Exercise-induced Anaphylaxis Research Articles

Nonspecific food dependant exercise-induced anaphylaxis with seizure: a case report

Exercise has been associated with several systemic reactions. These reactions can vary from mild symptoms to life threatening situations like anaphylaxis. In many of these cases, a predisposing factor in the form of food has been noticed. People may develop anaphylaxis on exercising after consumption of a nonspecific or specific food item. The patient being described developed anaphylaxis with seizure on exercising after having his meal. Nonspecific food dependant exercise-induced anaphylaxis is a rare scenario. Proper history taking is essential, as it can be lifesaving.

Oral mite anaphylaxis: who, when, and how?

To present an update on the recent advances in the understanding of the mechanisms and practical management of oral mite anaphylaxis (OMA, pancake syndrome). Among novel observations regarding OMA, this review highlights the increased prevalence of aspirin/NSAID hypersensitivity inpatients affected by OMA, the association of OMA with exercise-induced anaphylaxis, the presentation of OMA simulating acute asthma, the occurrence of OMA in childhood, the high severity and lethal potential of OMA, the contamination of other foods, such as oat and corn flour with mites, and the simultaneous induction of OMA symptoms in more than one individual exposed to the same food source. OMA is a severe, potentially lethal, acute allergic condition that should be suspected whenever symptoms begin soon after the intake of mite-contaminated foods. Physician awareness on this clinical picture is of paramount importance to establish a correct diagnosis and to implement adequate preventive measures to help patients at risk to avoid its occurrence.

Food Allergy from Infancy Through Adulthood

Food allergies are the result of immune responses that cause adverse reactions to foods. Immune responses to foods may produce a spectrum of symptoms and disorders, including acute allergic reactions and anaphylaxis, food protein-induced allergic proctocolitis, food protein-induced enterocolitis syndrome, food-dependent, exercise-induced anaphylaxis, and oral allergy syndrome (pollen-food allergy syndrome). Food-allergic responses also contribute to chronic inflammatory disorders such as eosinophilic esophagitis and atopic dermatitis. Although food allergy affects people from infancy through adulthood, there are allergic features that differ according to age (ie, presentation, triggers, and natural course) and have important implications for diagnosis, prognosis, and management. New food allergies can develop at any age, and we propose similarities in the etiology of de novo food allergy whether in infancy or adulthood. The approach to managing food allergy changes dramatically over the life course, and physicians and patients must respond accordingly to optimize care. Food allergy therapies are emerging, and the efficacy and safety of these interventions could differ by age group of those treated. In this review, we highlight interesting observations on the etiology and characteristics of food allergy presenting at different ages and discuss clinical management as it relates to life stage.

Gut microbiome alterations in patients with wheat-dependent exercise-induced anaphylaxis

The intestinal microbiota plays a critical role in food allergy development. However, little is known regarding the structure and composition of the intestinal microbiota in patients with wheat-dependent exercise-induced anaphylaxis (WDEIA). We examined the gut microbiota alterations in patients with WDEIA and the microbiota’s association with WDEIA. Fecal samples were collected from 25 patients with WDEIA and 25 healthy controls. Environmental exposure factors were obtained, serum total IgE, IgE specific to wheat, gluten, and ω-5 gliadin were measured. Fecal samples were profiled using 16S rRNA gene sequencing. The relative abundances of the bacterial genera Blautia (P < 0.05), Erysipelatoclostridium (P < 0.01), Akkermansia (P < 0.05) and Lachnospiraceae_NK4A136_group (P < 0.05) were significantly increased, while those of Lactobacillus (P = 0.001) and Dialister (P < 0.05) were significantly decreased in subjects with WDEIA. The microbial diversity did not differ between WDEIA patients and healthy controls. IgE specific to ω-5 gliadin was positively associated with the Oscillospira (r = 0.48, P < 0.05) and negatively associated with Leuconostoc (r = −0.49, P < 0.05). Total IgE levels were significantly negatively correlated with Bifidobacterium (P < 0.05). The gut microbiome compositions in WDEIA patients differed from those of healthy controls. We identified a potential association between the gut microbiome and WDEIA development. Our findings may suggest new methods for preventing and treating WDEIA.

