Immediate-Type Respiratory Allergy to Millet-Containing Seed Mixture of Bird Food
© World Allergy Organization; licensee BioMed Central Ltd. 2008
Received: 26 March 2008
Accepted: 28 May 2008
Published: 15 August 2008
A 21-year-old patient experienced asthmatic attacks when cleaning the cage of his budgerigar. Skin tests and radioallergosorbent test were positive to grass pollen and negative for budgerigar feathers and feces. When the food of the bird, a mixture of grain, was tested, a positive reaction to millet was found. Nasal provocation test with millet was positive. Specific immunoglobulin E antibodies against millet were detected in the radioallergosorbent test and in immunoblot analysis. The immunoblot showed specific immunoglobulin E antibodies against a 60-kd protein in millet of birdseed and against a 60-and 36-kd protein in common millet. Immediate-type allergy to millet is rare and occurs mostly as anaphylactic reaction after ingestion of millet but may also occur as asthmatic attack after inhalation of millet.
A 21-year-old man experiences perennial allergic rhinoconjunctivitis and bronchial asthma since childhood. Sensitizations to house-dust mite, grass pollen, and cat dander are known. Since 9 months, the patient reported deterioration of asthma and asthmatic attacks when cleaning the cage of his budgerigar. The asthma was well adjusted. The lung function showed no pathological findings. The vital capacity, the forced expiratory volume, and the peak expiratory flow were 6.98 L, 5.33 L, and 12.37 L/s, respectively, and within the reference range. His asthma medications consisted of fluticasone-17-propionate inhalation 2-0-2 and fenoterol inhalation when needed. The family history was positive; his sister was suffering from hay fever.
Skin prick test
In vitro test
Because millet is in most of the bird's food, it is difficult to dispense with millet. So the patient avoided cleaning the cage of his budgerigar, and the asthma attacks stopped.
Asthma and rhinoconjunctivitis after inhalation of millet in bird food are rare. So far, 1 case in the literature is described by Stuck et al, where cleaning of the birdcage led to asthma attacks. In this case, the patient also experienced anaphylaxis after ingestion of millet. The sensitization to millet via inhalation of millet in birdseed may later lead to manifest food allergy . Anaphylactic reactions after ingestion of millet are more common. There are about 10 cases described since 1981 [2, 12–14]. Anaphylactic reactions after ingestion of millet in our patient are not known in contrast to the study described by Stuck et al.
Cross-reactivity between cereal grains in the Poaceae family is not uncommon. A 16-kd rice protein is supposed to be one of the major allergens in rice grain extract and may be responsible for cross-allergenicity . Because the RAST inhibition assay in our patient between grass pollen and millet showed no decrease in IgE binding, the asthma attacks in our patient were caused by sensitization to millet and not due to cross-reactivity to grass pollen allergens as the basis of this hypersensitivity.
In conclusion, not only bird's feathers but also seeds in bird food can represent an additional risk factor for atopic bird keepers.
- Varjonen E, Vainio E, Kalimo K, Juntunen-Backman K, Savolainen J: Skin-prick test and RAST responses to cereals in children with atopic dermatitis. Characterization of IgE-binding components in wheat and oats by an immunoblotting method. Clin Exp Allergy. 1995, 25: 1100-1107. 10.1111/j.1365-2222.1995.tb03257.x.View ArticlePubMedGoogle Scholar
- Bohle B, Hirt W, Nachbargauer P, Ebner H, Ebner C: Allergy to millet: another risk for atopic bird keepers. Allergy. 2003, 58: 325-328. 10.1034/j.1398-9995.2003.00101.x.View ArticlePubMedGoogle Scholar
- Urisu A, Yamada K, Masuda S, Komada H, Wada E, et al: 16-Kilodalton rice protein is one of the major allergens in rice grain extract and responsible for cross-allergenicity between cereal grains in the Poaceae family. Int Arch Allergy Appl Immunol. 1991, 96: 244-252. 10.1159/000235502.View ArticlePubMedGoogle Scholar
- Dreborg S: The skin prick test in the diagnosis of atopic allergy. JAm Acad Dermatol. 1989, 21: 820-821. 10.1016/S0190-9622(89)70256-5.View ArticleGoogle Scholar
- Renz H, Becker WM, Bufe A, Kleine-Tebbe J, Raulf-Heimsoth M, et al: In vitro allergy diagnosis. Guideline of the German Society of Asthma and Immunology in conjunction with the German Society of Dermatology [in German]. J Dtsch Dermatol Ges. 2006, 4: 72-85. 10.1111/j.1610-0387.2006.04350.x.View ArticlePubMedGoogle Scholar
- Tiikkainen U, Klockars M: Clinical significance of IgG subclass antibodies to wheat flour antigens in bakers. Allergy. 1990, 45: 497-504. 10.1111/j.1398-9995.1990.tb00525.x.View ArticlePubMedGoogle Scholar
- Boluda L, Fernandez-Caldas E, Berrens L: The role of IgG in type-I allergy: an unsolved problem. J Investig Allergol Clin Immunol. 1997, 7: 205-210.PubMedGoogle Scholar
- Mempel M, Rakoski J, Ring J, Ollert M: Severe anaphylaxis to kiwi fruit: immunologic changes related to successful sublingual allergen immunotherapy. J Allergy Clin Immunol. 2003, 111: 1406-1409. 10.1067/mai.2003.1497.View ArticlePubMedGoogle Scholar
- Poulsen LK: In vivo and in vitro techniques to determine the biological activity of food allergens. J Chromatogr B Biomed Sci Appl. 2001, 756: 41-55. 10.1016/S0378-4347(01)00070-6.View ArticlePubMedGoogle Scholar
- Gosepath J, Amedee RG, Mann WJ: Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis. Laryngoscope. 2005, 115: 512-516. 10.1097/01.MLG.0000149682.56426.6B.View ArticlePubMedGoogle Scholar
- Druce HM, Schumacher MJ: Nasal provocation challenge. The Committee on Upper Airway Allergy. J Allergy Clin Immunol. 1990, 86: 261-264. 10.1016/S0091-6749(05)80074-0.View ArticlePubMedGoogle Scholar
- Stuck BA, Blum A, Klimek L, Hormann K: Millet, a potentially life-threatening allergen. Allergy. 2001, 56: 350-10.1034/j.1398-9995.2001.00061.x.View ArticlePubMedGoogle Scholar
- Parker JL, Yunginger JW, Swedlund HA: Anaphylaxis after ingestion of millet seeds. J Allergy Clin Immunol. 1981, 67: 78-80. 10.1016/0091-6749(81)90050-6.View ArticlePubMedGoogle Scholar
- Olivieri J, Hauser C: Anaphylaxis to millet. Allergy. 1998, 53: 109-110.View ArticlePubMedGoogle Scholar
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