Food-dependent Exercise-induced Anaphylaxis Research Articles

血漿ヒスタミン測定が診断に有用であった食物依存性運動誘発アナフィラキシーの1例

症例は15歳男児. ラーメン1杯を摂取後に行ったランニング中に顔面の発赤・腫脹, 呼吸困難などのアナフィラキシー症状を認めた. それまで小麦製品摂取による即時型の誘発症状はなく, 小麦による食物依存性運動誘発アナフィラキシー (FDEIA) を疑い誘発試験を実施した. 誘発試験において症状は認めなかったが, 小麦負荷と運動負荷, アスピリン負荷と小麦負荷, アスピリン負荷と小麦負荷と運動負荷のいずれの組み合わせにおいても, 血漿ヒスタミン濃度が誘発試験前値の200%, 190%, 248%と上昇を認めたため, 小麦によるFDEIAと診断した. エピペン®を所持してもらい, 小麦製品摂取後2時間以内の運動制限と解熱鎮痛薬使用中の小麦製品摂取の制限ならびに運動制限について指導した. 血漿ヒスタミン濃度の上昇を診断に用いることで, 誘発症状がないために偽陰性と判断されることの危険を回避しうることは, 臨床上極めて有用である.

A cautionary tale for the physician: case report and review of food-dependent exercise-induced anaphylaxis

A cautionary tale for the physician: case report and review of food-dependent exercise-induced anaphylaxis

Allergens involved in Food‐Dependent Exercise‐Induced Anaphylaxis (FDEIA) – experience of a centre in the North of Portugal

Methods Cross-sectional study of the patients of our Food Allergy Unit with FDEIA symptoms. Patient data regarding demography, personal history of atopy and suspected food were collected. Skin prick tests (SPT) with commercial extracts and skin prick-to-prick tests (SPPT) were performed. Specific IgE (sIgE) (ImmunoCAP Thermofisher) for the suspected food and potentially involved molecular allergens were determined.

A dangerous exercise

Exercise induced anaphylaxis and its subtype the Food-dependent exercise-induced anaphylaxis are uncommon and therefore under-diagnosed forms of physical allergy. Triggers include various degrees of exercise in combination with ingestion of specific food products. Treatment remains identical to that of Immunoglobulin E- mediated allergic reactions. The presentation is commonly under diagnosed and this case should raise the awareness of the attending Allergist/Physician. A 30 year old female was seen in the Allergy Clinic upon request of her General Practitioner. She reported an episode where after dinner she went into a local park to exercise. Shortly thereafter she collapsed with rash, lip swelling and breathing difficulties. Upon admission to hospital she was found to be hypotensive and required fluid resuscitation, systemic corticosteroids and adrenaline. She made a full and eventful recovery. Based on the clinical story and the subsequent specific allergy markers her presentation was attributed to food- induced exercise-induced anaphylaxis (FD-EIA).

Food Dependent Exercise-Induced Anaphylaxis - a Component Resolved Approach to Evaluate Suspected Cross-Reactive Ltp Sensitization

Food Dependent Exercise-Induced Anaphylaxis - a Component Resolved Approach to Evaluate Suspected Cross-Reactive Ltp Sensitization

Food-dependent exercise-induced anaphylaxis in Korean children: a single-center retrospective case study

Purpose: Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific clinical syndrome requiring both ingestion of an allergenic food and exercise to induce anaphylaxis. It may be underdiagnosed due to insufficient history taking in terms of the causes of anaphylaxis. This study aims to describe clinical characteristics and diagnostic results of FDEIA in children. Methods: We retrospectively reviewed the medical records of patients under 18 years old who were diagnosed with FDEIA at Asan Medical Center between January 2003 and August 2014. Results: Of the 170 children with anaphylaxis, 11 (6.5%) had FDEIA. The mean age at the onset of symptoms was 14.8±1.5 years. The causative foods were: wheat (n=4), meat (n=1), mung beans (n=1), rice (n=1), celery (n=1), cabbage (n=1), fish (n=1), and soy (n=1). The numbers of symptom development were: 7 (n=1), 6 (n=1), 3 (n=4), 2 (n=2), and 1 (n=3). The geometric mean (range of 1 standard deviation) of total serum IgE levels was 131.6 kU/L (53.5.324.2 kU/L). The skin prick test and immununoCAP were positive for causative foods in 3 of 6 patients (50.0%) and 7 of 10 patients (70.0%), respectively. The provocation test was performed in 8 of 11 patients and showed positive results except 1 patient. The interval between exercise and symptoms was 21.6±7.3 minutes. Conclusion: It is important to suspect FDEIA and take a detailed history in children with anaphylaxis. Provocation test should be considered to confirm the diagnosis. Further studies on disease course and long-term prognosis are warranted.(Allergy Asthma Respir Dis 2015;3:194-199)

