Food-dependent Exercise-induced Anaphylaxis Research Articles

Navigating the uncommon: a case of caesarean section associated with exercise-induced anaphylaxis

Exercise-induced anaphylaxis (EIA) and food-dependent exercise-induced anaphylaxis (FDEIA) are rare but serious conditions where physical activity triggers severe allergic reactions. These are rarely reported in pregnant women undergoing caesarean section. We present the case of a 33-year-old woman with a history of EIA, scheduled for a caesarean section at 37 weeks of gestation. To manage the planned caesarean section, a multidisciplinary team strategy was devised to mitigate anaphylaxis risks. The surgery proceeded without complications under spinal anaesthesia, and the patient did not exhibit any anaphylactic reactions. The patient was monitored in the high dependency unit (HDU) and was discharged two days later. This case highlights the importance of individualized anaesthesia planning, multidisciplinary collaboration, and detailed preparation to ensure the safety of pregnant patients with EIA undergoing caesarean section.

Food-dependent exercise-induced anaphylaxis caused by leek and several allergens of the allium family.

Exercise-induced anaphylaxis (EIA) is a relatively rare condition but can be a diagnostic pitfall in daily practice. Leek allergy is extremely rare, and there have been no reports, to our knowledge, of leek-dependent EIA. Here, we report the first case of exercise- and leek-induced anaphylaxis. An 18-year-old woman presented with symptoms of anaphylaxis after exercise in the morning. Prick-to-prick tests for leek was 1+ and challenge test for heated leek was negative, but leek-dependent physical exertion challenge test evoked anaphylaxis. We diagnosed food-dependent EIA by some additional tests including immunoblotting assay with patient's serum. Leek allergy is an extremely rare condition, so careful interview and investigation of allergens is important to eliminate causative substances of anaphylaxis.

Food-Dependent Exercise-Induced Anaphylaxis: A Distinct Form of Food Allergy-An Updated Review of Diagnostic Approaches and Treatments.

Food-dependent exercise-induced allergic reactions (FDEIA) represent a distinct clinical phenomenon where symptoms arise during exercise following the consumption of specific trigger foods, with the most severe manifestation being anaphylaxis-a condition distinct from typical exercise-induced or food-induced anaphylaxis. In FDEIA, patients can either exercise or tolerate specific foods separately without experiencing any allergic reactions. Diagnosis relies on patient history and provocation testing, requiring rigorous implementation within a supervised hospital environment. Positive symptoms and clinical signs during testing confirm FDEIA, while negative outcomes do not preclude its presence. Exercise stands as the primary trigger, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol. The utilization of various protocols for food cofactor challenges to confirm FDEIA yields differing diagnostic outcomes. We highlight the updated concept of food cofactor challenges, incorporating protocols reported in the literature, and summarize current recommendations and comprehensive management approaches for FDEIA patients.

Preprandial food-dependent exercise-induced anaphylaxis to banana

Food-dependent exercise-induced anaphylaxis is a disorder in which a reaction develops only in association with physical exertion that generally takes place postprandially. The reaction that occurs following food intake after exercise is uncommon. Banana is an infrequent cause of anaphylaxis, which has been previously reported in combination with postprandial exercise in only 1 patient. A probable case of preprandial food-dependent exercise-induced anaphylaxis to banana is described herein together with a brief review of recent related literature.

The Onset of Food-dependent Exercise-induced Anaphylaxis in an Elderly Patient: A Case Report.

The development of allergic diseases is common in the young but rare in the elderly. We encountered an elderly patient with food-dependent exercise-induced anaphylaxis (FDEIA). An 82-year-old man was rushed to the hospital for symptoms of anaphylaxis. Because the symptoms occurred after ingestion of wheat products and exercise, we made a diagnosis of FDEIA based on a high ω5-gliadin IgE level and a positive exercise test. Based on our review of the existing literature, this was the oldest patient to ever be diagnosed with FDEIA in Japan. This case suggests that physicians should keep in mind that older adults can develop FDEIA.

