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Rare presentation of anaphylaxis: pancake syndrome
  1. Katsunori Masaki1,2,
  2. Koichi Fukunaga3,
  3. Yuji Kawakami4 and
  4. Rubaiyat Haque2
  1. 1 Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
  2. 2 Department of Adult Allergy, Guy’s and St Thomas' NHS Foundation Trust, London, UK
  3. 3 Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
  4. 4 Environmental Science Laboratory, FCG Research Institute, Koto-ku, Japan
  1. Correspondence to Dr Koichi Fukunaga, km-fuku{at}


A 43-year-old woman presented with oral discomfort, sneezing, urticaria, eyelid angioedema, abdominal pain, diarrhoea, dyspnoea and wheeze soon after eating a Japanese flour pancake (okonomiyaki, containing wheat, egg, yam, pork, prawn and squid). Subsequent analysis of the flour used in the pancake revealed the presence of Dermatophagoides farinae (4500 mites/g). The patient tested positive for specific IgE to D. farinae (15.2 kU/L) and D. pteronyssinus (14.0 kU/L) with negative responses to other ingredients in the pancake. Oral ingestion of dust mite in poorly stored foods can cause anaphylactic reactions in patients with allergy.

  • dermatology
  • primary care
  • emergency medicine
  • occupational and environmental medicine
  • allergy, asthma

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  • Contributors KM, KF and RH wrote the draft. KM and KY collected the data and analysed the specimen. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Provided