Buckwheat Pillow Exposure Predisposes to Buckwheat Food-Induced Anaphylaxis

Background: Buckwheat (BW) is a common cause of anaphylaxis in several Asian countries. As BW has become a more popular food ingredient in the U.S., the prevalence of allergy has increased. However, BW anaphylaxis is rare in the U.S. We describe two patients who used BW-containing pillows and developed anaphylaxis following BW ingestion.

Methods: BW ImmunoCAP and western blot analyses were performed to semi-quantitate IgE anti-BW antibodies and IgE binding to the BW allergen (Fag e 1).

Results: Patients 1 (49 year old female) and 2 (26 year old female) were previously healthy with no prior BW ingestion. Both patients reported a history of sleeping on BW pillows with gradual worsening of nasal congestion and rhinorrhea. Upon initial ingestion of BW-containing foods, both patients experienced diffuse itching, chest discomfort and difficulty swallowing. The subjects required antihistamines, corticosteroids and epinephrine.  Both patients had class 3 (highly positive) ImmunoCAP assays for BW. Western blot analyses documented IgE antibodies specific for 24 (Fag e1), 19, and 16 kD known BW protein allergens. 

Conclusions: To our knowledge, this is the first case series describing anaphylaxis to BW in the U.S. We hypothesize that these patients became sensitized after use of BW pillows since there was no prior history of BW ingestion. These findings are particularly significant as the popularity of BW-containing foods and pillows increases in the U.S.