Epidemiology, outcomes, and disproportionate burden of food-dependent exercise-induced anaphylaxis from the Hong Kong Multidisciplinary Anaphylaxis Management Initiative (HK-MAMI).

Anaphylaxis is a life-threatening allergic reaction that poses a considerable burden on populations across all ethnicities and age groups. The Hong Kong Multidisciplinary Anaphylaxis Management Initiative (HK-MAMI) was established to streamline the assessment of patients with anaphylaxis via a multidisciplinary and protocol-driven approach. This prospective study aims to define the etiology, clinical manifestations, and treatment of patients with anaphylaxis in Hong Kong. Prospective clinical data from allergologic investigations from patients who completed evaluation by the HK-MAMI pathway between January 2017 and August 2022 were analyzed. Of the 161 patients referred via the HK-MAMI, 131 (81.4%) met the diagnostic criteria for anaphylaxis. The median delay in diagnosis was 2 years (range 0-30 years). The majority of anaphylaxis cases were attributed to food-dependent exercise-induced anaphylaxis (FDEIA), especially wheat-dependent exercise-induced anaphylaxis. In acute management settings, paired tryptase samples were taken in only around one-third of anaphylaxis cases, with 82.5% of the samples demonstrating significant elevation. There was a general underprescription of adrenaline autoinjectors, especially for food-related anaphylaxis. Patients with FDEIA had later ages of onset and diagnosis, and they presented with more cardiovascular manifestations. Skin prick tests and specific IgE level tests were able to diagnose 95% of FDEIA cases. Our study highlights the significant burden of FDEIA, and especially WDEIA, in Hong Kong, its association with severe presentations, and difficulties encountered in emergency or primary care settings. We advocate appropriate adrenaline use during acute-care management and discharge plans, as well as taking serum mast cell tryptase samples during acute episodes. Interdisciplinary collaboration remains crucial to upholding proper and optimized care for patients with anaphylaxis in Hong Kong.

Chapter 13, Food-Dependent Exercise-Induced Anaphylaxis (FDEIA)

本稿では2021年に発行された食物アレルギー診療ガイドラインにおける食物依存性運動誘発アナフィラキシー（food-dependent exercise-induced anaphylaxis，FDEIA）のセクションに関して，2016年ガイドラインの記載内容からの主な変更点について解説する．

Revisiting the Definition of Anaphylaxis.

Anaphylaxis is a common phenomenon that has been studied for many decades. Despite this, there is still disagreement among organizations regarding the precise definition for anaphylaxis. This article discusses the difference between the proposed definitions of anaphylaxis. Furthermore, the most up-to-date literature on specific subtypes of anaphylaxis is reviewed, and implications for clinical practice are discussed. Recent literature on various subtypes of anaphylaxis has been conducted. This has helped clarify guidelines for conditions such as allergy to radiocontrast media, idiopathic anaphylaxis, and food-dependent exercise-induced anaphylaxis. Recent literature has also studied available biomarkers for anaphylaxis and the cost-effectiveness of current standard-of-care prescription of epinephrine autoinjectors. Anaphylaxis is an increasingly more frequent phenomenon and remains a hot topic in current research. Much progress has been made in clarifying the definition of anaphylaxis and differentiating between subtypes, but more research is needed to identify a readily available biomarker for anaphylaxis and identify the standard of care for various subtypes of anaphylaxis.

Anaphylaxie induite par l’exercice après consommation de viandes : implication de l’alpha 1-3 galactose

We present the case of a 74-year-old patient diagnosed with exercised-induced anaphylaxis after meat consumption and alpha 1-3 galactose involvement. Food-dependent exercise-induced anaphylaxis represents about 5% of anaphylaxis [1]. In this case, the patient made an effort following a meal containing meat, then presented urticaria and respiratory discomfort. The skin tests were positives for pork and pork kidney. Anti-alpha 1-3 galactose IgE were strongly positive, involving this allergen. Eviction of meat before physical effort allowed any recurrence.

