Patients at risk are those who have an established allergy to dust mites and manifested in diseases such as; rhinitis, asthma, atopic dermatitis, conjunctivitis, or any combination of these diseases. Included in the list are patients allergic to domestic mites, and also known to be sensitive to acetylsalicylic acid, ie. aspirin.The symptoms of OMA are common to anaphylaxis. Symptoms include breathlessness, vomiting, wheezing, coughing, itching, skin rash, angioedema etc. Symptoms typically appear within the first 10 to 45 minutes after ingestion. Most patients diagnosed with OMA are adolescents or young adults.
Foods can be pancakes (most common), sponge cakes, pizza, pasta, wheat bread, white sauce, meat or fish dusted with wheat flour.
The allergen thought to be involved is the Group 2 mite allergen, a heat stable or 'thermoresistant' allergen and major trigger in allergic disease. Interestingly, following baking the allergen appears somewhat reduced in skin-prick test results.
Reporting of Pancake Syndrome or OMA occurs mostly in tropical and subtropical countries with high temperature and high relative humidity. However these conditions can occur as man made environments in kitchens.Some of the dust mites associated with (OMA) are Dermatophagoides pteronyssinus, D. farinae, Blomia tropicalis, and the storage mites Lepidoglyphus destructor, Tyrophagus putrescientiae, Tyreophagus entomophagus, Blomia freemani, S medanensis, and Aleuroglyphus ovatus. These mites are known as either house dust mites or storage mites, but they all can live indoors if the conditions are right. Indeed, in an old, damp mattress scientists found storage mites and house dust mites living together, yet as separate species of mites.
Although Pancake Syndrome is not yet fully recognised and the incidences of reported OMA are relatively rare, the World Allergy Organisation advises that the risk of anaphylaxis from mite contaminated wheat flour can be reduced by keeping packets of opened flour in a refrigerator or freezer where conditions for mite infestation are hostile. This hygiene exercise should be conducted with reduced exposure to all domestic mites indoors.
'Anaphylaxis from ingestion of Mites: Pancake anaphylaxis', 'J. Allergy and Clinical Immunology', 2013, Vol 131; Issue 1: p 31-34.
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