Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patients
    • Disease patterns
    • Diagnostics
    • Therapy
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Forum Gastroenterology
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Allergology and clinical immunology
    • General Internal Medicine
    • Anesthesiology
    • Angiology
    • Surgery
    • Dermatology and venereology
    • Endocrinology and Diabetology
    • Nutrition
    • Gastroenterology and Hepatology
    • Genetics
    • Geriatrics
    • Gynecology
    • Hematology
    • Infectiology
    • Cardiology
    • Nephrology
    • Neurology
    • Emergency and intensive care medicine
    • Nuclear Medicine
    • Oncology
    • Ophthalmology
    • ORL
    • Orthopedics
    • Pediatrics
    • Pharmacology and toxicology
    • Pharmaceutical medicine
    • Phlebology
    • Physical medicine and rehabilitation
    • Pneumology
    • Prevention and health care
    • Psychiatry and psychotherapy
    • Radiology
    • Forensic Medicine
    • Rheumatology
    • Sports Medicine
    • Traumatology and trauma surgery
    • Tropical and travel medicine
    • Urology
    • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
  • Log In
  • Register
  • My account
  • Contact
  • English
    • Deutsch
    • Français
    • Italiano
    • Português
    • Español
  • Publications
  • Contact
  • Deutsch
  • English
  • Français
  • Italiano
  • Português
  • Español
Subscribe
Medizinonline Medizinonline
Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patienten
    • Krankheitsbilder
    • Diagnostik
    • Therapie
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Forum Gastroenterology
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Fachbereiche 1-13
      • Allergology and clinical immunology
      • General Internal Medicine
      • Anesthesiology
      • Angiology
      • Surgery
      • Dermatology and venereology
      • Endocrinology and Diabetology
      • Nutrition
      • Gastroenterology and Hepatology
      • Genetics
      • Geriatrics
      • Gynecology
      • Hematology
    • Fachbereiche 14-26
      • Infectiology
      • Cardiology
      • Nephrology
      • Neurology
      • Emergency and intensive care medicine
      • Nuclear Medicine
      • Oncology
      • Ophthalmology
      • ORL
      • Orthopedics
      • Pediatrics
      • Pharmacology and toxicology
      • Pharmaceutical medicine
    • Fachbereiche 26-38
      • Phlebology
      • Physical medicine and rehabilitation
      • Phytotherapy
      • Pneumology
      • Prevention and health care
      • Psychiatry and psychotherapy
      • Radiology
      • Forensic Medicine
      • Rheumatology
      • Sports Medicine
      • Traumatology and trauma surgery
      • Tropical and travel medicine
      • Urology
      • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
Login

Sie haben noch keinen Account? Registrieren

  • Memories of an allergist

Acute Quincke’s edema to a lozenge in a two-year-old boy

    • Allergology and clinical immunology
    • Cases
    • Pediatrics
    • RX
  • 4 minute read

Anamnesis: The not yet two-year-old boy sat on his mother’s lap during a car ride and was given a sweet to suck. Within minutes, massive swelling of the face and lips, urticaria of the throat, and difficulty swallowing and signs of laryngeal edema with inspiratory stridor occurred. On admission to the emergency department, he was found to have an edematous face with crusted contours, swollen and red lips, and massive edema of the pharynx and larynx.

Blood pressure was 100/60 mmHg, pulse 98/min. After administration of intravenous therapy with steroids and antihistamines, the boy remained hospitalized for monitoring and was discharged the other day in good general condition after symptoms resolved.

For further clarification of the cause, a consultation was arranged at the allergy ward of the Dermatology Clinic of the University Hospital Zurich.

Allergological clarification

The family history revealed no evidence of atopic diseases; the father’s profession was baker/pastry chef and the boy regularly spent time in the bakery. For the past year, the boy had been suffering from intermittent respiratory problems.

On clinical examination at this time, the auscultation findings of the lungs were unremarkable, the cheeks were red and infiltrated, and there were discrete eczematous efflorescences on the backs of the hands and wrists, corresponding to atopic eczema (Fig. 1).

