Abstract
A cautionary tale for the physician: case report and review of food-dependent exercise-induced anaphylaxis
Highlights
Food-dependent exercise-induced anaphylaxis (FDEIA) is a rare subset of anaphylaxis that only occurs when a patient consumes the causative food within four to six hours prior to physical exercise
Though various case reports have described this phenomenon, FDEIA is rare and thought to be underdiagnosed as lack of familiarity with the condition likely results in many practitioners failing to include FDEIA in their differential diagnosis of patients presenting with anaphylaxis
A 20-year old female presented to the emergency department (ED) with acute-onset anaphylaxis beginning during an evening run 1.5 hours post-ingestion of a dinner comprised of rice, shrimp, and lobster
Summary
Food-dependent exercise-induced anaphylaxis (FDEIA) is a rare subset of anaphylaxis that only occurs when a patient consumes the causative food (or in some cases non-specific food intake) within four to six hours prior to physical exercise. Given the timing of this reaction (i.e., ingesting shrimp without reaction followed by acute anaphylaxis beginning with exercise 1.5 hours after her meal), regular exercise of similar intensity without difficulty, history of tolerating shellfish on numerous occasions without symptoms and no recollection of previously exercising after eating shellfish, the positive skin and radioallergosorbent tests for shrimp allergy, and negative open oral challenge to shrimp, the patient was diagnosed with food-dependent exercise-induced anaphylaxis. She was informed that she may continue to ingest shrimp, not to exercise for at least six hours after shellfish ingestion. The patient has not experienced another episode in more than two years despite frequent seafood-containing meals, including shrimp and clams, and regular exercise
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