食物アレルゲンの吸収機構の解明と食物アレルギーの発症に関する研究

Food–dependent exercise-induced anaphylaxis (FDEIA) is a peculiar form of food allergy, which is induced by physical exercise following the ingestion of causative food products. Patients with FDEIA typically exhibit generalized urticaria, dyspnea and anaphylaxis induced by the type–I allergic reaction. In addition to exercise, intake of nonsteroidal anti–inflammatory drugs, especially aspirin, is another well–documented trigger for FDEIA symptoms. The pathogenesis of aspirin–exacerbated FDEIA symptoms remains unclear. However, increases in the absorption of allergens via the intestinal tract and/or activation of inflammatory cells by aspirin are considered to be the underlying mechanisms for it. Recently, we found that food allergens including lysozyme and ovalbumin were absorbed via paracellular and transcytotic pathways, and aspirin facilitated the intestinal absorptions of these allergens via the paracellular pathway, resulting in the development and exacerbation of food–allergic symptoms. This review summarizes the pathogenesis of aspirin–induced FDEIA symptoms from the viewpoint of intestinal absorption pathway(s) of food allergens and the effect of aspirin on their absorptions.

Diversity of Food Allergy.

Food allergy is defined as an immune system-mediated adverse reaction to food components. Food allergic reactions are mostly IgE mediated and also known as immediate type hypersensitivity (type I reaction). There are several characteristic clinical types of food allergy, such as Anaphylaxis, Food-dependent exercise-induced anaphylaxis (FDEIA), and Oral allergy syndrome (OAS). In addition, food allergy is also classified into two types (class 1 and class 2) based on the pathophysiological mechanism. In the class 2 food allergy, pollen allergy causes plant food allergy; therefore this type of allergy is sometimes called Pollen-food allergy syndrome (PFAS). The risk of food allergy (allergenicity) may vary with the treatment of the food allergens. The formation or status of the causative food affects its allergenicity. Class 1 food allergens are generally heat-, enzyme-, and low pH-resistant glycoproteins ranging in size from 10 to 70 kD. Class 1 food allergens induce allergic sensitization via the gastrointestinal tract and are responsible for systemic reactions. Class 2 food allergens are generally heat-labile, susceptible to digestion, and highly homologous with pollen allergens. Taken together, it may be important to consider the diversity of food allergy in order to fight against food allergy.

Apple-dependent exercise-induced anaphylaxis

Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of anaphylaxis that requires both vigorous physical activity and the ingestion of specific causative foods. In particular, occurrence for FDEIA is rarely associated with apples. A 17-year-old male experienced generalized urticaria, dyspnea, headache, vomiting, and presyncope after ingestion of an apple and then 2 hours of exercise. The skin prick test showed a strong positive reaction to apple crude allergen extract, whereas the results of an open food challenge and exercise provocation tests were negative. However, the exercise test after apple consumption provoked a positive reaction with generalized urticaria, dyspnea, and presyncope. We detected 17 kD IgE-reactive protein band in immunoblotting assay with apple crude extract and patient’s serum. (Allergy Asthma Respir Dis 2015;3:224-227)

