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Romano A, Gaeta F, Caruso C, Fiocchi A, Valluzzi RL. Evaluation and Updated Classification of Acute Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAID-Exacerbated or -Induced Food Allergy. J Allergy Clin Immunol Pract 2023; 11:1843-1853.e1. [PMID: 36997117 DOI: 10.1016/j.jaip.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND There are hypersensitivity reactions (HRs) to foods in which nonsteroidal anti-inflammatory drugs (NSAIDs) act as aggravating factors (NSAID-exacerbated food allergy [NEFA]) or cofactors (NSAID-induced food allergy [NIFA]), often misdiagnosed as HRs to NSAIDs. Urticarial/angioedematous and/or anaphylactic reactions to two or more chemically unrelated NSAIDs do not meet current classification criteria. However, they may be considered part of a cross-reactive type of acute HR, which is NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis. OBJECTIVE To evaluate patients reporting acute HRs to NSAIDs and classify them according to updated criteria. METHODS We prospectively studied 414 patients with suspected HRs to NSAIDs. For all whom met these criteria, NEFA/NIFA was diagnosed: (1) mild reactions to (NEFA) or tolerance of (NIFA) the suspected foods without taking NSAIDs; (2) cutaneous and/or anaphylactic reactions to the combination foods plus NSAIDs; (3) positive allergy tests to the suspected foods; and (4) negative drug challenges (DCs) with the NSAIDs involved. RESULTS A total of 252 patients were given the diagnosis of NSAID hypersensitivity (60.9%), 108 of whom had NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis. We excluded NSAID hypersensitivity in 162 patients (39.1%) who tolerated DCs with the suspected NSAIDs, nine of whom received a diagnosis of NEFA, and 66 of NIFA. Pru p 3 was implicated in 67 of those 75 patients who received a diagnosis of NEFA or NIFA. CONCLUSIONS NEFA and NIFA account for about 18% of patients reporting HRs to NSAIDs, in which Pru p 3 is the main responsible food allergen. Therefore, patients with cutaneous and/or anaphylactic reactions to NSAIDs should be carefully questioned about all foods ingested within 4 hours before or after NSAID exposure, and targeted food allergy tests should be considered in the diagnostic workup of these patients. If testing is positive, DCs with the suspected NSAIDs should also be considered.
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Affiliation(s)
| | | | - Cristiano Caruso
- UOSD Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rocco Luigi Valluzzi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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2
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Malkovics T, Joura MI, Koszorú K, Sárdy M. [Dermatitis herpetiformis and other forms of wheat sensitivity]. Dermatologie (Heidelb) 2022; 74:955-960. [PMID: 37882829 PMCID: PMC10661880 DOI: 10.1007/s00105-023-05243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Wheat sensitivity is a collective term for several, especially gastrointestinal, diseases that occur as part of a hypersensitivity reaction after wheat consumption. The symptoms, which are mostly similar to those of irritable bowel syndrome, are often accompanied by skin lesions. In addition to celiac disease and dermatitis herpetiformis, the cutaneous manifestation of celiac disease, wheat sensitivity also includes nonceliac gluten sensitivity (NCGS), allergic nickel contact mucositis, wheat allergy, amylase-trypsin inhibitor intolerance, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) intolerance. OBJECTIVES This review article aims to provide an overview of the clinical, especially dermatological and gastrointestinal features of the different forms of wheat sensitivity. Diagnosis and therapeutic management are also discussed. MATERIALS AND METHODS A selective literature search was carried out with evaluation of our own clinical data. RESULTS The skin lesions in dermatitis herpetiformis are very disease-specific. In contrast, wheat allergy often shares signs and symptoms with many other diseases. Other forms of wheat sensitivity cause primarily gastrointestinal abnormalities, but extra-intestinal manifestations can also occur. Their diagnosis is often complex and requires cross-disciplinary collaboration with experts in gastroenterology. The therapy consists of a wheat- or gluten-free diet. CONCLUSIONS Knowledge of the different and frequently occurring dermatological signs of wheat sensitivity is of great importance, because dermatological manifestations associated with gastrointestinal pathology, intolerance reactions, and allergies appear more and more frequently.