The advances of allergen component detection in IgE-mediated food allergy

There are many types in food allergy, and the most common is mediated by IgE. Currently, the diagnosis of food allergy mainly relied on skin prick test and serum specific IgE of allergen extract, which can not identify cross-sensitization. Component-resolved diagnosis (CRD) can identify the major allergen components and cross-components of food allergens, which plays an important role in dietary guidance, prognosis monitoring and diagnosis of special types of IgE-mediated food allergy. This article enumerates clinical characteristics of the IgE-mediated common food allergies, such as milk, egg and seafood allergy, and special type of food allergy, such as cat pork syndrome, oral allergy syndrome, α-gal syndrome and food-dependent exercise-induced anaphylaxis, summarizes the advances of CRD in these types of IgE-mediated food allergy, in order to provide an evidence for the diagnosis, treatment and prevention of IgE-mediated food allergy.

Food-dependent exercise-induced anaphylaxis to orange, with possible underlying thaumatin-like protein allergy

Food-dependent exercise-induced anaphylaxis to orange, with possible underlying thaumatin-like protein allergy

Dupilumab for Treatment of Food-Dependent, Exercise-Induced Anaphylaxis: Report of One Case

Food-dependent, exercise-induced anaphylaxis (FDEIA) is a potentially life-threatening disorder that often occurs with exercise, and patients typically have eaten a specific food within hours before disease onset. This disease is exceedingly rare, with a prevalence of 0.02%. No well-recognized prevention or treatment strategy has been available for FDEIA except avoiding triggers strictly. Here we report an 11-year-old boy with a history of recurrent anaphylaxis of unknown etiology more than 10 times within two years. As the anaphylactic symptoms had not been controlled after traditional treatments, the patient was given subcutaneous injection of dupilumab seven times within 33 weeks. During dupilumab treatments, the patient was exposed to culprit mushrooms plus exercises at least twice a month but without notable anaphylaxis. Thus, dupilumab may improve the allergic reactions in FDEIA patients.

Food allergy

Food allergy is one of the adverse food reactions, which is developed by immunological reactions. Food allergy is increasing in prevalence among children and adults. In the diagnosis, food challenge is confirmative with history and laboratory tests. Avoidance of culprit food is the only preventive method, especially in patients with severe symptoms. In some food allergies, crossreactivity among allergens should be considered. Latex-fruit/vegetable syndrome and pollen food allergy syndrome are well-understood phenotypes of food allergy related to cross reaction. Red meat allergy is recently described as one of tick-borne diseases. In a rare phenotype of food-dependent exercise-induced anaphylaxis, factors affecting the absorption of food allergen are important in its pathophysiology.

Current situation of anaphylaxis in Japan: Data from the anaphylaxis registry of training and teaching facilities certified by the Japanese Society of Allergology – secondary publication

BackgroundAnaphylaxis is a potentially fatal severe systemic hypersensitivity reaction that causes symptoms in multiple organs such as the skin, respiratory tract, and gastrointestinal tract; however, no nationwide epidemiological survey on anaphylaxis has been conducted in Japan. This survey aimed to elucidate the triggers and treatment of anaphylaxis in Japan. MethodsBetween February 2015 and October 2017, we prospectively collected clinical data on the triggers and treatment of patients who developed anaphylaxis or were admitted to the emergency room with anaphylaxis in the training and teaching facilities of the Japanese Society of Allergology. ResultsThis study included 79 of the 451 affiliated facilities (18%), and a total of 767 patients were enrolled; 73% of them were aged <18 years and 7% had in-hospital triggers. The most common triggers were food (68%), drugs (12%), food-dependent exercise-induced anaphylaxis (5%), insects (4%), and oral immunotherapy (3%), with drugs being the most common in-hospital trigger and food being the most common out-of-hospital trigger. Intramuscular injection of adrenaline was administered therapeutically to 38% of the patients, with 10% requiring multiple doses. Adrenaline auto-injectors were used in 12% of out-of-hospital patients. ConclusionsThe present survey revealed the most common triggers and treatments for anaphylaxis in Japan. Self-management and adrenaline administration as first-line treatment may not be done sufficiently. Therefore, it is necessary to thoroughly educate and train patients and physicians about anaphylaxis.

