People with food allergies have to be careful about the meals and drinks they consume. A case report out today, however, shows that some allergic attacks can be caused by unexpected sources.

Annabelle Rowland, a physician in Atlanta, Georgia, detailed a case of anaphylaxis in a 15-year-old boy brought on by an energy drink. The boy had an unknown allergy to fish collagen—an ingredient in the drink. Thankfully, he made a full recovery, but the incident illustrates the complexities of having a fish allergy, Rowland said.

“This case demonstrates nuances of fish allergy which are important to consider as fish collagen is included in a growing number of products,” Rowland wrote in her case report, which is being presented today at the annual scientific meeting of the American College of Allergy, Asthma and Immunology (ACAAI).

According to the report, the teenage boy had a history of eczema, asthma, hay fever, and a rare immune-related lung condition called idiopathic pulmonary hemosiderosis.

He had never tried that energy drink before. Within minutes, he started experiencing hives all over his body, wheezing, and difficulty breathing—signs of a severe, potentially life-threatening allergic reaction, or anaphylaxis. He received care at an emergency allergy clinic, which included two shots of epinephrine and other anti-allergy medications, and his symptoms eased.

Afterward, Rowland tried to figure out what caused the attack. The patient felt normal prior to the episode and denied having exercised or used NSAIDs (nonsteroidal anti-inflammatory drugs) that day, both of which are potential, if rare, triggers for anaphylaxis.

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