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Affiliation(s)
- T Malkovics
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Fakultät für Medizin, Semmelweis Universität, Mária u. 41, 1085, Budapest, Ungarn.
| | - M I Joura
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Fakultät für Medizin, Semmelweis Universität, Mária u. 41, 1085, Budapest, Ungarn
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - K Koszorú
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Fakultät für Medizin, Semmelweis Universität, Mária u. 41, 1085, Budapest, Ungarn
| | - M Sárdy
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Fakultät für Medizin, Semmelweis Universität, Mária u. 41, 1085, Budapest, Ungarn
- Klinik für Dermatologie und Allergologie, Klinikum der Universität München (LMU), München, Deutschland
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Kulthanan K, Ungprasert P, Jirapongsananuruk O, Rujitharanawong C, Munprom K, Trakanwittayarak S, Pochanapan O, Panjapakkul W, Maurer M. Food-Dependent Exercise-Induced Wheals, Angioedema, and Anaphylaxis: A Systematic Review. J Allergy Clin Immunol Pract 2022; 10:2280-2296. [PMID: 35752432 DOI: 10.1016/j.jaip.2022.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Food-dependent exercise-induced wheals, angioedema, and anaphylaxis remain insufficiently characterized. OBJECTIVE We systematically reviewed the literature on clinical manifestations, laboratory investigations, culprit foods, triggering exercise, comorbidities, and treatment outcomes. METHODS 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 July 2021. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Orathai Jirapongsananuruk
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanyalak Munprom
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Oraya Pochanapan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waratchaya Panjapakkul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
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4
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Skypala IJ, Bartra J, Ebo DG, Antje Faber M, Fernández‐Rivas M, Gomez F, Luengo O, Till SJ, Asero R, Barber D, Cecchi L, Diaz Perales A, Hoffmann‐Sommergruber K, Anna Pastorello E, Swoboda I, Konstantinopoulos AP, Ree R, Scala E. The diagnosis and management of allergic reactions in patients sensitized to non-specific lipid transfer proteins. Allergy 2021; 76:2433-2446. [PMID: 33655502 DOI: 10.1111/all.14797] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/29/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022]
Abstract
Sensitization to one or more non-specific lipid transfer proteins (nsLTPs), initially thought to exist mainly in southern Europe, is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond. The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a cofactor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa) to be present for a food to elicit a reaction. The variability in the food and cofactor triggers makes it essential to include an allergy-focused diet and clinical history in the diagnostic workup. Testing on suspected food triggers should also establish whether sensitization to nsLTP is present, using purified or recombinant nsLTP allergens such as Pru p 3. The avoidance of known trigger foods and advice on cofactors is currently the main management for this condition. Studies on immunotherapy are promising, but it is unknown whether such treatments will be useful in populations where Pru p 3 is not the primary sensitizing allergen. Future research should focus on the mechanisms of cofactors, improving diagnostic accuracy and establishing the efficacy of immunotherapy.
