Discussion and Conclusions
We report the first pediatric case of honey-induced anaphylaxis in a child under 6 years of age sensitized to Compositae pollen reported in the literature.
Anaphylaxis is a life-threatening allergic reaction, and it is important to confirm the etiology to prevent recurrence. Severe allergic reactions caused by honey are rare. In the literature, honey allergy is usually attributed to the pollen content. Honey contains significant amounts of pollens, and this accounts for the role of pollen allergens in allergic reactions to honey. The importance of pollen allergens is confirmed by their identification in immunoblotting studies. However, the pollen content of honey depends on the location and the season when pollens are collected by honey bees. The most common pollens responsible for the reactions are assumed to be those of the Compositae family.
Our patient had no previous history of anaphylaxis after a bee sting or food allergy. He had a personal clinical history of allergic rhinitis from the age of 4 years, with skin prick tests and serum-specific IgE initially positive to dust mite and Plantago lanceolata. After the allergic reaction with honey ingestion, the allergology workup (skin prick test and serum-specific IgE) also yielded positive results for Compositae pollen: ragweed (Ambrosia artemisiifolia) and mugwort (Artemisia vulgaris).
Moreover, we observed that the prick-by-prick test yielded a positive result for artisanal honey and negative result for commercial honey. Commercial honey is heavily processed due to pasteurization and filtration, which removes most of the pollen. These observations highlight the role of Compositae pollen in the observed allergic reaction and suggest that the different pollen content in the artisanal honey relative to the commercial honey was responsible for the allergic reaction in our patient.
Patients sensitized to weed pollens who ingest bee products (honey, royal jelly, bee pollen) may experience an immediate allergic reaction because of the cross-reaction between weed pollens and Compositae bee product pollen. In this case, primary sensitization may be due to airborne Compositae pollen.
It is known that patients with pollinosis may display clinical characteristics caused by allergy to certain fruits and vegetables, but the mean age for the beginning of allergic symptoms is usually adulthood, and clinical manifestations are generally mild such as oral allergy syndrome.
To the best of our knowledge, this is the first reported pediatric case of honey-induced anaphylaxis in a child under 6 years of age sensitized to Compositae pollen. With regard to bee products in pediatric patients, Martín-Muñoz et al. described a 4-year-old boy with allergic symptoms, but without anaphylaxis, immediately following ingestion of bee pollen as a food supplement. Another case of honey-induced anaphylaxis was described in a 14-month-old boy, but in this case the authors found no sensitivity to pollens or bee venoms.
In conclusion, despite being a rarely observed condition, honey allergy has serious consequences, even in childhood. Allergic reactions to honey can be related to many factors, including pollens. Pediatricians should be aware of the potential risk of severe allergic reactions upon ingestion of honey and bee products, especially in patients sensitized to weed pollens. To diagnose honey allergy, obtaining a proper clinical history is essential. In addition, skin prick-by-prick tests are helpful, and may represent a simple method to screen for honey allergy in patients sensitized to Compositae pollen, in light of the potential risk.
The authors thank Dr. Eleonora Savi for the valuable advice provided for the study
The authors declare that they have no sources of funding.
Availability of data and materials
The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Ethics approval and consent to participate
Consent for publication
Written informed consent was obtained from the patient's legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
J Med Case Reports. 2021;15(235) © 2021 BioMed Central, Ltd.