Genetic variation at the interleukin-18 locus is associated with wheat-dependent exercise-induced anaphylaxis in the Han Chinese population

ObjectiveTo investigate the association of single nucleotide polymorphisms (SNPs) at the interleukin (IL)-18 locus with wheat-dependent exercise-induced anaphylaxis (WDEIA) in the Han Chinese population. Method130 patients with WDEIA and 600 healthy subjects were recruited for this study. Three tag SNPs (rs360729, rs360717 and rs1946518) were selected and genotyped, and total IgE and specific IgE levels were measured using the ImmunoCAP system. ResultsAfter Bonferroni correction, the frequency of the G-allele in rs1946518 in the WDEIA group was significantly higher than that in control group (P = 0.0015). Genotypic distributions of rs1946518 significantly differed between WDEIA and control groups, and compared with the TT genotype, the homozygote GG genotype was associated with a higher risk of WDEIA (P = 0.0031). At position rs1946518, the log-transformed total IgE values were significantly higher in the group with the heterozygous GT genotype than in TT genotype group (P = 0.0024). Haplotype AGG formed by three SNPs alleles occurred significantly more frequently in WDEIA group than in control group (P = 0.003). ConclusionThe minor allele G at position rs1946518 might serve as a marker for the risk of WDEIA.

Wheat-dependent exercise-induced anaphylaxis with Tri-a-14-sensitization as part of a lipid transfer protein syndrome

Wheat-dependent exercise-induced anaphylaxis with Tri-a-14-sensitization as part of a lipid transfer protein syndrome

Utilization of Component-Resolved Diagnosis in Precision Allergology

It is very important to identify the causal allergen of each patient in the diagnosis and treatment of allergic diseases. An experimental method of specific IgE testing for single clinically meaningful antigens is called component resolved diagnosis (CRD). Since the introduction of CRD, many single antigens with clinical significance from animal and plant allergenic source have become known. Bet v 1, the major allergen of white birch pollen, can be an indication marker for allergen-specific immunotherapy if the patient is sensitized. Phl p 1, the group I allergen of timothy grass pollen, is an important marker that suggests that patients are truly sensitized to grass pollen. The major allergen of ragweed pollen, Amb a 1 and Art v 1, which is the major allergen of mugwort pollen, are clinically important to distinguish true sensitization. House dust mites have several clinically useful component allergens. Der p 1 and Der p 2 are the initiation molecules in the molecular spreading of allergic diseases caused by house dust mites. Among food allergens, Ara h 2 from peanut, which is closely related to anaphylaxis among several clinical manifestation of peanut allergy. Tri a 19, well known to omega-5 gliadin is important in patients with wheat-dependent exercise-induced anaphylaxis. It is conceivable that the molecular biological concept of CRD methods should lead to ‘patient-customized treatment’ beyond ‘diagnosis’ in the future. Primary prevention of the allergic diseases will apply, which will conceptually be called ‘allergen immunprophylaxis’. This is the right direction of future precision allergology.

Dust mite ingestion-associated, exercise-induced anaphylaxis: a case report and literature review

BackgroundOral mite anaphylaxis (OMA) is a condition characterized by severe allergic reactions after ingesting food containing dust mite-contaminated flour. Physical exertion is recognized as a common trigger factor inducing anaphylaxis. The association of OMA with exercise-induced anaphylaxis has rarely been reported.Case presentationWe report a 29-year-old Thai woman who had dust mite ingestion-associated, exercise-induced anaphylaxis who tolerated the same bag of contaminated flour without exercise. A sample of contaminated cooking flour was examined under a light microscope. Living mites, Dermatophagoides farinae, were detected by a medical entomologist based on the morphology. We performed skin test to both mite-contaminated and newly opened Gogi® cooking flour, common aeroallergens, food allergens, and all other ingredients in the fried coconut rice cake 5 weeks after the anaphylactic episode. Specific IgE tests, using ImmunoCAP were also performed.ConclusionsDust mite ingestion-associated, exercise-induced anaphylaxis may be misdiagnosed as wheat-dependent exercise-induced anaphylaxis and should be suspected in patients with anaphylaxis linked to food intake and exercise, but who have no apparent evidence to the index food ingredients on allergy workup.