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Affiliation(s)
- Isabel J. Skypala
- Royal Brompton & Harefield NHS Foundation Trust London UK
- Department of Allergy and Clinical Immunology Imperial College London UK
| | - Joan Bartra
- Hospital Clinic Barcelona Spain
- IDIBAPS Universitat de Barcelona ARADyAL, Barcelona Spain
| | - Didier G. Ebo
- Department of Immunology, Allergology, Rheumatology Faculty of Medicine and Health Sciences Infla‐Med Centre of Excellence Antwerp University Hospital University of Antwerp Antwerp Belgium
- Jan Palfijn Ziekenhuis Ghent Ghent Belgium
| | - Margaretha Antje Faber
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology, Rheumatology Infla‐Med Centre of Excellence Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de Madrid IdISSC ARADyAL Madrid Spain
| | - Francisca Gomez
- Allergy Unit IBIMA—Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reaccionesadversas y Alérgicas (ARADyAL Madrid Spain
| | - Olga Luengo
- Allergy Unit Internal Medicine Department Vall d'Hebron University Hospital Universitat Autònoma de Barcelona ARADyAL Barcelona Spain
| | - Stephen J. Till
- Peter Gorer Department of Immunobiology King’s College London London UK
- Department of Allergy Guy’s & St Thomas’ NHS Foundation Trust London UK
| | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano Italy
| | - Domingo Barber
- IMMA School of Medicine Universidad San Pablo CEU, Universities Madrid Spain
- RETIC ARADYAL RD16/0006/0015 Instituto de Salud Carlos III Madrid Spain
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology USL Toscana Centro Prato Italy
| | - Araceli Diaz Perales
- Centro de Biotecnología y Genómica de Plantas Universidad Politecnica Madrid Spain
| | | | - Elide Anna Pastorello
- Unit of Allergology and Immunology ASST Grande Ospedale Metropolitano Niguarda University of Milan Milan Italy
| | - Ines Swoboda
- Biotechnology Section Campus Vienna Biocenter FH Campus Wien, University of Applied Sciences Vienna Austria
| | | | - Ronald Ree
- Department of Experimental Immunology Amsterdam University Medical Centers, location AMC Amsterdam The Netherlands
- Department of Otorhinolaryngology Amsterdam University Medical Centers, location AMC Amsterdam The Netherlands
| | - Enrico Scala
- Experimental Allergy Unit Istituto Dermopatico dell’Immacolata – IRCCS FLMM Rome Italy
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Pilz GF, Weber F, Mueller WG, Schaefer JR. Statistical Methods to Support Difficult Diagnoses. Diagnostics (Basel) 2021; 11:diagnostics11071300. [PMID: 34359382 PMCID: PMC8305132 DOI: 10.3390/diagnostics11071300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022] Open
Abstract
Far too often, one meets patients who went for years or even decades from doctor to doctor without obtaining a valid diagnosis. This brings pain to millions of patients and their families, not to speak of the enormous costs. Often patients cannot tell precisely enough which factors (or combinations thereof) trigger their problems. If conventional methods fail, we propose the use of statistics and algebra to provide doctors much more useful inputs from patients. We use statistical regression for triggering factors of medical problems, and in particular, "balanced incomplete block designs" for factors detection. These methods can supply doctors with much more valuable inputs and can also find combinations of multiple factors through very few tests. In order to show that these methods do work, we briefly describe a case in which these methods helped to solve a 60-year-old problem in a patient and provide some more examples where these methods might be particularly useful. As a conclusion, while regression is used in clinical medicine, it seems to be widely unknown in diagnosing. Statistics and algebra can save the health systems much money, as well as the patients a lot of pain.
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Affiliation(s)
- Guenter F. Pilz
- Institute of Algebra, Johannes Kepler University, 4040 Linz, Austria
- Correspondence: ; Tel.: +43-650-2468220
| | - Frank Weber
- German Air Force Center of Aerospace Medicine, 82256 Fuerstenfeldbruck, Germany;
| | - Werner G. Mueller
- Institute for Applied Statistics, Johannes Kepler University, 4040 Linz, Austria;
| | - Juergen R. Schaefer
- Center for Undiagnosed and Rare Diseases (ZusE), Philipps University, 35043 Marburg, Germany;
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Bird JA, Leonard S, Groetch M, Assa'ad A, Cianferoni A, Clark A, Crain M, Fausnight T, Fleischer D, Green T, Greenhawt M, Herbert L, Lanser BJ, Mikhail I, Mustafa S, Noone S, Parrish C, Varshney P, Vlieg-Boerstra B, Young MC, Sicherer S, Nowak-Wegrzyn A. Conducting an Oral Food Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work Group Report. J Allergy Clin Immunol Pract 2021; 8:75-90.e17. [PMID: 31950914 DOI: 10.1016/j.jaip.2019.09.029] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/17/2022]
Abstract
Oral food challenges are an integral part of an allergist's practice and are used to evaluate the presence or absence of allergic reactivity to foods. A work group within the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology was formed to update a previously published oral food challenge report. The intention of this document was to supplement the previous publication with additional focus on safety, treatment of IgE-mediated allergic reactions, guidance for challenges in infants and adults, psychosocial considerations for children and families participating in an oral food challenge, specific guidance for baked milk or baked egg challenges, masking agents and validated blinding recipes for common food allergens, and recommendations for conducting and interpreting challenges in patients with suspected food protein-induced enterocolitis syndrome. Tables and figures within the report and an extensive online appendix detail age-specific portion sizes, appropriate timing for antihistamine discontinuation, serum and skin test result interpretation, written consents, and instructional handouts that may be used in clinical practice.
