Systemic reactions: Testing can help find the underlying cause
Robert, an 18-year-old with a history of birch allergy visits his healthcare provider following a recent emergency admission after having a systemic reaction. His symptoms included coughing, sweating, dyspnea, swelling of lips, and tightness of throat. Robert reported that he had eaten a shrimp salad, drank a glass of soy milk, and was exercising before the reaction occurred.
Robert's healthcare provider conducts a full clinical history and physical examination and decides to test using soy components.
A boy with a birch allergy visits has systemic reaction after eating a shrimp salad and drinking a glass of soy milk.
Patient History
Family History
- None
Robert’s Personal History
- Robert has a known birch pollen allergy and experiences rhinitis during tree pollen season.
- He also has oral allergy syndrome (OAS) symptoms when eating apples, but has no other known allergies.
Robert’s ImmunoCAP™ Test Results
These results together with this patient's case history and symptoms, help confirm the diagnosis.
Test |
Type |
Robert’s Results |
Egg |
Whole Allergen |
<0.1 |
Shrimp |
Whole Allergen |
<0.1 |
Soy |
Whole Allergen |
4.2 |
Test |
Type |
Robert’s Results |
Gly m 4 |
Allergen Component |
40.9 |
Gly m 5 |
Allergen Component |
<0.1 |
Gly m 6 |
Allergen Component |
<0.1 |
Birch |
Whole Allergen |
99.6 |
Differential Diagnosis
Robert’s test results indicate a clinically relevant cross-reaction between birch pollen and the PR-10 protein Gly m 4. IgE antibodies to Gly m 4 are often associated with local reactions. However, systemic reactions may occur, particularly when consuming high amounts of low processed soy. Robert’s reaction was most likely provoked by a high Gly m 4 content in the soy milk.1
REFINED DIAGNOSIS
- Birch allergy confirmed, pollen-related soy allergy established.
HEALTHCARE PROVIDER MANAGEMENT PLAN
- Robert’s healthcare provider refers him to a dietitian for help in adjusting his diet.
- Robert’s healthcare provider advises him to avoid large amounts of soy, e.g., soy milk. But no strict dietary restrictions on soy, and hence no stress due to the risk of eating “hidden” soy.
- Robert’s healthcare provider also advises him to continue to use antihistamines for the birch pollen symptoms, starting treatment two weeks before the season.
FOLLOW UP
- Robert is seen by his healthcare provider one year later. He has had no further episodes, and is doing well.
The people, places, and events depicted in these case studies and photographs do not represent actual patients, nor are they affiliated in any way with Thermo Fisher Scientific.
- Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, et al. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol. 2016;27 Suppl 23:1-250.