A Case of Food-dependent Exercise-induced Anaphylaxis Diagnosed by Provocation Test with Spear Squid After the Pretreatment with Asprin

16 歳，男性。夕食時にヤリイカを含む寿司を摂取した約 1 時間後，歩行帰宅途中に眼瞼浮腫，全身に蕁麻疹が出現した。前医を受診し，収縮期血圧低下を認めアナフィラキシーショックと診断され加療された。食物アレルギー精査目的に当科に紹介受診となり，食物依存性運動誘発アナフィラキシー（fooddependent exercise-induced anaphylaxis：FDEIA）を疑い精査を行った。イカを含む数種の魚介類の特異的 IgE 抗体が陽性であった。Prick-prick test ではヤリイカのみ陽性となった。ヤリイカを原因食物として疑い，入院下で運動負荷誘発試験を施行した。運動とヤリイカの摂取のみでは症状誘発はされなかったが，アスピリン 1.5 g を内服しヤリイカ 50 g の摂取と 30 分間の運動との組み合わせで眼瞼浮腫を生じた。以上よりヤリイカによる FDEIA と診断した。本症は診断のために詳細な問診と特異的 IgE 抗体の測定，プリックテスト，食物負荷試験が重要であるが必ずしも再現性は高くない。食物負荷試験と運動の組み合わせでは偽陰性となることがあり，自験例の結果より増強因子であるアスピリンを投与することも重要であることが示唆された。

Food allergy in Sri Lanka – A comparative study

BackgroundThe incidence of IgE mediated food allergy (FA) is increasing in the west. Cow's milk (CM), hen's egg, wheat, soy, peanut, tree nut, fish, and shellfish are responsible for 90% of food allergy in the west; however, local dietary habits may result in specific allergies. Data on food allergies in South Asia is scarce. The present study aims to evaluate the foods that cause immediate type hypersensitivity in Sri Lanka, and to compare with Asia and the developed west. MethodsRecords of patients referred to an Immunology clinic from 2010–January 2022 were reviewed. The diagnosis of food allergy was based on standard guidelines. Confirmation of the specific food implicated was based on the history and the presence of specific IgE or component resolved diagnostics by in vitro methods (Phadia ImmunoCap) or by skin prick testing with commercial extracts (Alk Abello). Prick to prick testing was performed for fruits and vegetables when commercial extracts were unavailable. ResultsThree hundred and forty-six patients were confirmed with food allergy. CM allergy (CMA) was the commonest (31.2%) followed by red meat allergy (27.7%) and food dependent exercise induced anaphylaxis (FDEIA) (17.9%). Allergy to alpha-gal crustaceans, eggs, gelatin, wheat, coconut milk, and mollusks were seen in 2–10% of patients.The onset of CMA was mainly in childhood. However, in 23/108 patients, onset was after 5 years, including 8 patients in adulthood, and in 14 of the 23, it was preceded by red meat allergy. Onset of primary red meat allergy was predominantly in children, but in 33/96 (34.3%) of patients, it was in adults. Most patients with alpha-gal allergy (21/29, 72.4%) had initial symptoms in childhood and adolescence.Anaphylaxis was diagnosed in 213 patients. FDEIA is the commonest cause (24.7%) followed by red meat allergy (23%), CMA (21.5%) and alpha-gal allergy (10.3%). Allergy to peanuts and fruits were rare.Patients with red meat allergy and/or CMA developed allergy, including anaphylaxis, to vaccines containing bovine/porcine products. ConclusionCM was the most common food allergy in children, but egg allergy was uncommon. Primary red meat allergy was the second most common, and was associated with allergy to vaccines containing bovine products, such as the measles, mumps and rubella (MMR) vaccine. Allergy to peanuts and fruits were rare. Primary red meat allergy may be responsible for late onset CMA.