CHARACTERISTICS OF THE SYMPTOMS DURING FOOD AND EXERCISE PROVOCATION TESTS IN PATIENTS AFTER ORAL IMMUNOTHERAPY: COMPARISON WITH FOOD-DEPENDENT EXERCISE-INDUCED ANAPHYLAXIS

We aim to examine the characteristics of the symptoms induced by exercise provocation tests following allergen consumption in patients who have undergone oral immunotherapy (OIT). Patients who were positive for exercise provocation tests in Miyagi Children's Hospital from April 2012 to January 2019 were retrospectively analyzed. Patients were classified into food-dependent exerciseinduced anaphylaxis (FDEIA) group and post-OIT-FDEIA group. Six patients in the FDEIA group and 19 patients in the post-OIT-FDEIA group were analyzed. There were no significant differences in age, sex, and number of complications between the FDEIA and post-OIT-FDEIA groups, except for level of total serum immunoglobulin E. The median time from the start of exercise to onset of symptoms was 20 min in the FDEIA group and 25 min in the post-OIT-FDEIA group. The rate of adrenaline administration in post-OIT-FDEIA group was significantly lower. The median time from exercise to onset of severe symptoms requiring adrenaline was 32.5 min in the FDEIA group and 25 min in the post-OIT-FDEIA group. These data suggest that FDEIA and post-OIT-FDEIA patients can exhibit similar clinical symptoms, and all symptoms occurred in 60 minutes after exercise.

Differences in omega-5-gliadin allergy: East versus West.

BackgroundOmega-5-gliadin (O5G) allergy, also known as wheat-dependent exercise-induced anaphylaxis, is commonly reported in the Western, but not Asian, populations. Although significant differences in O5G allergy presentation across different populations are likely but there have been no previous reports on this important topic.ObjectiveTo report on the prevalence and characteristics of O5G allergy in Hong Kong (HK) compared with the United Kingdom (UK).MethodsO5G allergy patients attending Queen Mary Hospital (HK cohort), and Guy's and St Thomas' Hospital, London (UK cohort) were studied and compared.ResultsA total of 46 O5G allergy patients (16 HK; 30 UK) were studied. In the HK cohort, 55% of all patients previously labeled as “idiopathic anaphylaxis” were diagnosed with O5G allergy. Exercise was the most common cofactor in both cohorts, followed by alcohol and nonsteroidal anti-inflammatory drugs (NSAID). A higher proportion of the HK cohort reported NSAID as a cofactor (13% vs. 0%, p = 0.048). In the HK cohort, more patients presented with urticaria and cardiovascular manifestations (100% vs. 77%, p = 0.036; 100% vs. 70%, p = 0.015, respectively); the range of presentation was more diverse in the UK cohort. In HK fewer patients adhered to wheat avoidance (50% vs. 87%, p = 0.007) and more patients avoided cofactors only (44% vs. 10%, p = 0.008).ConclusionO5G allergy appears relatively underdiagnosed in HK. Urticaria and cardiovascular manifestations are common; NSAID plays an important role as a cofactor and patients are less concordant with dietary avoidance measures than in the Western population.

A Case of Pork-cat Syndrome That Developed as Food-dependent Exercise-induced Anaphylaxis

is missing (Short communication).

Modified acid-PAGE method for rapid screening and phenotyping of wheat gliadin mutant lines

Acid-polyacrylamide gel electrophoresis (A-PAGE) is used to phenotype different varieties of wheat based on their gliadin profiles. The family of gliadin proteins is a major component of wheat gluten. Gluten is the major determinant of the unique viscoelastic property of wheat dough that is necessary in the production of important food products including bread, cake, cookies and pasta. However, several gliadin proteins are also known to be causal agents in triggering human immunogenic responses that lead to several gluten-related health risks like celiac disease and wheat-dependent exercise-induced anaphylaxis. Therefore, research to identify wheat lines with reduced levels of immunogenic proteins is being vigorously pursued in several laboratories around the world. Unfortunately, no commercial A-PAGE gels are currently available for cereal researchers to use for separating wheat gliadins. This work reports the development of an easy-to-use A-PAGE protocol to resolve gliadins with high reproducibility and resolution to screen and phenotype gliadin deficient lines in wheat.•This acetic acid based A-PAGE method with urea utilizes commercially available reagents and materials to make gel casting simpler and more efficient.•It can be used to phenotype different wheat varieties to establish purity and to identify mutants of wheat with altered gliadin protein profiles.

