YOU CAN RUN BUT YOU...CAN HIVE!

Abstract

Introduction Food-dependent, exercise-induced anaphylaxis (FDEIAn) is characterized by anaphylaxis which occurs only after the patient exercises within hours of eating. This is a case of tomato-dependent, exercise-induced anaphylaxis. Figure. Reactions of Episodes 1 and 2. (Episode 1) Generalized urticaria and face angioedema of episode 1 and generalized urticaria of episode. (Episode 2) The pictures were taken less than 5 minutes after onset of symptoms and prior to self-treatment with H1 and H2 antihistamines. Case description A 15-year-old male without any history of allergies reported three episodes of anaphylaxis in a three-month period. In all episodes, symptoms included generalized urticaria, swelling of the eyes and lips, lightheadedness, runny nose, nausea, and throat itching. Episodes 1 and 2 began 10-30 minutes after he started jogging and having eaten approximately 2 hours earlier. Both events resolved after self-treatment with diphenhydramine and famotidine. Episode 3 started after running 50-75 yards and eating 8 hours prior to exercising. This time he visited the ED where a 10.4 tryptase level was drawn (baseline 3; ref He ate tomato before each episode in pizza, pulled pork, and fresh tomatoes respectively. He denied any symptoms with tomatoes and exercise alone, chronic urticaria, GERD, and exposure to alcohol and NSAIDs. The patient had positive skin-prick testing to tomato and negative to all other common food allergens including prick-prick testing. He was prescribed epinephrine auto-injectors and recommended to avoid tomato at least 8 hours before exercising, training with partners who know of condition. Discussion Diagnosis of FDEIAn is made in patients with anaphylaxis during or shortly after exercise preceded by food ingestion, evidence of specific IgE to the implicated food, and absence of an alternate diagnosis for the clinical presentation. This patient meets criteria for anaphylaxis, was exposed to tomato in all episodes, and had positive skin-testing.