A case of apple allergy with initial symptoms like food-dependent exercise-induced anaphylaxis

Abstract

A 13-year-old boy with two episodes of anaphylaxis after exercise was suspected as food-dependent exercise-induced anaphylaxis (FEIAn). The exercise challenge test after ingestion of an apple was performed, because apple was commonly contained in meals before the both episodes and a prick test for apple was positive. The exercise test was positive accompanied with nasal discharge, sneezing, throat discomfort, swelling of the uvula. The patient was instructed to refrain from exercise for 4 hours after ingestion of apple. In five months, he developed allergic symptoms only by an intake of foods containing heated apple without exercise and showed a slight increase in apple-specific IgE from negative to 0.51 IU/ml. The prognosis of FEIAn has not been well described. Cases with FEIAn to apples like this case require a close follow-up in consideration of development of allergic reactions without exercise.