Anaphylaxis after jellyfish ingestion with no history of stings: a pediatric case report

Abstract

Background: Jellyfish stings are known to induce allergic skin reactions; however, case reports of anaphylaxis after jellyfish ingestion have been increasing, especially in Asian countries. Some cases of anaphylaxis after jellyfish ingestion have been reported in patients with a previous history of frequent jellyfish stings. Herein, we report a pediatric patient with anaphylaxis after jellyfish ingestion with no history of jellyfish stings.

Case presentation: A 14-year-old girl developed two episodes of anaphylaxis, and her diet diaries revealed that edible jellyfish was common to the meals in both the anaphylaxis events. A skin prick test using five types of edible jellyfish products revealed a positive reaction to some jellyfish, and anaphylaxis was observed after the ingestion of jellyfish in an oral food challenge test. She had no history of jellyfish stings or frequent swimming in the ocean. The basophil activation test showed positive results on stimulation with extracts from various types of edible jellyfish. We observed serum immunoglobulin E (IgE) reactivity to purified jellyfish collagen and jellyfish acid-soluble extracts. Moreover, immunoblotting analysis showed IgE reactivity to two bands at approximately 40 and 70 kDa using purified jellyfish collagen, which may be a causative antigen.

Conclusions: Edible salted jellyfish can be one of the causative foods of anaphylaxis. Clinicians should be aware of the possibility of anaphylactic reactions due to jellyfish ingestion even without a history of jellyfish stings.

Keywords: Anaphylaxis; Basophil activation test; Food allergy; Immunoglobulin E; Jellyfish; Oral food challenge; Skin prick test.

Fig. 1

Whole-blood basophil activation tests stimulated with four types of jellyfish extracts. Four types of edible jellyfish (Rhopilema esculentum, Stomolophus meleagris, Rhopilema hisphidum, and Lobonema smithi) were prepared for the stimulation. The patient’s whole blood was cultured with each edible jellyfish extract. CD203c-expressing basophils were detected using fluorescence-activated cell sorting. The positive control was incubated with anti-immunoglobulin E antibody

Fig. 2

Serum IgE reactivity against purified jellyfish collagen and five types of edible jellyfish extracts. Each well was coated with purified jellyfish collagen solution and five kinds of acid-soluble jellyfish extracts, and serum from the patient or 3 control patients was applied to the appropriate wells for the reaction. The serum jellyfish-specific IgE antibody bound to the coated jellyfish antigen was recognized with an HRP-conjugated mouse anti-human IgE Fc receptor monoclonal antibody. This photo shows the color change to blue in each well due to TMB substrate oxidized by enzymatic reaction. The graphs indicate the absorbance at 450 nm after the color change to yellow after the addition of hydrochloric acid

Fig. 3

Serum IgE reactivity of patient serum against jellyfish collagen in immunoblot analysis. Purified jellyfish collagen (Rhopilema esculentum) was separated using SDS-PAGE, blotted on PVDF membrane, and immuno-probed with the serum from present patient (P) or control allergic patient without jellyfish allergy (C). Lane (M), molecular weight marker