Oral mite anaphylaxis (pancake syndrome) caused by storage mite Acarus siro and its treatment with allergen immunotherapy

A 10-year-old atopic patient with asthma, peanut, and house dust mite allergy developed frequent episodes with symptoms including abdominal pain, nausea, vomiting, dizziness, drop of blood pressure, and occasionally shortness of breath and wheezing. After detailed diagnostics including an ISAC test and several other specific IgE blood tests, which could not explain the symptoms, the patient tested positive for specific IgE to Acarus siro (flour mites) (9.2 kU/L). As no oral food challenge with Acarus siro was available, the patient’s family implemented avoidance measures by storing food containing flour in the refrigerator, and the patient started subcutaneous immunotherapy (SCIT) with Depigoid Acarus siro. The implementation of avoidance measures led to an immediate improvement of symptoms, and after 3 years of treatment, products containing flour, stored at room temperature, are tolerated again.