Blue cheese allergic reaction
A 40 year-old old male had an anaphylactic reaction to penicillin 24 years ago. Since the last five years, he has been experiencing angioedema after ingesting blue cheese. The symptoms resolve with steroids and antihistamines. In the last two years, he has reactions after contact with the cheese. With all the reactions there are no other associated symptoms. The reactions happen within a few minutes. How do I go about testing to prove that he is allergic to blue cheese? He is scheduled to get SPT to mold.
I suggest that the patient bring blue cheese to your office so that you may perform prick skin testing. If the skin test is positive, you could consider putting a small amount of blue cheese on a swab and then applying it to a small area of the buccal mucosa followed by a period of observation with repeated visualization of the area to look for swelling. If the skin test is negative, you could do the same, and if there is no reaction after mucosal contact, then proceed to an oral food challenge.
Of note, the main cheese-making penicilliums: roquefort (blue cheese), camemberti (Camembert and Brie) and glaucum (Gogonazola) are not penicillin producers.
I hope this information helps you with your patient.
Jacqueline A. Pongracic, MD, FAAAAI