We here report a 34-years old male who had nattou-(fermented-soybean) induced late-onset anaphylaxis following SCUBA diving to about 20m in the ocean off a small remote Japanese island (Kuroshima, Okinawa). He had eaten nattou for breakfast at 7 : 30 am. He traveled by boat to the dive site, dove twice and then ate lunch at 12 : 30 on the diving boat (no nattou at lunch). After lunch at 14 : 30 he dove again (third dive of the day) during which time itchiness started. Back on the diving boat, urticarial was noticed. At 15 : 30, while washing his diving gear at the diving shop near the harbor, he fainted. A physician arrived on the scene at 15 : 45. Chest sound was clear and SpO2 was 98%, and blood pressure was 60/-mmHg. Intra-venous hydrocortisone was given, however, his recovery was not satisfactory. Then he was transferred to the Yaeyama Hospital by helicopter at 17 : 45. The examination of diving computer analysis reveals no sign of increased residual nitrogen, denying the possibility of decompression syndrome. Prick to prick test shows a strongly positive response to nattou. Nattou-induced late-onset anaphylaxis following SCUBA diving was suspected.
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