{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:10:35Z","timestamp":1772165435199,"version":"3.50.1"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We report a case of anaphylaxis induced by natto (fermented soybeans) allergy that occurred following dermal sensitization from a jellyfish sting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 49-year-old male presented to the emergency room complaining of an acute onset of erythema with pruritis that appeared while he was surfing. Given that his heart rate dropped to ~\u200940\u00a0bpm without a decline in blood pressure or oxygen saturation, we suspected anaphylaxis and administered 0.5\u00a0mg of adrenaline intramuscularly. Immediately after the muscular adrenaline injection, his heart rate recovered to ~\u200960\u201370\u00a0bpm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The major allergen that induces natto allergy is poly(\u03b3-glutamic acid) (PGA), which is present in its mucilage. Given that PGA is also produced by jellyfish tentacles, it can be inferred that the PGA sensitization occurred via dermal exposure to jellyfish PGA. This is an example of a food allergy induced by animal stings. As PGA is a high-molecular-weight polymer, natto allergy, despite being IgE-mediated, often presents with late-onset anaphylaxis, which typically develops half a day after digestion. PGA has a wide range of applications in pharmaceuticals, cosmetics, and foods. Patients may develop allergic symptoms and experience repeated anaphylaxis with no known cause. Therefore, it is important to obtain a detailed medical history and individually instruct patients suspected of being allergic to PGA to avoid PGA-containing products.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12245-024-00617-1","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T04:03:06Z","timestamp":1710734586000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Natto (fermented soybeans)-induced anaphylaxis in a surfer with the possibility of sensitization to poly(\u03b3-glutamic acid) from cutaneous exposure to jellyfish sting: a case report"],"prefix":"10.1186","volume":"17","author":[{"given":"Ayami","family":"Shigeno","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsuyoshi","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masakazu","family":"Obayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kei","family":"Asada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoru","family":"Matsushima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,3,18]]},"reference":[{"key":"617_CR1","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/S1081-1206(10)60995-7","volume":"94","author":"N Inomata","year":"2005","unstructured":"Inomata N, Osuna H, Yanagimachi M, Ikezawa Z. Late-onset anaphylaxis to fermented soybeans: the first confirmation of food-induced, late-onset anaphylaxis by provocation test. Ann Allergy Asthma Immunol. 2005;94:402\u20136.","journal-title":"Ann Allergy Asthma Immunol"},{"key":"617_CR2","doi-asserted-by":"publisher","first-page":"257","DOI":"10.2332\/allergolint.O-06-460","volume":"56","author":"N Inomata","year":"2007","unstructured":"Inomata N, Osuna H, Kawano K, Yamaguchi J, Yanagimachi M, Matsukura S, et al. Late-onset anaphylaxis after ingestion of Bacillus Subtilis-fermented soybeans (Natto): clinical review of 7 patients. Allergol Int. 2007;56:257\u201361.","journal-title":"Allergol Int"},{"key":"617_CR3","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/j.alit.2017.11.001","volume":"67","author":"N Inomata","year":"2018","unstructured":"Inomata N, Miyakawa M, Aihara M. Surfing as a risk factor for sensitization to poly(\u03b3-glutamic acid) in fermented soybeans, natto, allergy. Allergol Int. 2018;67:341\u20136.","journal-title":"Allergol Int"},{"key":"617_CR4","doi-asserted-by":"publisher","first-page":"9664","DOI":"10.1016\/S0021-9258(19)38721-6","volume":"265","author":"J Weber","year":"1990","unstructured":"Weber J. Poly(gamma-glutamic acid)s are the major constituents of nematocysts in Hydra (Hydrozoa, Cnidaria). J Biol Chem. 1990;265:9664\u20139.","journal-title":"J Biol Chem"},{"key":"617_CR5","first-page":"24","volume":"68","author":"Y Chinuki","year":"2019","unstructured":"Chinuki Y. Prognosis of adult food allergy caused by percutaneous sensitization. Arerugi. 2019;68:24\u20138.","journal-title":"Arerugi"},{"key":"617_CR6","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.1016\/j.jaci.2008.04.032","volume":"121","author":"G Lack","year":"2008","unstructured":"Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol. 2008;121:1331\u20136.","journal-title":"J Allergy Clin Immunol"},{"key":"617_CR7","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1097\/ACI.0b013e3283624560","volume":"13","author":"SP Commins","year":"2013","unstructured":"Commins SP, Platts-Mills TA. Tick bites and red meat allergy. Curr Opin Allergy Clin Immunol. 2013;13:354\u20139.","journal-title":"Curr Opin Allergy Clin Immunol"},{"key":"617_CR8","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1056\/NEJMoa074943","volume":"358","author":"CH Chung","year":"2008","unstructured":"Chung CH, Mirakhur B, Chan E, Le QT, Berlin J, Morse M, et al. Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. N Engl J Med. 2008;358:1109\u201317.","journal-title":"N Engl J Med"},{"key":"617_CR9","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/j.jaci.2008.10.052","volume":"123","author":"SP Commins","year":"2009","unstructured":"Commins SP, Satinover SM, Hosen J, Mozena J, Borish L, Lewis BD, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2009;123:426\u201333.","journal-title":"J Allergy Clin Immunol"},{"key":"617_CR10","first-page":"863","volume":"71","author":"K Hitomi","year":"2019","unstructured":"Hitomi K, Hiroe N, Ayako S, Aizumi A, Takeaki S, Tadao M. A case of fermented soybeans, natto, allergy potentially induced by jellyfish stings. Rinsho Hifuka. 2019;71:863\u20137.","journal-title":"Rinsho Hifuka"},{"key":"617_CR11","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1111\/1346-8138.12542","volume":"41","author":"N Inomata","year":"2014","unstructured":"Inomata N, Chin K, Aihara M. Anaphylaxis caused by ingesting jellyfish in a subject with fermented soybean allergy: possibility of epicutaneous sensitization to poly-gamma-glutamic acid by jellyfish stings. J Dermatol. 2014;41:752\u20133.","journal-title":"J Dermatol"},{"key":"617_CR12","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1016\/j.jaci.2004.02.037","volume":"113","author":"N Inomata","year":"2004","unstructured":"Inomata N, Osuna H, Ikezawa Z. Late-onset anaphylaxis to Bacillus natto-fermented soybeans (natto). J Allergy Clin Immunol. 2004;113:998\u20131000.","journal-title":"J Allergy Clin Immunol"},{"key":"617_CR13","first-page":"816","volume":"64","author":"T Nagakura","year":"2015","unstructured":"Nagakura T, Tanaka K, Horikawa S. A case of nattou (fermented-soybean)-induced late-onset anaphylaxis following scuba diving. Arerugi. 2015;64:816\u201321.","journal-title":"Arerugi"}],"container-title":["International Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12245-024-00617-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12245-024-00617-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12245-024-00617-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T04:03:09Z","timestamp":1710734589000},"score":1,"resource":{"primary":{"URL":"https:\/\/intjem.biomedcentral.com\/articles\/10.1186\/s12245-024-00617-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,18]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["617"],"URL":"https:\/\/doi.org\/10.1186\/s12245-024-00617-1","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3528984\/v1","asserted-by":"object"}]},"ISSN":["1865-1380"],"issn-type":[{"value":"1865-1380","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,18]]},"assertion":[{"value":"31 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was approved by internal review board of Chutoen General Medical Center. Written informed consent was obtained from all participants and from a parent and\/or legal guardian.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this study and accompanying images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"43"}}