Severe reaction in a child with asymptomatic codfish allergy: Food challenge reactivating recurrent pancreatitis

Abstract

An 8-year-old child during the first year of life manifested severe atopic dermatitis and chronic diarrhea with mucorrhea and rectal bleeding; a fish-free diet was started based on weakly positive skin-prick tests to codfish extract. At the age of 4 years the child began to suffer of recurrent pancreatitis. When he came to our attention for the evaluation of his fish allergy, he was asymptomatic; a weak reactivity to codfish was observed (SPTs: cod, 4 mm, sIgE ImmunoCAP: cod, 1.30kU/l). The food challenge test with cod was negative. When the child ate cod again, within 5 minutes, developed anaphylactic reaction and complained of abdominal pain compatible with pancreatitis (enzyme serum levels risen and parenchymal oedema at ultrasonography), that resolved within 7 days after specific therapy. This case raises two issues: the elimination diet in asymptomatic food allergy on the basis only of SPT and the ethicality of food challenge in gastrointestinal chronic disease.

Food-Induced Acute Pancreatitis

“…Several case reports of acute pancreatitis, provoked by food allergies to mustard [22], milk [13, 23], egg [24], bananas [10], fish [25] and kiwi fruits [26] in human have been published in the literature. Chronic pancreatitis persisting for as long as 8 to 10 years due to consumption of different types of food such as beef, milk, potato, fish, and eggs have also been reported [12].…”

“…Unfortunately, in the current scenario, the prevalence of food-induced acute or chronic pancreatitis is still not well reported. Since 1933, food-induced allergy has been known to be a cause of acute pancreatitis in dogs [21]; furthermore, several cases of acute pancreatitis in human caused by allergy to mustard [22], milk [13, 23], cod roe [14], egg [24], bananas [10], fish [25], and kiwi fruits [26] have been reported in literature. Several studies indicate that a high dietary glycemic load [27], fat, meat, egg etc.…”

Hepato-pancreato-biliary system pathology among children with atopic dermatitis

“…Одной из причин не-достаточного внимания врачей к патологии со стороны внутренних органов признают стёртость и недостаточную выраженность клинической картины заболеваний ЖКТ при дерматозах. Известно, что на фоне активной терапии заболеваний пищеварительного тракта часто купируются симптомы атопии, наступает длительная ремиссия [5][6][7].…”

АЛЕРГІЧНІ ПРОЯВИ ПРИ ХРОНІЧНОМУ ПАНКРЕАТИТІ (Погляд На Проблему)

“…При впливі харчових алергенів підшлункова залоза може виступати як шоковий орган. У дорослих харчову алергію викликають фрукти, молюски, молочні продукти, деякі овочі, арахіс [8]. У плані гендерних особливостей підкреслюється, що чоловіки при ХП мають алергію на харчові продукти частіше, ніж жінки.…”

“…Pellegrino, K. (2012). Severe reaction in a child with asymptomatic codfish allergy: Food challenge reactivating recurrent pancreatitis.…”