Anaphylaxis caused by artisanal honey in a child: a case report

Abstract

Background Honey is a rare cause of food allergy, especially in children, but it can cause severe systemic allergic reactions. In the pediatric age group, only a few cases have been reported in the literature. Honey allergy may be caused by pollen content or bee-derived proteins. A role for Compositae has been suggested among pollen allergens. Allergology workup of a patient with suspected honey allergy is not well defined. Here we describe a rare case of anaphylaxis in a 5-year-old boy, sensitized to Compositae pollen (ragweed and mugwort), after the ingestion of artisanal honey. Case presentation The Slavic patient was referred to our hospital emergency department for generalized urticaria and breathing impairment. All the symptoms occurred approximately 30 minutes after the ingestion of a meal containing salmon and artisanal honey. The allergology workup revealed that a skin prick-by-prick test with the implicated artisanal honey was positive, while a variety of different commercial honey and salmon products yielded negative results. Skin prick test and serum-specific immunoglobulin E (IgE) results were also positive for Compositae pollen (ragweed and mugwort). Patients sensitized to weed pollens who ingest bee products may experience an immediate allergic reaction because of the cross-reaction between weed pollens and Compositae bee product pollen. In this case, primary sensitization may be due to airborne Compositae pollen. Commercial honey is heavily processed due to pasteurization and filtration, which removes most of the pollen. These observations highlight the role of Compositae pollen in the observed allergic reaction and suggest that the different pollen content in the artisanal honey relative to commercial honey was responsible for the allergic reaction in our patient. Conclusions This is the first reported pediatric case of honey-induced anaphylaxis in a child under 6 years of age sensitized to Compositae pollen. Pediatricians should be aware of the potential risk of severe allergic reactions upon ingestion of honey and bee products, especially in patients sensitized to weed pollens. To diagnose honey allergy, obtaining a proper clinical history is essential. In addition, skin prick-by-prick tests are helpful, and may represent a simple method to screen for honey allergy in patients sensitized to Compositae pollen, in light of the potential risk.

Honey Allergy, First Documentation in Iraq – A Case Report

“…Positive and negative controls were included to ensure the accuracy of the result, as shown in Figure 1a-d. As mentioned in a previous report [13], the positive control was histamine, while the negative control was normal saline, as shown in Figure 1d and a, respectively. The results appear after 15 min of injection and are considered positive when three wheals of 3 mm or more appear.…”

“…This processing leads to the removal of most of the pollen. With time, increased honey consumption, especially for medical purposes, and an increase in the numbers of patients with a diagnosis of honey allergy [9], [11], [13] and this explains why our patient did not have any symptoms when he was eating commercial honey.…”

“…Pollen is a component of honey and is responsible for honey allergy. Immunoblotting studies [11], [13] confirmed pollen's role as an allergen, and the amount of pollen in honey varies depending on many factors, including location and season [14]. However, in fact, these factors are not very important due to the properties of honey in storage for a long time across various seasons.…”

“…Certain tests were recommended to dtermine if a person has certain food allergy. The SPT (prick-to-prick) is the most sensitive test to diagnose anaphylaxis to honey [2], [13].…”

“…The child suffered from many symptoms after 30 min of honey ingestion, and the results of all routine laboratory tests were normal. After the patient follow-up for 2 weeks, a prick-by-prick test for honey gave a positive result [13]. All these cases were diagnosed based on the Skin Prick Test (SPT).…”