicroscope. Results: The skin prick test performed was considered positive for Blomia tropicalis, Dermatophagoides pteronyssinus and negative for flour, milk and egg. The total IgE was increased and the specific IgE resulted positive for Dermatophagoides pteronyssinus and Blomia tropicalis, but negative for flour, egg and milk. The microscopic examination of the pancake wheat showed 3 different species of mites: Blomia tropicalis, Blomia sp. and Dermatophagoides pteronyssinus, the first one in major proportion. Conclusions: The anaphylactic shock of the patient was produced by the ingestion of a commercial pancake contaminated by mites to which the patient was sensitized. Flour kept in open containers becomes a fertile ground for the growth of mites in tropical climates. Allergic patients should be warned of the danger of anaphylaxis in such conditions.