Oral mite anaphylaxis after pizza consumption in a child: A case report and review of the literature

INTRODUCTION: House dust and storage mites are allergens associated with allergic rhinitis and asthma. Oral mite anaphylaxis manifests after ingesting contaminated flour with mites. We present the case of a 13-year-old child who developed anaphylaxis after consuming pizza. CASE PRESENTATION: A 13-year-old boy presented with respiratory distress after consuming pepperoni pizza, which he had previously tolerated. Skin prick and specific IgE test results revealed sensitization to house dust and storage mites. He passed an oral food challenge (OFC) for pepperoni pizza. DISCUSSION: Anaphylaxis to foods contaminated by mites (also known as "pancake syndrome") is often overlooked. In this case, the diagnosis was supported by the skin prick tests and specific IgE, although the flour used for pizza preparation could not be tested. The patient passed an OFC using ingredients from a different source. CONCLUSION: Oral mite anaphylaxis is an unusual presentation that must be considered when other possible food allergy triggers have been excluded and the patient is sensitized to mites.