In vitro allergy diagnostics performed at the initial consultation revealed an elevated total IgE level to 575 U/ml (norm to 50 U/ml) and RAST elevation of specific IgE to house dust mite (Dermatophagoides pteronyssinus), cat epithelium and wheat flour of class 3 each and of class 2 each to gluten and rye flour.

The candy that was sucked was a “10 mogul”… (Fig.2). After inquiry, the confectionery company told us the exact composition: Sugar, glucose syrup, vegetable fat, citric acid, glyceryl stearate monoester (GMS), raspberry flavoring, strawberry red (E 124), lecithin and Hyfoama 88. Our suspicions were directed at the food coloring E 124, but we asked the company to send us samples of the various ingredients. Performing the prick-to-prick tests with all ingredients of the candy yielded a result that was surprising to us: only powdered Hyfoama 88 showed a clear wheal comparable to the histamine control (Fig. 3).

The boy’s serum together with the Hyfoama sample (kindly provided by the manufacturer PPF International, The Netherlands) was sent to Prof. S.G.O. Johansson (Karolinska Institute, Department of Clinical Immunology, Stockholm), who prepared a RAST disc. Specific IgE determination yielded a positive result of RAST class 3.

The prospectus of the Hyfoama 88 product states that it is a soluble protein powder made from wheat gluten protein after exposure to calcium hydroxide. This results in a mixture of gluten polypeptides.

Diagnosis

  • Acute Quincke’s edema in IgE-mediated allergy to the gluten polypeptide hyfoama;
  • Respiratory allergy to dust mites, cat epithelium and flours;
  • Neurodermatitis atopica.

Comment

The boy, with no family history of atopy, apparently became sensitized to flours by inhalation while in his parents’ bakery and to dust mites and cat epithelium at home. The asthmatic complaints, which recurred intercurrently from the first year of life, were apparently not associated with allergy. Until the acute event, symptoms of food allergy had never been observed before, even after eating breads, cereals, or other baked goods. Hyfoama 88 provided by the manufacturing company is a cream-colored, soluble, tasteless vegetable protein powder, which is formed from wheat gluten protein after exposure to calcium hydroxide. It thus consists of a mixture of gluten polypeptides. With these characteristics, Hyfoama as a dietary protein belongs to the group of emulsifiers, stabilizers and thickeners. According to EC directives, these products are not considered additives. Hyfoama is widely used in bakery products and in the confectionery industry, e.g. as an ingredient in nougat, caramel, frappés, gummy bears, bars or strawberries with icing. On the corresponding packages Hyfoama is declared as wheat protein. Prior to our case report at that time, no allergic reactions had been described in either manufacturers or consumers [1]. In a recent search on Google, our case study is cited again and again, but new cases were not described. However, it is likely that latent sensitization to Hyfoama is also present in a proportion of those sensitized to wheat and gluten IgE. Prof. Johansson found at that time by RAST testing that two-thirds of those sensitized to gluten also had positive results against Hyfoama.

The question arises as to the triggering epitope in Hyfoama. Now, it is known that in ingestive wheat allergy in children or in wheat flour-related effort-induced anaphylaxis, the major allergen in wheat flour is rTri-α19-omega-5-gliadin, and thus RAST f416 is considered a pathognomonic marker of ingestive wheat flour allergy [2,3]. In baker’s asthma, the major allergens of wheat are the α-amylase/trypsin inhibitors with molecular weights of 15-17 kDa, which are found in all three protein fractions of raw and cooked wheat. IgE sensitization to a dimeric wheat α-amylase inhibitor (Tri α28) was observed most frequently [4]. The α-amylase added to flours is also an important trigger of baker’s asthma [5].

