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Case Report |
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Prawns, Barnacles, and Nonsteroidal
Anti-Inflammatory Drugs: Effect Modifiers or Interaction? |
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C Vidal,1 B Bartolomé,2
A González-Quintela,3 V Rodríguez,1
M Armisén1 |
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1 Departments of Allergy, Complejo
Hospitalario Universitario de Santiago, Santiago de
Compostela, Spain
2 Research and Development Department, Bial-Arístegui,
Bilbao, Spain
3 Department of Internal Medicine, Complejo Hospitalario
Universitario de Santiago, Santiago de Compostela, Spain |
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J Investig Allergol Clin Immunol
2007; Vol. 17(2): 113-118 |
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Abstract |
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A 42-year-old woman
with no history of
atopy reported
several episodes of
generalized
urticaria and
shortness of breath
after eating
shellfish (prawns
and barnacles) but
with good tolerance
of the same foods
between episodes.
Skin prick tests (SPTs),
serum enzyme
allergosorbent tests
(EAST) for specific
immunoglobulin (Ig)
E, Western blot and
inhibition assays,
and oral challenge
tests with prawns,
barnacles,
nonsteroidal
anti-inflammatory
drugs (NSAIDs), and
alcohol as potential
effect modifiers
were performed.
Specific IgE to both
barnacle and prawn
were detected by
SPTs and EAST.
Results from a
Western blot of raw
prawn revealed an
IgE binding band of
37 kDa and IgE
binding bands of
143, 83, 38, 32, and
20 kDa appeared in
the raw barnacle
assay. Oral
challenge tests were
positive with prawns
and prawn extract
only if preceded by
NSAIDs. Oral
challenges with
NSAIDs alone, prawns
alone, barnacles
with or without
NSAIDs and alcohol
led to no reaction.
A synergistic effect
of NSAIDs in
inducing anaphylaxis
after prawn intake
was confi rmed. No
similar effect was
achieved with
barnacles despite
the presence of
specific IgE.
Additional factors
needed to elicit a
clinical reaction in
food allergy may not
be obvious and
several oral
challenge protocols
are mandatory in
such cases.
Key words:
Barnacle.
Nonsteroidal anti-infl
ammatory drugs.
Prawn. Cross-reaction.
Food allergy.
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