Mixed plant extract-dependent exercise-induced anaphylaxis

Food-dependent exercise-induced anaphylaxis (FDEIA) is a potentially life-threatening clinical reaction in which anaphylaxis develops when physical activity occurs within a few hours after ingesting a specific food. An 18-year-old girl experienced generalized urticaria, periorbital swelling, and dyspnea repeatedly by exercise after intake of a red ginseng health supplement. A confirmed diagnosis was established in this case by using an exercise challenge test after ingesting mixed-plant extract containing red ginseng health supplement. To the best of our knowledge, this is the first case of FDEIA caused by components in a red ginseng health supplement. (Allergy Asthma Respir Dis 2015;3:219-223)

A Severe Case of Wheat-Dependent Exercise-Induced Anaphylaxis in Adulthood

Food-dependent exercise-induced anaphylaxis (FDEIA), is a severe form of allergy for which the ingestion of a specific food, usually before physical exercise induces symptoms of anaphylaxis. Patients typically have IgE antibodies to the food that triggers the reactions; however, the symptoms appear only if the co-factors act together. The most common reported cause of these reactions seems to be wheat. In some cases FDEIA is displayed even when the food is eaten immediately after exercise, showing that in FDEIA, not the sequence but rather the coincidence of triggering factors use, is of crucial importance. The risk to develop anaphylaxis in these patients depends on the presence and, in some cases, on the amount of cofactors of anaphylaxis. There are lots of evidences about the role of NSAIDs as cofactors of anaphylaxis.

A Severe Case of Wheat-Dependent Exercise-Induced Anaphylaxis in Adulthood

Food-dependent exercise-induced anaphylaxis (FDEIA), is a severe form of allergy for which the ingestion of a specific food, usually before physical exercise induces symptoms of anaphylaxis. Patients typically have IgE antibodies to the food that triggers the reactions; however, the symptoms appear only if the co-factors act together. The most common reported cause of these reactions seems to be wheat. In some cases FDEIA is displayed even when the food is eaten immediately after exercise, showing that in FDEIA, not the sequence but rather the coincidence of triggering factors use, is of crucial importance. The risk to develop anaphylaxis in these patients depends on the presence and, in some cases, on the amount of cofactors of anaphylaxis. There are lots of evidences about the role of NSAIDs as cofactors of anaphylaxis.

Food-dependent exercise-induced anaphylaxis

As a unique form of food allergy,food-dependent exercise-induced anaphylaxis (FDEIA) is a rare and potentially life-threatening clinical syndrome.It only occurs in the presence of both ingested sensitizing food and exercise,and either of them alone cannot induce its development.The pathophysiology of FDEIA is not fully understood,and relevant hypotheses include increase in gastrointestinal permeability,redistribution of blood flow,ingestion of aspirin,alteration in plasma pH,and so on.Symptomatic therapy remains the mainstay of treatment for FDEIA,such as anti-histamines,epinephrine and glucocorticoids. Key words: Exercise-induced; Food hypersensitivity; Anaphylaxis

Loss‐of‐function mutations in the gene encoding filaggrin underlie a Japanese family with food‐dependent exercise‐induced anaphylaxis

Food-dependent exercise-induced anaphylaxis (FDEIA) is a serious food allergy in which anaphylaxis develops when exercise is performed within several hours after food intake. The precise mechanism underlying allergic sensitization in FDEIA has been an important issue but remains poorly understood. We aimed to elucidate the pathomechanism including the route of allergen sensitization involved in FDEIA. A Japanese family with wheat-dependent exercise-induced anaphylaxis (WDEIA), a specific form of FDEIA, were clinically examined. Mutation analysis of the gene encoding filaggrin (FLG) was also performed. Two of the family members were confirmed as WDEIA on the basis of their medical history and positive provocation test results. Notably, the two affected individuals in the family had concomitant ichthyosis vulgaris. Mutation analysis of FLG revealed that they carry one or more loss-of-function mutations that have not been described in the Japanese population. These results indicate that FLG mutations might be involved in the pathogenesis of WDEIA in the present case.

Corn-dependent exercise-induced anaphylaxis

Background Exercise-induced anaphylaxis is a rare disorder characterized by the development of a severe allergic response occurring after mildto-strenuous physical activity. Food-dependent exercise-induced anaphylaxis (FDEIA) comprises 30-50% of all cases of exercise-induced anaphylaxis [2]. Diagnosis involves careful history and appropriate skin prick testing and food specific IgE levels [4,6]. However, food dependent exercise challenges may be required to confirm the diagnosis [6]. We describe the case of a 51 year old male, diagnosed with corn dependent exercise anaphylaxis via serial exercise challenges.