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Affiliation(s)
- J Andrew Bird
- University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Stephanie Leonard
- University of California, San Diego, Calif; Rady Children's Hospital, San Diego, Calif
| | - Marion Groetch
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amal Assa'ad
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | - David Fleischer
- Children's Hospital Colorado, Denver, Colo; University of Colorado School of Medicine, Aurora, Colo
| | - Todd Green
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Matthew Greenhawt
- Children's Hospital Colorado, Denver, Colo; University of Colorado School of Medicine, Aurora, Colo
| | - Linda Herbert
- Children's National Hospital, Washington, DC; GW School of Medicine and Health Sciences, George Washington University, Washington, DC
| | | | - Irene Mikhail
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shahzad Mustafa
- Rochester Regional Health, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sally Noone
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Pooja Varshney
- Dell Children's Medical Center, Austin, Texas; Dell Medical School at University of Texas Austin, Austin, Texas
| | - Berber Vlieg-Boerstra
- OLVG, Department of Pediatrics, Amsterdam, The Netherlands; Department of Nutrition & Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands
| | | | - Scott Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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González-Santamaría J, Arámburo-Gálvez JG, Beltrán-Cárdenas CE, Mora-Melgem JA, Figueroa-Salcido OG, Ramírez-Torres GI, Cárdenas-Torres FI, Carvalho Gomes I, Geralda André T, Macêdo-Callou MA, Braga Rocha ÉM, Ontiveros N, Cabrera-Chávez F. Design, Assessment, and Validation of a Questionnaire to Estimate Food-Dependent Exercise-Induced Anaphylaxis Prevalence in Latin American Population. Healthcare (Basel) 2020; 8:healthcare8040519. [PMID: 33260469 PMCID: PMC7712264 DOI: 10.3390/healthcare8040519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022] Open
Abstract
There are no epidemiological data about food-dependent exercise-induced anaphylaxis (FDEIA) in Latin America. Our aim was to design, assess, and validate a questionnaire to identify potential FDEIA cases and/or estimate its prevalence by self-report. Questions were included in the instrument to address the main symptoms of FDEIA, type/intensity of physical activity, and anaphylaxis. The instrument’s clarity, comprehension and repeatability were evaluated. These evaluations were carried out by Hispanic people (Argentinians/Colombians/Mexicans/Peruvians), including nine individuals with medical diagnosis of FDEIA, and Brazilians. The Flesch–Kincaid score was calculated using the INFLESZ software. The instrument was translated from Spanish to Brazilian Portuguese following the translation back-translation procedure. The participants rated the two versions of the questionnaire as clear and comprehensible (three-point ordinal scale) and very easy to understand [0.33; average (scale 0–10)]. For these evaluations, the Kendall’s W coefficient showed strong agreement among raters (W = 0.80; average). The Flesch–Kincaid score was 63.5 in average (documents considered as readable). The Cohen’s Kappa coefficient showed almost perfect agreement in repeatability (0.88; average). The validation process of two versions of an instrument, used to identify potential FDEIA cases, was successfully carried out and it was found applicable to Latin American countries for generating epidemiological data.