Omalizumab in the treatment of wheat-dependent exercise-induced anaphylaxis: Case report

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a rare but possibly fatal condition. Patients with WDEIA may have severe difficulty for controlling their symptoms as the level of exercise, that can potentially trigger an anaphylaxis, may be very low. We, herein, report two patients with severe chronic spontaneous urticaria who subsequently developed WDEIA. Their symptoms occurred within minutes of walking at a slow pace after eating wheat-containing meals. Diagnosis were confirmed by positive omega-5 gliadin, gluten and wheat flour-specific IgE results. They have received omalizumab mainly for controlling their urticaria-related symptoms, but significant benefit has been obtained in regards to their exercise tolerance as well as their urticaria after the first injection of omalizumab. We have discussed the beneficial effects of omalizumab in these cases. However, additional clinical evidence would be needed for using omalizumab as a possible treatment option in WDEIA.

Wheat-dependent Exercise-induced Anaphylaxis

Gluten-related disorders are an emerging worldwide with a global prevalence estimated at 5% in the general population. They include celiac disease, nonceliac gluten sensitivity and wheat allergy. Specifically, the peculiar wheat-dependent exercise-induced anaphylaxis is a particular allergy that occurs after wheat ingestion followed by physical exercise.

Evaluation of the allergenicity of ω5-gliadin-deficient Hokushin wheat (1BS-18) in a wheat allergy rat model

We previously developed Hokushin wheat line as a hypoallergenic wheat lacking ω5-gliadin (1BS-18), a major allergen for wheat-dependent exercise-induced anaphylaxis. However, the allergenicity of 1BS-18 has not been understood completely. In this study, we evaluated the allergenicity of 1BS-18 such as anaphylactic elicitation ability and sensitization ability using rats sensitized with ω5-gliadin or glutens prepared from Hokushin (Hokushin gluten) or 1BS-18 (1BS-18 gluten). Rats were sensitized by intraperitoneal administration of ω5-gliadin, Hokushin gluten or 1BS-18 gluten. Immunoglobulin E-mediated systemic anaphylaxis was evaluated by measuring changes in rectal temperature for 30 min after intravenous challenge with ω5-gliadin or the test glutens in unsensitized rats or rats sensitized with ω5-gliadin or the test glutens. In ω5-gliadin-sensitized rats, intravenous challenge with ω5-gliadin or Hokushin gluten significantly decreased the rectal temperature at 30 min after challenge while challenge with 1BS-18 gluten did not reduce the rectal temperature. Furthermore, intravenous challenge with ω5-gliadin significantly decreased the rectal temperature in rats sensitized with Hokushin gluten or 1BS-18 gluten. However, the reduced degree observed in 1BS-18 gluten-sensitized rats was smaller than that in Hokushin gluten-sensitized rats. In conclusion, 1BS-18 elicited no allergic reaction in ω5-gliadin-sensitized rats and had less sensitization ability for ω5-gliadin than that of Hokushin wheat.

Dehydration affects exercise-induced asthma and anaphylaxis.

Allergies are generally triggered by food, medication, physical exercise, stress, alcohol consumption, and dehydration. There are reports that indicate dehydration affects various kinds of physical allergies. However, there are few studies that have focused on the effects of dehydration on asthma and allergy anaphylaxis. Therefore, we analyzed the effects of dehydration on several kinds of allergy responses and exercise-induced asthma especially during the endurance exercise. PubMed was searched from April to July of 2019 using predefined search terms “dehydration,” “exercise,” and “allergy responses.” Based on the reference search, more than one-hundred articles were identified but eighteen papers met the inclusion criteria and were analyzed for connections among exercise and dehydration, dehydration and exercise-induced asthma, and allergy responses in the main text. Results suggest that dehydration directly impairs stroke volume, cardiac output, and skin blood flow. This results in larger increases in core temperature, heart rate, and stroke volume. Additionally, exercise-induced dehydration reduces airway surface hydration, which results in an amplified brocnchoconstriction. This response to exercise occurs in those who suffer from exercise-induced asthma. Moreover, damage to the gut and impaired gut function relates to increased intestinal permeability after endurance exercise. Endurance exercise changes the immunological profiles to activate antibody-mediated immunity. Also, numerous mast cells and eosinophils were recruited, therefore isotype switching to IgE antibodies occur, this hypersensitivity activates mast cell degranulation. After degranulation, proteases, leukotrienes, prostaglandins, and histamine lead to many kinds of allergy symptoms.

