2020 Volume 3 Issue 3 Pages 443-450
A 42-year-old man presented with a 7-month history of generalized urticaria and anaphylaxis characterized by loss of consciousness, dyspnea and nausea. He was a fisherman living in Sanriku, Japan, and had been treated for erako dermatitis for 2 years. Erako (Pseudoptamilla occelata) belonging to the phylum Annelida, lives in gaps between rocks, at the bottom of ropes for aquaculture, and is used as fishing bait. After the patient's first medical consultation, he ate natto, and eleven hours later developed dyspnea, abdominal pain, and generalized urticaria. Skin prick tests using 1 mg /ml, 10μg /ml, and 1μg /ml poly γ-glutamic acid (PGA) , the viscous component of natto and the tip of the erako tube elicited positive reactions. The patient was then diagnosed as having late-onset anaphylaxis due to natto in association with erako dermatitis. Erako dermatitis is caused by PGA produced by Proboscidactyla flavicirrata, the polyp of a jellyfish that has a symbiotic relationship with its host, erako. As PGA is included in a number of foods, cosmetics, and medicines, the risk of sensitization is increasing. Therefore, patients with late-onset anaphylaxis due to natto PGA and erako dermatitis should avoid not only natto but also other materials containing PGA.
(日本皮膚免疫アレルギー学会雑誌, 3 (3) : 443-450, 2020)