Anaphylaxis is a serious systemic allergic reaction with rapid onset and potentially life-threatening. We report in detail a case of severe nocturnal anaphylaxis due to pigeon tick bite showing the diagnostic value of the extract and the recombinant allergen in the diagnostic procedures (basophil activation test, IgE immunoblot, and experimental ImmunoCAP). Apart from the presented case, we describe that during the last 10 years, we have collected 28 cases of allergy to Argas reflexus from several European countries. We suspect that this allergy is underdiagnosed because of the lack of diagnostic reagents. Because of the growing number of pigeons in Middle and Southern Europe cities, some cases of idiopathic anaphylaxis could potentially be caused by A. reflexus in those countries. The identification of pigeon ticks as a trigger of anaphylaxis would greatly improve medical care and advice for these patients as the parasite can be exterminated by eradication measures to avoid further incidents.

Allergology Department of Dermatology University Hospital Basel Basel Switzerland

Allergy and Asthma Center Westend Berlin Germany

Allergy and Clinical Immunology Department Medical Sciences University of Torino Torino Italy

Clinic of Immuno Allergology CHU Brugmann Université Libre de Bruxelles Brussels Belgium

Department of Allergy and Clinical Immunology Faculty Hospital Kralovske Vinohrady Prague Czech Republic

Department of Biomedical Sciences Humanitas University Milan Italy

Department of Dermatology and Allergy Center Odense Research Center for Anaphylaxis University of Southern Denmark Odense Denmark

Department of Infection and Immunity Luxembourg Institute of Health Esch sur Alzette Luxembourg

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Institute of the Ruhr Universität Bochum Bochum Germany

Service de Dermatologie Centre Hospitalier Lyon Sud Pierre Bénite France

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