Response to “anaphylaxis due to mint”

We thank Dr Öner Özdemir for his letter titled “Anaphylaxis due to mint” (APA-25-092) and his interest in our article titled “A rare case of anaphylaxis caused by mint-containing toothpaste in a child: A case report.” Although the patient maintained good oxygen saturation on room air and was not tachypneic, the diagnosis of anaphylaxis was made after considering the overall clinical picture. He presented with symptoms of shortness of breath, bilateral wheeze on auscultation, angioedema, and urticaria. These manifestations involved 2 organ systems (respiratory and mucocutaneous) and occurred following exposure to the allergen, mint. We agree that it was not clear whether the Brand B toothpaste used during his second presentation to the Children’s Emergency was mint-flavored. One possible explanation is contamination of his toothbrush with mint-containing Brand A toothpaste, which could have precipitated his symptoms. We thank you for highlighting this point and acknowledge that the precise trigger of anaphylaxis remains uncertain. Regarding the diagnosis of mint allergy, we hypothesize that the patient may have been sensitized to mint via the buccal route through prior exposure to mint-containing toothpastes. With increasing sensitization, he subsequently developed an anaphylactic rather than a localized reaction. As mint tea typically contains spearmint, while most mint-containing toothpastes contain peppermint, it is possible that he is specifically allergic to peppermint. Although the mint-specific serum immunoglobulin E test was negative, he demonstrated a positive skin-prick test to mint leaves. We appreciate your suggestion to perform skin-prick testing with mint leaves in healthy controls, which is indeed a worthwhile consideration. With regards to oral challenge, we plan to first conduct a clinic-supervised administration of nonmint toothpaste, followed by an oral mint challenge at a later stage, given the potential risk of anaphylaxis. We hope this clarifies the points raised, and we thank you once again for your thoughtful comments and interest in our report. Conflicts of interest The authors have no financial conflicts of interest. Author contributions ASHT drafted the initial manuscript. KWC critically reviewed and finalized the manuscript.