Literature:

  1. Varga EM, Wüthrich B: Acute Quincke’s edema in a two-year-old boy after consumption of a lozenge in type I allergy to the gluten polypeptide Hyfoama 88. Allergology 1995; 18: 331-333.
  2. Wüthrich B: What is your diagnosis? (Quiz). Food-induced exertion-induced anaphylaxis in cases of severe sensitization to cereal proteins, especially rTri α19-omega-5-gliadin. DERMATOLOGIE PRAXIS 2013; 1: 25 and 32-33.
  3. Wüthrich B: What do pizza, Guetzli and a turkey with garnish have in common? DERMATOLOGIE PRAXIS 2014; 24(2): 26-27.
  4. Sander I, Raulf-Heimsoth M: Tracking down causes of baker’s asthma. IPA Journal 2011; 2 : 20-21. www.ipa.ruhr-uni-bochum.de/pdf/IPA_Journal_11_02_Baecker.pdf.
  5. Wüthrich B, Baur X: Baking agents, especially α-amylase, as occupational inhalant allergens in the bakery industry. Schweiz Med Wochenschr 1990; 120: 446-450.
     

DERMATOLOGIE PRAXIS 2016; 26(2): 34-36
DERMATOLOGIE PRAXIS 2018 Special Edition (Anniversary Issue), Prof. Brunello Wüthrich

 

Autoren
  • Prof. em. Dr. med. Brunello Wüthrich
Publikation
  • DERMATOLOGIE PRAXIS
Related Topics
  • Edema
  • hyfoama 88
  • Quincke
Previous Article
  • An impossibility?

Weight reduction in patients with type 2 diabetes

  • Education
  • Endocrinology and Diabetology
  • General Internal Medicine
  • Nutrition
  • Partner Content
  • RX
  • Surgery
View Post
Next Article
  • Eleven day old boy with indolent bluish nodule on capillitium

Congenital tumor?

  • Cases
  • Dermatology and venereology
  • Pediatrics
  • RX
View Post
You May Also Like
View Post
  • 4 min
  • Guideline update

Dietary recommendations for Crohn’s disease and colitis

    • Education
    • Gastroenterology and Hepatology
    • General Internal Medicine
    • Nutrition
    • RX
    • Studies
View Post
  • 4 min
  • Circadian rhythm during Ramadan

Disturbed sleep patterns lead to metabolic stress

    • Education
    • Endocrinology and Diabetology
    • General Internal Medicine
    • Nutrition
    • RX
    • Studies
View Post
  • 6 min
  • Case Report

Breast cancer metastases in the bladder

    • Cases
    • Education
    • Gynecology
    • Oncology
    • RX
    • Urology
View Post
  • 11 min
  • Findings from the ALS Symposium 2024 in Montreal

Current and future approaches in the treatment of amyotrophic lateral sclerosis (ALS)

    • Congress Reports
    • Interviews
    • Neurology
    • RX
    • Studies
View Post
  • 8 min
  • Efficacy, mechanism of action and clinical effects

Garlic and high blood pressure

    • Cardiology
    • Education
    • General Internal Medicine
    • Pharmaceutical medicine
    • Phytotherapy
    • RX
    • Studies
View Post
  • 7 min
  • Moderate to severe chronic hand eczema

Delgocitinib cream – first topical pan-JAK inhibitor approved in Switzerland

    • Allergology and clinical immunology
    • Dermatology and venereology
    • Education
    • Infectiology
    • Market & Medicine
    • Pharmacology and toxicology
    • RX
View Post
  • 9 min
  • Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CA)

Diagnosis at an early stage, prognostic classifications and outlook

    • Cardiology
    • Education
    • RX
    • Studies
View Post
  • 4 min
  • Case report: Drug-induced hepatitis

Rare side effect of tirzepatide therapy

    • Cases
    • Education
    • Endocrinology and Diabetology
    • Gastroenterology and Hepatology
    • Pharmacology and toxicology
    • RX
    • Studies
Top Partner Content
  • Forum Gastroenterology

    Zum Thema
  • Herpes zoster

    Zum Thema
  • Dermatology News

    Zum Thema
Top CME content
  • 1
    Patience, knowledge and persistence in therapy
  • 2
    Sarcopenia and malnutrition in the context of pneumological rehabilitation
  • 3
    Medical and psychosocial perspectives
  • 4
    New nomenclature for non-alcoholic fatty liver disease
  • 5
    Examinations and considerations before therapy

Newsletter

Sign up and stay up to date

Subscribe
Medizinonline
  • Contact
  • General terms and conditions
  • Imprint

Input your search keywords and press Enter.