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Affiliation(s)
- Jhonatan González-Santamaría
- Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacán 80019, Sinaloa, Mexico
- Faculty of Health and Sports Sciences, University Foundation of the Andean Area, Pereira 66001, Risaralda, Colombia
| | | | | | - José Antonio Mora-Melgem
- Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacán 80019, Sinaloa, Mexico
| | | | | | | | | | | | - María Auxiliadora Macêdo-Callou
- Department of Nutrition, University Center of Juazeiro do Norte, Juazeiro do Norte, Juazeiro do Norte 63010-215, Ceara, Brazil
| | - Élida Mara Braga Rocha
- Department of Nutrition, University Center of Juazeiro do Norte, Juazeiro do Norte, Juazeiro do Norte 63010-215, Ceara, Brazil
| | - Noé Ontiveros
- Clinical and Research Laboratory (LACIUS, URS), Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Division of Sciences and Engineering, University of Sonora, Navojoa 85880, Sonora, Mexico
| | - Francisco Cabrera-Chávez
- Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacán 80019, Sinaloa, Mexico
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Lozoya-Ibáñez C, Morgado-Nunes S, Rodrigues A, Fernandes P, Lourenço O, Mafalda Fonseca A, Taborda-Barata L. Prevalence and clinical features of adverse food reactions in Portuguese adolescents. World Allergy Organ J 2020; 13:100453. [PMID: 32817783 PMCID: PMC7424229 DOI: 10.1016/j.waojou.2020.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/10/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background & aims The objective of the present study was to determine, for the first time, the prevalence and clinical features of food allergy in Portuguese adolescents. Methods Cross-sectional study performed in various secondary schools in central Portugal. Randomly selected adolescents replied to a validated food allergy questionnaire. Those who reported an adverse food reaction were seen at participating hospitals, where clinical history was taken, skin prick (SPT) and prick-prick skin (SPPT) tests were performed, and food allergen-specific IgE levels (sIgE) were determined. An open oral challenge was performed in selected cases. Cases of positive clinical history of immediate (up to 2 h after ingestion) reaction in association with positive food sIgE levels and/or SPT were classified as IgE-associated probable food allergy and as confirmed IgE-mediated food allergy if food challenges were positive. Cases of positive clinical history of delayed (more than 2 h after ingestion) and negative food sIgE levels independently of positive SPT or SPPT results, were classified as non-IgE associated probable food allergy. Results The prevalence of probable food allergy in Portuguese adolescents was 1.41% (95% CI: 0.90–2.03%), with fresh fruits, shellfish, nuts, and peanut as the most frequently implicated foods. IgE-mediated probable food allergy occurred in 1.23% (95% CI: 0.67–1.72%) of cases, with fresh fruits, shellfish, and nuts mainly involved. Cutaneous symptoms were most frequently reported. Conclusions The prevalence of probable food allergies in Portuguese adolescents is low, is mostly related to fresh fruits, shellfish, nuts, and peanut, and most frequently involves cutaneous symptoms.
