From Idiopathic to Identifiable: Oral Mite Sensitization Revealed by Component-Resolved Diagnostics

Abstract

Introduction:

Oral mite anaphylaxis (OMA) is an uncommon form of food-induced anaphylaxis caused by ingestion of foods contaminated with house dust mites. Exercise may act as a cofactor, sometimes mimicking food-dependent exercise-induced anaphylaxis (FDEIA).

Case Presentation:

We describe a 14-year-old boy with atopic dermatitis, allergic rhinitis, and mild asthma who experienced three episodes of anaphylaxis. Each reaction occurred 30–60 min after eating wheat-based foods, followed by physical activities such as football or basketball. Symptoms started with urticaria and progressed to cough and abdominal pain. Notably, he tolerated the same foods in the absence of exercise. Skin prick testing and specific IgE showed strong sensitization to Dermatophagoides pteronyssinus and Dermatophagoides farinae, but not to wheat. Multiplex component testing confirmed broad mite sensitization. Evaluation for primary immunodeficiency was unremarkable. The patient was prescribed an epinephrine auto-injector, and asthma therapy was optimized with budesonide/formoterol. Over 6 months of follow-up, no further episodes occurred, asthma control improved (Asthma Control Test score 24–25), and rhinitis symptoms subsided with intranasal antihistamines.

Discussion:

The clinical picture, together with negative wheat-specific IgE and strong mite sensitization, supported OMA rather than classical food allergy or FDEIA. Component-resolved diagnostics were especially helpful in confirming the diagnosis.

Conclusion:

This case underlines the importance of considering OMA in children with exercise-related anaphylaxis after wheat-based meals, particularly in patients who may initially appear to have idiopathic anaphylaxis. Careful history, use of CRD, and close follow-up are essential. Education, asthma control, and preventive measures remain key to reducing recurrence risk.