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2020

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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CAT-PORK SYNDROME AS CAUSE OF ANAPHYLACTIC REACTION TO WELL COOKED MEAT

Inês Sangalho1, Susana Palma-Carlos1, Paula Leiria Pinto1, Borja Bartolomé2

1 – Serviço de Imunoalergologia, CHULC – Hospital Dona Estefânia
2 – R&D Department, Roxall, Bilbao, Spain

Reunião Internacional, apresentação sob a forma de Poster, na European Academy of Allergy and Clinical Immunology Annual Congress 2019, Lisboa, 1 a 5 de Julho de 2019

Introdução: Cat-pork syndrome is rare, occurs in patients allergic to cat dander (CD) and is caused by cross-reactivity (CR) between serum albumin (SA) of cat and pork. Usually there is respiratory allergy to CD that precedes alimentary allergy. This suggests a primary sensitization to cat SA. Since SA is thermolabile, the reaction tends to be more severe when the meat is less cooked. CR with others mammalian SA may occur.
Descrição do caso: Woman, 27 years (y), from Mozambique, living in Lisbon since 2010. She has rhinoconjunctivitis that has been worsening in the past 3y. She always had dogs and cats in outdoor; and got a dog and a cat that live indoor, 6 and 3y ago, respectively. In the last 8y she has been eating mammalian meat and had reproducible local oedema when contacting with raw pork meat (PM). She also had 2 systemic mucocutaneous reactions 30 minutes after intake of small amounts of pork meat in the last 6y. Skin prick and prick-prick tests were positive for extracts from Blomia tropicalis (BT), Acarus siro (AS), olive pollen (OL), grass pollen (GR), CD, dog dander (DD) and raw PM; it was negative with cooked PM. She developed an erythematous and pruriginous papule 5 minutes after contact with raw PM on skin, compatible with an immediate reaction. Specific IgE were positive for CD, PM, BT, AS, OL and GR and the microarray ISAC showed sensitization to several allergens, including Fel d 2. Two oral provocation tests (OPT) with well-cooked meat were positive, developing anaphylaxis after had eating 2 and 8g of well-cooked PM and cow meat (CM), respectively. SDS PAGE IgE immunoblotting assays were performed with pork meat extract, and a 60 kDa band was detected. In the Immunoblotting-inhibition assays, cat SA produced a total IgE binding inhibition to pork meat extract, which proves CR between the two SA, hence confirming the cat-pork syndrome diagnosis. The inhibition assays with other mammalian meats are in progress. An epinephrine autoinjector was provided, although a mammalian meat free diet was advised.
Discussão: A cat-pork syndrome diagnosis was made with probable clinical CR to other mammalian SA. It was not expected neither the severity nor the reaction to the well-cooked meats.
Conclusões: This case should raise awareness for performing OPT with well-cooked mammalian meats in patients with cat-pork syndrome in order to stablish tolerance threshold and avoid possible anaphylactic reactions. It would be interesting to study the effect of immunotherapy for SA cat allergy on food allergy.

Palavras Chave: reactividade cruzada, albumina sérica, anafilaxia, síndrome gato-porco