Matavhengig treningsindusert anafylaksi under graviditet

Pregnant women with rare comorbid diagnoses need a safe delivery plan. This case report describes labour and delivery in a patient with food-dependent exercise-induced anaphylaxis.

Food-Dependent Exercise-Induced Wheals, Angioedema, and Anaphylaxis: A Systematic Review

Food-dependent exercise-induced wheals, angioedema, and anaphylaxis remain insufficiently characterized. We systematically reviewed the literature on clinical manifestations, laboratory investigations, culprit foods, triggering exercise, comorbidities, and treatment outcomes. Using predefined search terms and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) recommendations, we searched 3 electronic databases to identify relevant literature published before July2021. Of 722 patients (median age 25 years; 55.4% male) from 231 studies (43 cohort studies, 15 cases series, and 173 case reports), 79.6% and 3.7% had anaphylaxis with and without wheals and/or angioedema, respectively. The remaining 16.6% had wheals and/or angioedema without anaphylaxis. The duration from eating to exercising and from exercising to symptom onset ranged from 5 minutes to 6 hours (median 1 hour) and from 5 minutes to 5 hours (median 30 minutes), respectively, and virtually all patients exercised within 4 hours after eating and developed symptoms within 1 hour after exercising. Wheat was the most common culprit food. Running was the most common trigger exercise. Most patients were atopic, and 1 in 3 had a history of urticaria. Aspirin and wheat-based products were the most frequent augmenting factors. On-demand antihistamines, corticosteroids, and epinephrine were commonly used and reported to be effective. Patients who stopped eating culprit foods before exercise no longer developed food-dependent exercise-induced allergic reactions. Food-dependent exercise-induced allergic reactions are heterogeneous in their clinical manifestations, triggers, and response to treatment. Patients benefit from avoidance of culprit foods before exercise, which highlights the need for allergological diagnostic workup and guidance.

Risk factors for severe reactions in food allergy: Rapid evidence review with meta-analysis.

This rapid review summarizes the most up to date evidence about the risk factors for severe food‐induced allergic reactions. We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88 studies and synthesized the evidence narratively, undertaking meta‐analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking, although food‐dependent exercise‐induced anaphylaxis may be an exception. Some medications such as beta‐blockers or ACE inhibitors may increase severity, but appear less important than age as a factor in life‐threatening reactions. The relationship between dose of exposure and severity is unclear. Delays in symptom recognition and anaphylaxis treatment have been associated with more severe outcomes. An absence of prior anaphylaxis does not exclude its future risk.

Whoever goes slowly (after eating) goes far.

Food-dependent exercise-induced anaphylaxis (FDEIA) is an uncommon IgE-mediated hypersensitivity disease with limited prevalence data. Recently, reported cases of FDEIA have been increasing both in adults and children. FDEIA pathogenetic mechanisms are not yet completely understood. Factors that add up their effects are food ingestion and physical effort and, in some cases, concomitant diseases, alcohol, drugs, emotional stress, menstruation, and particular weather conditions contribute to enhancing the reaction. Food-specific FDEIA (sFDEIA) implies the presence of an IgE-mediated sensitization to one or more foods, while in unspecific FDEIA (nsFDEIA), any food can induce anaphylaxis without sensitization. Among causative foods, the most dominant trigger of FDEIA is wheat, in particular the allergen ω-5 gliadin (Tri a 19). Other common foods are seafood, seeds, grains, nuts, vegetables and fruit, cow’s milk, meat, and eggs. We present three cases of sFDEIA in children with clinical features and laboratory findings; the first was induced by a culprit food less frequently involved in sFDEIA than the others (www.actabiomedica.it).