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When Pancake Day Ends in a Trip to the Emergency Department

Pancakes stacked on a plate.
Credit: Anna Zaro / Unsplash.
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It’s pancake day! Time to whip out the frying pan, perfect your batter recipe and get flipping. Try to avoid getting pancakes stuck to the ceiling too, if possible.


It’s a joyous day, generally speaking. Who doesn’t love having an excuse to eat pancakes with copious amounts of sugary toppings?


But for some people, the lure of delicious, fluffy pancakes results in a trip to the emergency room with severe illness.

What is pancake syndrome?

Oral mite anaphylaxis (OMA) is characterized by symptoms of moderate to severe acute allergic reactions after eating mite-contaminated foods.1 OMA is a newly-recognized condition, also called “pancake syndrome”, after a number of patients presented with symptoms shortly after eating pancakes made from contaminated flour.2


The most common symptoms are breathlessness, wheezing, a runny nose, cough, face orlaryngeal angioedema and wheals. In some patients, the allergic reaction can be so severe that it proves fatal.3

How common is pancake syndrome, and what causes it?

Pancake syndrome is relatively rare; most cases have been reported in tropical climates where high temperatures and humidity likely contribute to mite proliferation.


There are, however, case studies from Philadelphia and Detroit, where contaminated flour has been transported from other regions.2 Three students in Ireland were diagnosed with pancake syndrome after cooking pancakes using out-of-date flour, which had been stored through an “unusually warm” Irish summer.1  


As the allergic reactions occured after eating cooked food, thermoresistant allergens are considered to be responsible for pancake syndrome.


In 2013, a team of clinicians led by the late Professor Mario Sánchez-Borges summarized the available literature on pancake syndrome cases reported after 1993.2 The review lists domestic species of mites that have been linked to pancake syndrome, including but not limited to Dermatophagoides pteronyssinus, Dermatophagoides farina and Blomia tropicalis, plus storage mites such as Suidasia medanensis, Aleuroglyphus ovatus, Tyrophagus putrescientiae and Tyreophagus entomophagus.


Pancake syndrome can affect individuals of any age, though the majority of case reports feature patients with a history of atopy – a tendency to develop allergic conditions. Sánchez-Borges et al. list the following risk factors:2

  • Previous atopic disease
  • Mite sensitization
  • Non-steroidal anti-inflammatory drug hypersensitivity 
  • Ingestion of pancakes or other meals containing wheat flour
  • Ingestion of more than 1 milligram of mite allergen (>500 mites per gram of flour)

Preventing pancake syndrome

As lower temperatures help to prevent mite proliferation, storing flour within sealed containers in the fridge has been suggested as one way to help prevent pancake syndrome.2


Other environmental measures that can help to prevent episodes include using air purifiers, adopting methods to decrease intradomiciliary humidity, using acaricides and cleaning and disinfecting furniture and floors.2


Awareness can also help with prevention, Canavan et al. emphasized.1 Because pancake syndrome can be easily confused with wheat or other allergies, misdiagnosis is an issue. “Consequences of this are repeat exposure and recurrence which have serious implications in predisposed individuals,” they said. “Increased awareness among physicians of the importance of asking about hidden allergens in this syndrome is key to prevention."1


References:

1. Canavan M, Mitchell A, Sharkey A, et al. Oral mite anaphylaxis. QJM. 2018;111(3):189-190. doi: 10.1093/qjmed/hcx255


2. Sánchez-Borges M, Suárez Chacón R, Capriles-Hulett A, Caballero-Fonseca F, Fernández-Caldas E. Anaphylaxis from ingestion of mites: Pancake anaphylaxis. J Allergy Clin Immunol. 2013;131(1):31-35. doi: 10.1016/j.jaci.2012.09.026


3. Sánchez-Borges M, Fernandez-Caldas E. Hidden allergens and oral mite anaphylaxis: the pancake syndrome revisited. Curr Opin Allergy Clin Immunol. 2015;15(4). doi: 10.1097/ACI.0000000000000175