D3.335 - Anaphylaxis After Eating Sushi - Emergent allergies with new food habits?

Brief statement:A case report of anaphylaxis after a sushi meal. Introduction:In food allergy it can be difficult to find a trigger as varied foods are ingested at the same time.Furthermore, cooking methods can affect allergenicity and the occurrence of symptoms.Additionally, accidental contamination might also confuse the diagnostic investigation.In Portugal, seafood is a culinary staple, traditionally served cooked.It is also a significant cause of anaphylaxis, with shellfish and fish accounting for 26.8% and 7.6% of food-induced anaphylaxis cases, respectively.We present the case of a 70-year-old man who developed anaphylaxis(swelling of the tongue and eyelids, dyspnea, generalized urticaria, and vomiting) after eating at a Japanese restaurant.His meal consisted of miso soup, wheat bread, and sushi(various types of fish were served).The previous year, he had a history of vomiting, nausea, and diarrhea hours after ingesting shiitake mushrooms, but did not seek medical help.However, since the reaction, he has avoided consuming shiitake mushrooms.Previously, he consumed seafood without any reaction.Since the reaction, he has stopped eating sushi, without experiencing any further reactions. Methods:Skin prick tests with commercial battery of fish, shellfish and seasonings were performed.The patient was questioned about all the components of the meal and asked to bring these components to perform prick-to-prick tests. Serum specific IgE (sIgE) for suspected triggers and basal serum tryptase were also performed. Results:Skin prick tests with commercial extracts of fish, shellfish and seasonings were negative.Basal serum tryptase was 5.7 UI/ml.Prick-to-prick tests and sIgE results are shown in the table. Discussion:Although there was initially a suspicion of fish allergy, sensitization was not confirmed to any species ingested.Instead, anisakis, miso and wasabi sensitization was discovered.Anisakis simplex, a part of a group of roundworms that frequently parasite fish and shellfish, is usually destroyed after the cooking process.Miso is a Japanese fermented paste made from soybeans, salt, and koji.Wasabi is a paste made from the grated rhizome of the Wasabia japonica plant.In this case, the simultaneous ingestion of raw fish, miso, and wasabi possibly contributed to the occurrence of a severe reaction. Conclusion:We must be aware of a new reality: new cultural and culinary trends can trigger new allergies, whether due to new allergens or new forms of exposure.