Food Dependent Exercise Induced Anaphylaxis Treatment With Specific Oral Tolerance Induction Using IFN-Gamma

Food dependent exercise induced anaphylaxis (FDEIA) was induced by exercise within three or four hours after ingestion of specific allergenic foods. There is no specific treatment method. The avoidance of allergenic food with exercise is the only way to treat the FEDIA.

Two cases of food-dependent exercise-induced anaphylaxis with different culprit foods

Food-dependent exercise-induced anaphylaxis (FDEIA) is one of the severe allergic reactions in which symptoms develop only if exercise takes place within a few hours of eating a specific food. It is important to consider FDEIA in cases of unexplained anaphylaxis as reactions can occur several hours after ingesting the culprit food(s). We herein report the first two cases of FDEIA in the Middle East. The first one is induced by wheat, while the other by peanut. The pathophysiology, predisposing factors, diagnosis, and treatment of FDEIA are also summarized here.

A New Reliable Method for Detecting Specific IgE Antibodies in the Patients with Immediate Type Wheat Allergy due to Hydrolyzed Wheat Protein: Correlation of Its Titer and Clinical Severity

Immediate-type wheat allergy caused by a specific hydrolyzed wheat protein (HWP-IWA), Glupearl 19S (GP19S), typically develops food-dependent exercise-induced anaphylaxis (FDEIA), but is different from conventional FDEIA, or simple wheat allergy in many aspects. The skin prick test (SPT) is considered to be the most effective method for diagnosis of HWP-IWA. As SPT is a relatively qualitative method, we developed quantitative and high-throughput test method for HWP-IWA. An enzyme-linked immunosorbent assay (ELISA)-based GP19S-specific IgE assay was tested using sera from 14 HWP-IWA and five conventional wheat-dependent exercise-induced anaphylaxis (CO-WDEIA) patients, as well as five healthy subjects. Then a validation study at five different institutions was carried out using sera from 10 HWP-IWA and five CO-WDEIA patients, as well as five healthy subjects different from the previous studies. The mean unit values converted from measured absorbance of ELISA were 68.3, 1.3 and 1.1 respectively. Furthermore, the validation study revealed reproducible results across all five institutions, with the standard deviation (SD) being 0.3-0.4 for the healthy group, 0.2-0.6 for the CO-WDEIA group, and 3.8-9.6 for HWP-IWA group except for one case. One case of HWP-IWA was excluded from analysis due to the high SD of 53.3 units, indicating that samples with a unit value > 100.0 will affect inter-laboratory reproducibility. Our findings suggest that the ELISA-based GP19S-specific IgE assay can be used to test HWP-IWA using venous blood samples, except for those with a unit value > 100.0.

Food-Dependent Exercise-Induced Anaphylaxis: Is Wheat Unique?

This review draws comparisons between wheat-dependent exercise-induced anaphylaxis (WDEIA) and other food-dependent exercise-induced anaphylaxis (FDEIAs) and discusses the importance of co-factors in its pathophysiology. FDEIA remains an enigmatic condition since it was first described 30years ago. The sporadic and unpredictable nature of its reactions has puzzled clinicians and scientists for decades, but recent studies on WDEIA have enlightened us about the pathophysiology of this condition. The identification of defined allergic epitopes such as Tri a 19, α-gliadin, β-gliadin and γ-gliadin in WDEIA enables it to become the perfect model for studying FDEIA, but WDEIA is by no means a unique condition. On a larger scale, FDEIA represents a crucial link between IgE-mediated and anaphylactoid reactions and provides supportive evidence for the concept of 'summation anaphylaxis' and the need to overcome the 'allergen threshold'. Future work should focus on identifying more of the FDEIA epitopes and understanding their distinct molecular properties. The development of a biomarker in order to identify patients susceptible to co-factor influences would be invaluable.

Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-α-1,3-galactose

Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-α-1,3-galactose