Anaphylaxis by antihistamine containing bovine gelatin: the utility of the basophil activation test in the diagnostic work-up.

Gelatin, a collagen protein obtained from cow and pig bones and fish skin is widely used, by the hydrolysis of collagen, in food preparations (sweets, yoghurt, etc.) and as a stabilizer in the pharmaceutical industry. In particular it could be found as an ingredient of drug capsules, plasma expanders, vaccines and plasma substitutes. Systemic allergic reactions to gelatin-containing vaccines and drugs have been proven by anti-gelatin IgE assay [1–3] and by the Basophil Activation Test (BAT) [4]. Bovine gelatin sensitization is commonly associated with cow milk allergy and beef allergy [5]. We report the case of a 14-year-old patient affected by cow’s milk allergy, who experienced lip paraesthesia, generalized itching and dyspnoea with bronchospasm after the ingestion of lyophilised ebastine; the reaction was handled in the emergency room with intramuscular and aerosolized epinephrine, systemic corticosteroids and antihistamines.