Morales Gavilán M, Claver Monzón A, Navarro Gracia B, Elduque Mora C, Botey Faraudo E, Castillo Fernández M, Cisteró-Bahíma A.

Allergy Deparment “Al.lèrgia-Dexeus”, Hospital Universitari Dexeus-GQS. UAB. Barcelona. Spain.
Application Department, Laboratories Diater. Madrid. SpainBACKGROUND
Beer is one of the alcoholic beverages with more consumption over the world but despite this allergy reactions are unusual.
We present a case report of an 18-year-old male with personal history of mild intermittent asthma, who presented a severe anaphylactic shock (dyspnea, hypotension and unconsciousness with cardiorespiratory arrest) shortly after beer ingestion (Chimay Blue®).

Skin Prick Test (SPT) to aeroallergens: Positive to dust mites, molds, dog dander and polen (grass mix, Chenopodium, olive).
SPT to commercial foods and cereals: Mild positive to rice (correct tolerance). Negative the rest, including non-specific lipid transfer proteins (nsLTPs).
SPT with beers (Steinburg Dark®, Bock-Damm®, Leffe Brune®, Duvel®): All positive.
Serum-specific IgE determinations (ImmunoCAP®) to Cladosporium (3.1 kU/L), Alternaria (8.63 kU/L), wheat (0.05 kU/L) and hops (0.28 kU/L).
SDS-PAGE and Western Blot with different beers, Chimay Blue® (1), Chimay Red® (2), Estrella Damm® (3), Estrella Galicia® (4), Daura Damm® (5), Leffe® (6), showed IgE-binding proteins between 35 and 75 kDa for the extracts number 1, 2, 5 and 6 and one IgE-binding protein of 18 kDa for the extracts number 1 and 2.

We present a case of anaphylactic shock in a patient with mild intermittent asthma and predominant sensitization to molds and grass.

The immunological study (SPT and in vitro study) suggest that our patient is sensitized to a different allergen from those previously described (those related to cereals or nsLTPs, typical in our area). The several ingredients and methods used in beer elaboration launch a challenge in the identification of culprit allergens.