2008 Volume 118 Issue 6 Pages 1085-1093
A 23-year-old female had presented with a one year history of four episodes of urticaria and angioedema, which had been getting more severe. During the last episode, she suffered generalized urticaria, perioral and perioribital angioedema, and dyspnea requiring emergency treatment after the ingestion of several foods and drinks including Campari-Orange. After the treatment, she visited our clinic to determine the cause of her symptoms. We found no correlation between any the common foods or drugs and her episodes. Challenge tests with several food additives, food colorings, and aspirin were negative. Challenge tests after taking aspirin with individual or complex ingestion of several foods and drinks that she had taken during her episodes gave positive results for strawberry milk (dairy drinks including fruit juice) made by A company, fish sausage made by B company, and Campari (liqueur) imported from Italy. A challenge test after taking aspirin also gave positive results for cochineal extract which is commonly included in these foods and drinks, but a high dose of cochineal extract was required for the results. Western blotting analysis revealed the presence of cochineal-extract-specific IgE antibodies in patient’s serum that react to four bands at about 40kDa. Physicians should be aware of the possibility of rare but important adverse effects to cochineal extract, which is sometimes listed as carmic acid.