An unusual case of anaphylaxis - Mold in pancake mix

Anaphylactic reactions involve contact with an antigen that evokes an immun e reaction that is harmful. This type of reaction is a rapidly developing i mmunologic reaction termed a type I hypersensitivity reaction. The antigen complexes with an IgE antibody that is bound to mast cells and basophils in a previously sensitized individual. Upon re-exposure, vasoactive and spasm ogenic substances are released that act on vessels and smooth muscle. The r eaction can be local or systemic and may be fatal. The authors report the death of a 19-year-old white male who had a history of "multiple allergies," including pets, molds, and penicillin. One morning , he and his friends made pancakes with a packaged mix that had been opened and in the cabinet for approximately 2 years. The friends stopped eating t he pancakes because they said that they tasted like "rubbing alcohol." The decedent continued to eat the pancakes and suddenly became short of breath. He was taken to a nearby clinic, where he became unresponsive and died. At autopsy, laryngeal edema and hyperinflated lungs with mucous plugging were identified. Microscopically, edema and numerous degranulating mast cells w ere identified in the larynx. The smaller airways contained mucus, and find ings of chronic asthma were noted. Serum tryptase was elevated at 14.0 ng/m l. The pancake mix was analyzed and found to contain a total mold count of 700/g of mix as follows: Penicillium, Fusarium, Mucor, and Aspergillus. Wit ness statements indicate that the decedent ate two pancakes; thus he consum ed an approximate mold count of 21,000. The decedent had a history of aller gies to molds and penicillin, and thus was allergic to the molds in the pan cake mix. The authors present this unusual case of anaphylaxis and a review of the literature.