Oral mite anaphylaxis (OMA), also known as pancake syndrome, is a rare but under‐recognized cause of food‐induced anaphylaxis in tropical countries. We report two pediatric cases of anaphylaxis following ingestion of food deep fried in wheat‐based flour stored at room temperature. The first case involved a 14‐year‐old girl who developed chest tightness and wheezing within 30 min of consuming deep‐fried maitake mushrooms. In the second case, a 10‐year‐old girl presented with periorbital angioedema and respiratory symptoms three hours after eating deep‐fried imitation crab. In both cases, sensitization to Dermatophagoides pteronyssinus and Dermatophagoides farinae was confirmed by skin prick testing and specific IgE. Microscopic examination of the flour used in both cases revealed live mites. The patient exhibited positive skin test reactions to contaminated flour, while showing no reaction to uncontaminated flour. Both patients responded well to intramuscular epinephrine and remained symptom free during a 6‐month follow‐up. These findings highlight the importance of proper flour storage and considering OMA in the differential diagnosis of food‐induced anaphylaxis, particularly in warm and humid climates.
Wongthai et al. (Thu,) studied this question.