Abstract
We present two cases of food and exercise-induced anaphylaxis (FEIA) in patients with a diagnosis of oral allergy syndrome (OAS) to the implicated foods. Patient A had FEIA attributed to fresh coriander and tomato and Patient B to fresh celery. These food allergens have been implicated in OAS and have structural antigenic similarity to that of birch and/or grass. Both patients’ allergies were confirmed by fresh skin prick tests. In both cases, strenuous exercise was antecedent to the systemic anaphylaxis reaction and subsequent ingestion without exercise produced only local symptoms of perioral pruritus. We review the current proposed mechanisms for food and exercise induced anaphylaxis to oral allergens and propose a novel and more biologically plausible mechanism. We hypothesize that the inhibitory effects of exercise on gastric acid secretion decreases the digestion of oral allergens and preserves structural integrity, thereby allowing continued systemic absorption of the allergen whether it be profilins, lipid transfer proteins, or other antigenic determinants.
Highlights
Food and Exercise-induced anaphylaxis (FEIA) is a variant of exercise-induced anaphylaxis (EIA) that was first described by Maulitz et al in 1979 [1]
food and exercise-induced anaphylaxis (FEIA) differs from typical EIA in that ingestion of food allergens is required prior to exercise in order to elicit an Immunoglobulin E (IgE)-mediated anaphylactic reaction [2]
Food allergen or exercise alone cannot elicit the anaphylactic reaction in FEIA and as such both factors are required
Summary
Food and Exercise-induced anaphylaxis (FEIA) is a variant of exercise-induced anaphylaxis (EIA) that was first described by Maulitz et al in 1979 [1]. FEIA differs from typical EIA in that ingestion of food allergens is required prior to exercise in order to elicit an IgE-mediated anaphylactic reaction [2]. Food allergen or exercise alone cannot elicit the anaphylactic reaction in FEIA and as such both factors are required.
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