Food-Dependent Exercise Anaphilaxy: A Systematic Review of Literature

Over and over again food-induced exercise-induced anaphylaxis is underdiagnosed by the physician and is reported to be an idiopathic anaphylaxis. In this context, the patient does not receive the proper guidelines for the correct management of his disease. Therefore, you will not know how to act, either to avoid it or to intervene in a possible crisis, so you will be potentially subject to life-threatening situations. Thus the research question was thus outlined: “How should the patient with food-dependent exercise-induced anaphylaxis (AIEDA) act in the face of a likely crisis, particularly in reducing the number of fatal events?” A literature review was performed. on the following bases: Online Medical Literature Search and Analysis System (MEDLINE), Scientific Electronic Library Online (SCIELO). The following controlled descriptors were selected for the location of the studies: “Wheat-Dependent Exercise-Induced Anaphylaxis”, “Impending Anaphylactic Crisis”, “Patients Exposed to Imminent Anaphylactic Crisis” (patients exposed to impending anaphylactic crisis). ). Exercise-induced anaphylaxis (EIA) is believed to be associated with 5-15% of all anaphylaxis cases. AIEDA prevalence data are limited and not reported accurately. Most reported cases have been related to wheat. Reported prevalence ranged from 0.001% to 0.017% worldwide for all foods. In most patients, when there is a mediated IgE reaction, exercise decreases the threshold for mast cell degranulation, giving rise to symptoms even when isolated ingestion is tolerated. Severe food allergy sometimes develops during exercise in association with a specific food (up to four hours after ingestion), characterizing food-dependent exercise-induced anaphylaxis. Proper professional diagnosis and management will help to avoid unnecessary limitations on the patient's diet and exercise. In any situation of anaphylaxis, it is never an exaggeration to stress the importance of educating patients to know how and when to use the self-injecting adrenaline kit, and to convey the notion of ineffective premedication with antihistamines. even mask prodromal symptoms, preventing patients from predicting more severe reactions. Keywords: Wheat-Dependent Exercise-Induced Anaphylaxis; Impending anaphylactic crisis; Patients exposed to impending anaphylactic crisis

145 Establishment of wheat peroxidase I-specific IgE test to identify wheat-dependent exercise-induced anaphylaxis developed by sensitization to grass pollen

145 Establishment of wheat peroxidase I-specific IgE test to identify wheat-dependent exercise-induced anaphylaxis developed by sensitization to grass pollen

Wheat Allergy in Children: A Comprehensive Update.

Gluten-related disorders are very common in pediatric patients. Wheat allergy is triggered by an immunoglobulin E (IgE)-dependent mechanism; its prevalence varies according to the age and region, and in Europe has been estimated to be lower than 1%. Many studies investigated the potential role of several external factors that can influence the risk to developing wheat allergy, but results are still inconclusive. It can be responsible for several clinical manifestations depending on the route of allergen exposure: food-dependent exercise-induced anaphylaxis (FDEIA), occupational rhinitis or asthma (also known as baker’s asthma), and contact urticaria. The prognosis of IgE-mediated wheat allergy in children is generally favorable, with the majority of children becoming tolerant by school age. Patients who experienced an anaphylactic reaction prior to 3 years of age and patients with higher level of wheat- or ω-5 gliadin-specific IgE antibodies seem to be at higher risk of persistent wheat allergy. The current management of patients is dietary avoidance. Nowadays, oral immunotherapy has been proposed for wheat allergy with promising results, even if further studies are necessary to establish the best protocol in order to promote tolerance in wheat-allergic children.

A challenging diagnosis of exercise-related transient abdominal pain

A 17-year-old woman, high-performance triathlete, presented transient abdominal pain, face angioedema and sometimes syncope during exercise. Exercise-induced anaphylaxis was suspected at first. Allergic explorations with skin prick tests were negative but wheat flour specific IgE and recombinant rTri a14 (LTP) were weakly positive. However, wheat eviction did not improve the symptoms and stress test after wheat oral challenge did not show any signs of anaphylaxis. An abdominal ultrasound revealed peak expiratory velocities with a stenosis evaluated at 70 to 80 percent with turbulences in the celiac artery, confirmed by computed tomography angiogram. The diagnosis of exercise-induced median arcuate ligament syndrome (MALS) was retained and we discuss here the challenging diagnosis mimicking exercise-induced anaphylaxis.