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Anaphylaxis caused by the pectin component of barium sulphate suspension
871
Anaphylaxis Caused by the Pectin Component of Barium Sulphate Suspension
E. Hernández-García1, M. de las Heras1, B. Bartolomé2, E. Compés1, J. Sastre1, J. Cuesta1; 1Fundación Jiménez Díaz, Madrid, SPAIN, 2BialAristegui laboratories, Bilbao, SPAIN. Pectin (E440), a structural polysaccharide found in vegetables, is widely used as an additive in the food and pharmaceutical industries. Allergic reactions to pectin have rarely been reported, only in occupational setting. A 59-year-old male developed widespread urticaria, angioedema, cough and shortness of breath within 15 min after an enema examination with a barium sulphate suspension (Barigraf), requiring epinephrine, fluids and methylprednisolone. Personal history revealed episodes of urticaria, vomits and bronchospasm after eating nuts, some confectioner products and dressing salads. Skin prick test (SPT) were positive to Barigraf and the pectin excipient, eliciting wheals of 15 and 18 mm. SPT were negative to the remaining Barigraf components, common inhalants and latex. SPT and specific IgE determinations to food (CAP, EAST techniques) revealed a strongly positive response to cashew nut and pistachio, being moderate to other nuts, chickpea, bean, peach and orange peel. ELISA-specific IgE was positive to pectin and Barigraf. ELISA-inhibition assays showed a complete inhibition in IgE-binding to Barigraf using pectin in liquid phase, as well as in the opposite way. Moreover, a high inhibition level of IgE-binding to pectin and barigraf was achieved using cashew or pistachio extracts as inhibitors and in a lower level with other nuts. CONCLUSION: We report the first case of IgE-mediated anaphylaxis by pectin contained in a barium suspension. Cross-reactivity was demonstrated with cashew, pistachio and other nuts. Physicians should be aware of allergy to pectin in barium examinations, mainly in patients allergic to vegetables and nuts. Funding: Self-funded
MONDAY
Abstracts S243
J ALLERGY CLIN IMMUNOL VOLUME 113, NUMBER 2
Anaphylaxis Caused by the Pectin Component of Barium Sulphate Suspension
E. Hernández-García1, M. de las Heras1, B. Bartolomé2, E. Compés1, J. Sastre1, J. Cuesta1; 1Fundación Jiménez Díaz, Madrid, SPAIN, 2BialAristegui laboratories, Bilbao, SPAIN. Pectin (E440), a structural polysaccharide found in vegetables, is widely used as an additive in the food and pharmaceutical industries. Allergic reactions to pectin have rarely been reported, only in occupational setting. A 59-year-old male developed widespread urticaria, angioedema, cough and shortness of breath within 15 min after an enema examination with a barium sulphate suspension (Barigraf), requiring epinephrine, fluids and methylprednisolone. Personal history revealed episodes of urticaria, vomits and bronchospasm after eating nuts, some confectioner products and dressing salads. Skin prick test (SPT) were positive to Barigraf and the pectin excipient, eliciting wheals of 15 and 18 mm. SPT were negative to the remaining Barigraf components, common inhalants and latex. SPT and specific IgE determinations to food (CAP, EAST techniques) revealed a strongly positive response to cashew nut and pistachio, being moderate to other nuts, chickpea, bean, peach and orange peel. ELISA-specific IgE was positive to pectin and Barigraf. ELISA-inhibition assays showed a complete inhibition in IgE-binding to Barigraf using pectin in liquid phase, as well as in the opposite way. Moreover, a high inhibition level of IgE-binding to pectin and barigraf was achieved using cashew or pistachio extracts as inhibitors and in a lower level with other nuts. CONCLUSION: We report the first case of IgE-mediated anaphylaxis by pectin contained in a barium suspension. Cross-reactivity was demonstrated with cashew, pistachio and other nuts. Physicians should be aware of allergy to pectin in barium examinations, mainly in patients allergic to vegetables and nuts. Funding: Self-funded
MONDAY
Abstracts S243
J ALLERGY CLIN IMMUNOL VOLUME 113, NUMBER 2