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Severe Anaphylaxis in Non-Atopic Teenager Due to Carmine Allergic: A Detective Work.
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Inmaculada Sanchez-Machin, MD, Borja Bartolome, Paloma Poza Guedes, MD, Ruperto González Pérez, Victor Matheu, MD, PhD
Rationale:

Searching for hidden allergens in foodstuffs can be sometimes very complicated and challenging. 

Methods:

A non atopic girl, consulted in early 2013 by an episode of anaphylaxis with urticaria, angioedema, dyspnea, dysphagia and disphonia treated and solved with epinephrine. Over 2013 and 2014 patient suffered 4 similar episodes. Every single episode started 10-30 minutes after take some food.

Results:

Skin prick tests (SPT) with commercial extracts of every foodstuff involved in all episodes were all negative. Study of idiopathic anaphylaxis was also negative. Basal tryptase was 3.27μg/L (1-15.0).

Late 2014, patient suffered a new similar episode 10 minutes after taken some candies. Autoinjector of epinephrine was used by patient and was later assisted in Emergency Department. Tryptase after 120 minutes was 22.6μg/L.

Study in Allergy Office by prick-prick with candies was positive with reddish candies and negative with other colored ones. Specific IgE with carmine (ImmunoCap, Phadia, Sweden) was negative.  Prick-prick with the insect Dactylopius coccus, collected from the cactus Opuntia coccinellifera, was positive.

A protein extract with cochineal and one with carminic acid were made. SPT with both extracts resulted positive and negative in 20 atopic controls. An IgE western-blot was performed. Two bands were recognized (16-18kDa, 38-40kDa) with the cochineal insect extract. One band was recognized with carmine extract (38-45kDa).

Conclusions:

Cochineal carmine (E120) is used as a biologic dye in food, cosmetics and drugs. In this case, we can provide evidence of an IgE-mediated reaction.