Correspondence

Kissing and Food Reactions

N Engl J Med 2002; 347:1210October 10, 2002

Article

To the Editor:

Hallett and colleagues (June 6 issue)1 describe kissing-triggered reactions to food allergens. We would like to point out that kissing may lead to allergic reactions to far more than food. Liccardi et al.2 recently reported the induction of severe drug-related angioedema in a 45-year-old woman due to kissing-transmitted bacampicillin, which her husband had ingested as a tablet two hours before kissing her.2 Clearly, the kissing mode of exposure may be relevant not only for teenagers, as Hallett et al. suggest, but for all age groups. Physicians should be aware of this problem.

Axel Fischer, M.D.
David A. Groneberg, M.D.
Humboldt University, D-13353 Berlin, Germany
axel.fischer@charite.de

2 References

1. 1

   Hallett R, Haapanen LAD, Teuber SS. Food allergies and kissing. N Engl J Med 2002;346:1833-1834
   Full Text | Web of Science | Medline

2. 2

   Liccardi G, Gilder JA, D'Amato M, D'Amato G. Drug allergy transmitted by passionate kissing. Lancet 2002;359:1700-1700
   CrossRef | Web of Science | Medline

To the Editor:

Allergists are frequently asked to evaluate patients with anaphylaxis. However, despite a thorough history, allergy skin tests, radioallergosorbent tests, and other diagnostic investigations, the cause of anaphylaxis often cannot be determined. The problem is often labeled “idiopathic anaphylaxis” — a diagnosis associated with much anxiety. Many of these patients have a constant fear of having another reaction “out of the blue” and of having no control over their future. After reading the letter by Hallett et al., one must wonder how many of these so-called idiopathic anaphylactic reactions were, in fact, caused by a kiss from a person who ate food to which the patient was allergic. Inquiring about kissing that occurred before the onset of the allergic reaction should become part of the routine medical history.

Roswitha Moehring, M.D.
695 S. Colorado Blvd., Denver, CO 80246
rmoehring@pol.net

Author/Editor Response

The authors reply:

To the Editor: We agree with the supposition by Drs. Fischer and Groneberg that other reactions can be caused by mucosal contact or kissing. However, we did not conclude that this mode of exposure is relevant only for teenagers, as they assert; we simply pointed out that “since one third of our subjects had reactions while dating, teenagers and young adults in particular need to be informed.” The phrase “in particular” was used to provide emphasis, not to indicate exclusivity. Physicians should understand that education should not be limited to young patients. Given the responses of the volunteers in our study, it seems that teenagers and young adults are the groups who are most likely to be kissing someone who is not aware of any food allergies they may have. Patients with severe food allergies and parents of young children with severe food allergies should also be advised that brief kisses from well-meaning relatives who have just eaten the source of the allergen could trigger a systemic reaction. Modification of the behavior of family members, who have a high level of motivation to keep the allergic patient safe, is straightforward, but severely allergic patients who are starting to date may need to be reminded about less common routes of exposure. Educational materials would be enhanced by inclusion of this information.

Dr. Moehring raises a good point. In the subjects we spoke to, the reactions began within moments after a kiss, but if a few minutes were to go by, a kiss might not be reported as part of the history of the reaction.

Rosemary Hallett, M.D.
Suzanne S. Teuber, M.D.
University of California, Davis, School of Medicine, Davis, CA 95616
ssteuber@ucdavis.edu

Citing Articles (4)

Citing Articles

1. 1

   Gennaro Liccardi, Gianenrico Senna, Giuseppina Rotiroti, Gennaro D'Amato, Giovanni Passalacqua. (2007) Intimate behavior and allergy: a narrative review. Annals of Allergy, Asthma & Immunology 99:5, 394-400
   CrossRef

2. 2

   Jean A. Chapman, I.L. Bernstein, Rufus E. Lee, John Oppenheimer, Richard A. Nicklas, Jay M. Portnoy, Scott H. Sicherer, Diane E. Schuller, Sheldon L. Spector, David Khan, David Lang, Ronald A. Simon, Stephen A. Tilles, Joann Blessing-Moore, Dana Wallace, Suzanne S. Teuber. (2006) Food allergy: a practice parameter. Annals of Allergy, Asthma & Immunology 96:3, S1-S68
   CrossRef

3. 3

   John S. O'Shea. (2003) The Power of Social Change: The Women's Movement and Breast Cancer. The Breast Journal 9:5, 347-349
   CrossRef

4. 4

   David Coghlan, Colin Powell. (2003) Treatment of Childhood Asthma. Pediatric Drugs 5:10, 685-698
   CrossRef