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Affiliation(s)
- Carlos Lozoya-Ibáñez
- Allergy Department, Castelo Branco Local Health Unit, Portugal.,CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal
| | - Sara Morgado-Nunes
- CACB - Clinical Academic Center of Beiras, Portugal.,Polytechnic Institute of Castelo Branco, Escola Superior de Gestão, Castelo Branco, Portugal
| | - Alexandra Rodrigues
- CACB - Clinical Academic Center of Beiras, Portugal.,Outpatient Clinic Department, Castelo Branco Local Health Unit, Portugal
| | - Patrícia Fernandes
- CACB - Clinical Academic Center of Beiras, Portugal.,Clinical Pathology Department, Castelo Branco Local Health Unit, Portugal
| | - Olga Lourenço
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal
| | - Ana Mafalda Fonseca
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal
| | - Luis Taborda-Barata
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal.,Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
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9
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Geller M. Clinical Management of Exercise-Induced Anaphylaxis and Cholinergic Urticaria. The Journal of Allergy and Clinical Immunology: In Practice 2020; 8:2209-2214. [DOI: 10.1016/j.jaip.2020.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/03/2020] [Accepted: 01/17/2020] [Indexed: 01/19/2023]
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10
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Abstract
Introduction: Food-dependent, exercise-induced anaphylaxis (FDEIA) is a rare type of anaphylaxis with a growing incidence. Although the precise mechanism by which the patient reacts only in a combination of a culprit food and cofactors are not currently understood, many advances in diagnosis and management have been made since their first description. Areas covered: A literature search in PubMed was performed to review the diagnosis and management of FDEIA. Clinicians should have a high level of suspicion for identification of the culprit foods and the cofactors involved. Component-resolved diagnosis and more accurate provocation tests have revolutionized the diagnosis accuracy. Management is not easy and involves educating the patient to evict the combination of exposure to the culprit foods and the cofactors that elicit anaphylaxis, and how to act and treat if a reaction occurs. Expert opinion: FDEIA is currently misdiagnosed and the authors believe that there are many FDEIA patients labelled as idiopathic anaphylaxis with unnecessary evictions and with a poor quality of life because of the fear of an imminent reaction. Due to recent advances in diagnostic tools and the use of monoclonal antibodies for prophylaxis in persistent cases, FDEIA can have a better prognosis improving the quality of life of the patients and their families.
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Carrillo-Martin I, Chamorro-Pareja N, Haehn DA, Irizarry-Alvarado JM, Gonzalez-Estrada A. Food-dependent exercise-induced anaphylaxis with sensitization to tomato: Diagnostic approach involving food-exercise challenge. Ann Allergy Asthma Immunol 2019; 123:316-8. [PMID: 31228627 DOI: 10.1016/j.anai.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/23/2019] [Accepted: 06/13/2019] [Indexed: 11/24/2022]
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Abstract
PURPOSE OF REVIEW Gain of function KIT mutations are detected in clonal mast cell diseases, namely mastocytosis and monoclonal mast cell activation syndrome. Timely diagnosis and treatment of these disorders are crucial because of their association with severe and life-threatening anaphylaxis. KIT mutations also have implications for targeted therapies of mast cell disorders. This review article strives to serve as an overview of the role of clonal mast cell disorders in anaphylaxis while elucidating current and future therapies. RECENT FINDINGS Clonal mast cell disease has been increasingly diagnosed in patients with severe hymenoptera allergy and those with recurrent unexplained anaphylaxis. The current state of knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of mastocytosis with a particular focus on anaphylaxis and its triggers which are described in this context. Novel and forthcoming treatments are discussed including the relevance of KIT mutation status. This review provides an overview of the role of KIT mutations in mastocytosis and anaphylaxis, and highlights emerging therapies for mastocytosis, targeting these mutations.
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Affiliation(s)
- Elise Coulson
- Department of Internal Medicine, Division of Allergy and Immunology, University of Michigan, 24 Frank Lloyd Wright Drive, Suite H-2100, PO Box 442, Ann Arbor, MI, 48106-0442, USA
| | - Sherry Zhou
- Department of Internal Medicine, Division of Allergy and Immunology, University of Michigan, 24 Frank Lloyd Wright Drive, Suite H-2100, PO Box 442, Ann Arbor, MI, 48106-0442, USA
| | - Cem Akin
- Department of Internal Medicine, Division of Allergy and Immunology, University of Michigan, 24 Frank Lloyd Wright Drive, Suite H-2100, PO Box 442, Ann Arbor, MI, 48106-0442, USA.
