Abstract
We encountered 2 cases of food anaphylaxis, which were non-immediate with regard to the time of onset. One case was a 6-year-old boy who developed anaphylaxis 3 hours and 35 minutes after ingestion of casein in a sausage. Based on positive casein-specific IgE antibody and past history of milk-induced anaphylaxis, the patient was diagnosed as IgE-dependent non-immediate-type anaphylactic response. The other was a 6 month-old boy who developed anaphylaxis 3 hours after ingestion of rice. Based on negative rice-specific IgE antibody, positive oral food challenge test, and positive lymphocyte stimulation test to rice, the patient was diagnosed as non-IgE-dependent non-immediate-type anaphylactoid response. Both cases were serious, and needed emergency treatment. In general, anaphylaxis is IgE-dependent and develops immediately, but non-immediate-type food-induced anaphylactic (anaphylactoid) responses may occur irrespective of the existence of food-specific IgE antibody, depending on the characteristics of the food materials or reactivity of the patients. Although it occurs rarely, non-immediate-type onset should be considered in diagnosing food-induced anaphylaxis or during the performance of oral food challenge test.
