2114 Two Caces of Prawn Allergy in Adult Patients

Thursday, 15 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)

Ismet Bulut, MD , Immuonology and Allergy, Süreyyapaşa Chest Disease and Chest Surgery Training and Research Hospital, Istanbul, Turkey

Zeynep Ferhan Ozseker, MD , Immunology and Allergy, Sureyyapasa Chest Diseases and Chest Surgery Training Hospital, Istanbul, Turkey

M,S, 30 years old, Works at a restaurant.

Complaint: Sneezing, clogged nose, impaired sensitivity of smelling, post nasal drip, sneezing in the mornings.

Sneezing provocated by exposition to prawn smell, itching sensation in the nose, nasal drip,

Itching and wetness in the eyes, shortness of breath, pressure sensation in the chest.

History of Complaints:Fort he last 5 years, he has been working at the kitchen of a restaurant that serves sea products including prawn (Large Shrimp).  For 1 year, he has been experiencing sneezing, post nasal drip and itching sensation in the eyes, all of which are provocated by exposure to smell of prawn while it is being cleaned and prepared.

Exposure to prawn smell  caused edema and swelling in the lips and eyelids, suggestive of angioedema. Prawn smell inhalation also caused shortness of breath, pressure sensation in the chest, stridor.Medical history also revealed angioedema triggered by intake of appranax (naproxen)

Laboratory:

Eosinophils %13.83 (0.5-11.0),Total Ig E: 138 IU/ML (1.31-165.3) Specific Ig E ( mixed 5 ) (food panel 2): (morino fish, Prawn,shell, tuna fish, salmon fish): 26.5 KU/L (0-0.35 KU/L), wchich indicates strong positive result.Inasmuch as our patient had allergic rhinitis, a skin-prick test with respiratory allergen panel was conducted in order to determine the causative inhalatory allergen. The results were as follows: Der P: 13x11 mm, Der F: 17x11 mm,B.Germenica: 7x7 mm, Negative Control: (-), Histamin.7x7 mm

We subjected our patient to prick-to-prick test: Prawn: 37x18 mm, strong positive, Negative control: (-), Histamin : 7x7 mm

A.O , 27 years old male patient

Complaint:The patient has been experiencing sensation of itching in the mouth, swelling in tongue and throat, difficulty to swallow; all of which occured following consumption of prawn.

History of complaints:

None of these complaints occured before the age of 27. The patient has been experiencing those symptoms fort he last 1 year, and upon consumption of prawn.

While our patient experienced only swelling in the tongue and throat, along with an itching sensation in these localisations when he consumed prawn in the restaurant A; he experienced swelling in tongue and throat, laryngeal edema accompanied by dizziness and sensation of fainting and hypotension, suggesting anaphylactic reaction, when he consumed prawn in the restaurant B.The patient favoured prawn a lot and  did not quit consuming prawn in spite of all these complaints. He had about 3 or 4 such allergic episodes when he had applied to our clinic.

Result:

The patient was issued an adrenalin auto-injection certificate. He was instructed about  auto injection technique.

He was adviced not to ever consume prawn from now on. He was also adviced to be cautious about restaurants serving prawn since certain kitchen equipments might be contaminated with prawn particles.