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Greve M. Food dependent exercise induced anaphylaxis triggered by inhaled antigen. Am J Emerg Med 2019; 37:796.e1-796.e2. [PMID: 30803849 DOI: 10.1016/j.ajem.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 11/20/2022] Open
Abstract
We present a unique case of food dependent exercise induced anaphylaxis (FDEIA) triggered by an inhaled allergen in a 23- year-old professional cyclist. FDEIA is considered a rare form of anaphylaxis in which the state of exercise can trigger mast cell degranulation to an allergen which normally does not cause a reaction. It is closely related to exercise induced anaphylaxis, which occurs with exercise but in the absence of a food trigger. The patient experienced an anaphylactic reaction during a bicycle race when the race went through an almond orchard in full bloom. He was successfully stabilized with aggressive measures including steroids, fluids, anti-histamines and multiple doses of epinephrine.
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Affiliation(s)
- Mark Greve
- Warren Alpert School of Medicine at Brown Univ, Department of Emergency Medicine, Division of Sports Medicine, United States of America.
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Farrell A, Judge C, Redenbaugh V, Awad H, Conlon N. Food-dependent exercise-induced reactions: lessons from a 15-year retrospective study. Ir J Med Sci 2019; 188:815-819. [PMID: 30661174 DOI: 10.1007/s11845-019-01965-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Food-dependent exercise-induced anaphylaxis (FDEIA) is a life-threatening disorder in which the signs and symptoms of anaphylaxis occur if physical exertion occurs within a few hours of exposure to a food. AIMS The aim of this study was to characterise patients diagnosed with FDEIA and related disorders. METHODS A retrospective review of electronic clinical data from 2001 to 2016 was carried out. Fifty-seven cases were identified and analysed to establish clinical features, triggering factors and sensitisation patterns. RESULTS The number of patients per annum diagnosed with FDEIA or related reactions increased from 1 in 2001 to 18 patients in 2016. Sixty-nine percent reported systemic symptoms consistent with anaphylaxis, and 31% had skin manifestations only. In 33% of cases, the level of triggering exercise was mild. Forty-four percent of patients were sensitised to the omega-5-gliadin fraction of wheat. CONCLUSIONS FDEIA is an increasingly recognised serious allergic disease. The clinical diagnosis is supported by targeted sensitisation testing and molecular-based allergy diagnostics. These tools allow implementation of effective dietary and lifestyle modifications that mitigate against future serious reactions. Given the limited access to physicians with specialist allergy training in Ireland, increased awareness of this condition amongst sports medicine specialists and general physicians is required.
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Affiliation(s)
- Aisling Farrell
- Department of Immunology, St. James's Hospital, Dublin, Ireland.
| | - Ciaran Judge
- Department of Immunology, St. James's Hospital, Dublin, Ireland
| | | | - Hanna Awad
- Department of Immunology, St. James's Hospital, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St. James's Hospital, Dublin, Ireland
- Department of Immunology, Trinity College Dublin, Dublin, Ireland
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Christensen MJ, Eller E, Kjaer HF, Broesby-Olsen S, Mortz CG, Bindslev-Jensen C. Exercise-induced anaphylaxis: causes, consequences, and management recommendations. Expert Rev Clin Immunol 2019; 15:265-273. [DOI: 10.1080/1744666x.2019.1562904] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Morten J. Christensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Esben Eller
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Henrik F. Kjaer
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
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Abstract
PURPOSE OF REVIEW This paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years. RECENT FINDINGS Exercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The pathophysiology of EIAn is still under investigation. EIAn and FDEIAn are rare clinical syndromes characterized by symptoms during or shortly after exercise. Despite recent advances in the understanding of EIAn and FDEIAn, the pathophysiology of both conditions is not fully understood.
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Affiliation(s)
- Matthew P Giannetti
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 60 Fenwood Rd., Building for Transformative Medicine, 5th Floor, Boston, MA, 02115, USA.
