Pancake Syndrome – Oral anaphylaxis from mite ingestion
As far back as 1993 there have been clinical reports of cases of oral anaphylaxis from mite infested wheat flour even after baking. In 2009 The World Allergy Organization (WAO) recognized this phenomenon by publishing a paper on the subject, calling it Pancake Syndrome. One of the species of mite found infesting poorly stored packets of wheat flour is the common house dust mite Dermatophagoides pteronyssinus and Dermatophagoides farinae. Although these mites are referred to as house dust mites they can thrive in poorly stored wheat flour as well as beds, etc.
In addition there are several storage mites that are known to reside in wheat or corn flour, such as the yellow mite Blomia freemani. This mite thrives in temperate climates (often in coastal regions) with high humidity such as the UK. The severe allergic reaction associated with storage mites has been described clinically as Pancake Syndrome or Oral Mite Anaphylaxis. The condition is associated with patients with respiratory allergy to dust mites and known to be intolerant to acetylsalicylic acid such as aspirin.
Considering the amount of published papers on this phenomenon scientists ponder what mite allergen has the potential to survive baking or high temperature cooking. They speculated in 1997 and wrote: “Investigations are needed to identify the allergens responsible for mite ingestion reactions. The negative results after skin testing with the problem wheat flour .… suggest the Group I allergens …. is not the cause of these reactions. The responsible mite allergens must be stable to heat, to extremes of pH, and to digestion by proteases – conditions that Group I I allergens fulfill.” Group II allergens are known as a major cause of mite related disease and are common to both house and storage mites.
Although this issue is not yet resolved and the incidences of oral mite-related anaphylaxis are relatively rare, the WAO advises that the risk of Pancake Syndrome can be reduced by keeping packets of opened wheat flour in a refrigerator or freezer where conditions for mite infestation are hostile.
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References‘Anaphylaxis after ingestion of beignets contaminated with Dermatophagoides farinae’, Erben AM, Rodrigues JL, McCullough J, Ownby DR, 1993, J Allergy Clin. Immunol. 92: 846-849
‘House dust mite ingestion can induce allergic intestinal syndrome’. Scala G., 1995, Allergy, 50: 517-519
Systemic anaphylaxis after eating storage-mite-contaminated food, Matsumoto T, Hisano T, Hamaguchi M, Miike T, 1996 Int. Arch. Allergy Immuno.l, 109:197-200
Mite contaminated foods as a cause of anaphylaxis. Sanchez-Borges M, Capriles-Hulett A, Fernandez-Caldas E, et al, J Allergy Clin Immun. 1997;99(6 Pt 1):738-43
‘The Importance of Storage Mite Allergens in Occupational and Domestic Environments’, Chambers J, Thind B, Dunn JA, Pearson DJ, 1999, Proceedings of the 3rd International Conference on Urban Pests, Wm H Robinson, F Rettich and G.G. Rambo (editors)
‘The occurrence of mite-containing wheat flour’, Matsumotos T, Satoh A, Petiatr. Allergy Immunol. 2004 Oct. 15 (5):469-471
‘Systemic anaphylaxis after the ingestion of pancake contaminated with storage mite Blomia freemani,’ Wen DC et al, Ann Allergy Asthma Immunol., 2005, Dec. 95; (6):612-614
‘Oral mite anaphylaxis (pancake syndrome) also observed in children’, Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonesca F. Ann Allergy Asthma Immunol. 2006 May; 96(5):755-6
‘Dust mite ingestion-associated, exercise-induced anaphylaxis’, Sanchez-Borges M, Iraola V, Fernandez-Caldas E, Capriles-Hulett A, Caballero-Fonseca F, J. Allergy Clin. Immunol. 2007 Sept; 120(3):714-6
‘Anaphylaxis after ingestion of wheat flour contaminated with mites.’ Blanco C, Quiralte J, Castillo R, et al. J Allergy Clin Immunol. 1997; 99(3):308-13
Additional Information on the pancake syndrome Sanchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F, Ann. Allergy Asthma Immunol. 2008 Aug 101 (2) 221. Comment on: Ann. Allergy Asthma Immunol. 2008 Apr; 100 (4) 397-8
Pancake Syndrome (Oral Mite Anaphylaxis), Sanchez-Borges M, Suarez-Chacon R, Capriles-Hulett A, Cabellero-Fonseca F, Iraola V, Fernandez-Caldas E, World Allergy Organization Journal, May, 2009 Vol. 2, Issue 5, pp. 91-96
‘Dust Mites’, Matthew J. Colloff, 2009, Mites Associated with Storage Food Products, Page 51. CSIRO Publishing, ISBN 978-0-6430-6589-5.
The pre-larva of a dust mite develops an egg tooth to help escape its shell, just like birds. Once out, the larva leave the tooth behind.
