a Case of Multiple Food Allergies with Recurrent Anaphylaxis Successively Controlled By Omalizumab

Food allergy is defined as an adverse health effect that occurs reproducibly on exposure to a given food. Food allergy is classified into Immunoglubulin E (IgE)-mediated and non-IgE-mediated reactions. Clinical manifestations include gastrointestinal, cutaneous, and respiratory symptoms. IgE mediated food allergies usually manifest as acute gastrointestinal hypersensitivity, pollen-food allergy syndrome, acute urticaria, angioedema, allergic rhinoconjunctivitis, and acute bronchospasm. A diagnosis can be made by history, skin prick test, or serum food-specific IgE level although oral food challenges confirm the diagnosis. Managements of food allergy are food avoidance and treatment of acute reactions. We report here a case of multiple food allergies with recurrent anaphylaxis successively controlled by omalizumb.

A 43-year-old male patient visited allergy department for evaluation of chest tightness, throat swelling and dyspnea 20 minutes after an ingestion of two strawberries. The patient had repeatedly suffered from multiple food allergies to peach, plum, apricot, raspberry, and apple since his childhood, which was presented as acute urticaria. Laboratory test results showed an elevated blood eosinophil count (1800 /mm³) and an elevated serum specific IgE level to strawberry (measured by ImmunoCAP^® [ThermoFisher Scientific, Uppsala, Sweden] system, 3.98 KU/L). Spirometry showed normal range. We assessed him as food allergy to strawberry and eosinophilia was thought to be resulted from the food allergy. After using systemic corticosteroid and antihistamines, blood eosinophil count decreased to normal range and the patient’s symptoms were resolved. Five months later, he complained of acute urticarial, dizziness, dyspnea after ingestions of pineapple, celery, and sesame. Blood eosinophil count was 900 /mm³ and serum specific IgE levels to pineapple, celery, and sesame were 0.68 KU/L, 0.93 KU/L, and 0.77 Ku/L, respectively. One month later, the patients visited emergency department for acute urticaria, dyspnea, general weakness, and numbness of legs after an ingestion of almond. Blood eosinophil count was 1,600 /mm³ and serum specific IgE level to almond was 4.63 KU/L. Recurrent episode of anaphylaxis due to multiple food was occurred with eosinophilia and food avoidance strategy was failed because of allergic reactions to unknown food. Furthermore, sesame was widely used to various Korean food as a spice. Omalizumab was treated monthly to him to control the IgE-mediated food allergy. After the treatment, there was no episode of anaphylaxis to him and the patient performed his daily tasks without disturbances. When complete avoidance of food allergy is impossible, omalizumab can be an alternative treatment to control symptoms.