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Bartra J, Araujo G, Muñoz-cano R. Interaction between foods and nonsteroidal anti-inflammatory drugs and exercise in the induction of anaphylaxis. Curr Opin Allergy Clin Immunol 2018; 18:310-6. [DOI: 10.1097/aci.0000000000000461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Kulthanan K, Tuchinda P, Chularojanamontri L, Maurer M. Food-dependent cold urticaria: A new variant of physical urticaria. The Journal of Allergy and Clinical Immunology: In Practice 2018; 6:1400-1402. [DOI: 10.1016/j.jaip.2018.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/02/2018] [Accepted: 04/17/2018] [Indexed: 11/30/2022]
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Huston DP, Sabato V. Decoding the Enigma of Urticaria and Angioedema. The Journal of Allergy and Clinical Immunology: In Practice 2018; 6:1171-1175. [DOI: 10.1016/j.jaip.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 01/09/2023]
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Worm M, Francuzik W, Renaudin J, Bilo MB, Cardona V, Scherer Hofmeier K, Köhli A, Bauer A, Christoff G, Cichocka‐Jarosz E, Hawranek T, Hourihane JO, Lange L, Mahler V, Muraro A, Papadopoulos NG, Pföhler C, Poziomkowska‐Gęsicka I, Ruëff F, Spindler T, Treudler R, Fernandez‐Rivas M, Dölle S. Factors increasing the risk for a severe reaction in anaphylaxis: An analysis of data from The European Anaphylaxis Registry. Allergy 2018; 73:1322-1330. [PMID: 29318637 DOI: 10.1111/all.13380] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preventive measures to decrease the frequency and intensity of anaphylactic events are essential to provide optimal care for allergic patients. Aggravating factors may trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided. OBJECTIVE To identify and prioritize factors associated with an increased risk of developing severe anaphylaxis. METHODS Data from the Anaphylaxis Registry (122 centers in 11 European countries) were used in logistic regression models considering existing severity grading systems, elicitors, and symptoms to identify the relative risk of factors on the severity of anaphylaxis. RESULTS We identified higher age and concomitant mastocytosis (OR: 3.1, CI: 2.6-3.7) as the most important predictors for an increased risk of severe anaphylaxis. Vigorous physical exercise (OR: 1.5, CI: 1.3-1.7), male sex (OR: 1.2, CI: 1.1-1.3), and psychological burden (OR: 1.4, CI: 1.2-1.6) were more often associated with severe reactions. Additionally, intake of beta-blockers (OR: 1.9, CI: 1.5-2.2) and ACE-I (OR: 1.28, CI: 1.05, 1.51) in temporal proximity to allergen exposition was identified as an important factor in logistic regression analysis. CONCLUSION Our data suggest it may be possible to identify patients who require intensified preventive measures due to their relatively higher risk for severe anaphylaxis by considering endogenous and exogenous factors.
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Affiliation(s)
- M. Worm
- Department of Dermatology and Allergology Charite‐Universitätsmedizin Berlin Berlin Germany
| | - W. Francuzik
- Department of Dermatology and Allergology Charite‐Universitätsmedizin Berlin Berlin Germany
| | - J.‐M. Renaudin
- Allergy Vigilance Network University Hospital Nancy Nancy France
| | - M. B. Bilo
- Department of Internal Medicine/Allergy Unit University Hospital Ospedali Riuniti Ancona Italy
| | - V. Cardona
- Allergy Section, Department of Internal Medicine Hospital Universitari Vall d'Hebron Barcelona Spain
| | | | - A. Köhli
- Division of Allergology University Children's Hospital Zurich Switzerland
| | - A. Bauer
- Department of Dermatology University Allergy Center University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - G. Christoff
- Faculty of Public Health Medical University‐Sofia Sofia Bulgaria
- Tokuda Medical Centre Allergy Out‐patient Clinic Sofia Bulgaria
| | - E. Cichocka‐Jarosz
- Department of Pediatrics Jagiellonian University Medical College Krakow Poland
| | - T. Hawranek
- Department of Dermatology Paracelsus Private Medical University Salzburg Salzburg Austria
| | | | - L. Lange
- Department of Pediatrics St. Marien‐Hospital Bonn Germany
| | - V. Mahler
- Department of Dermatology University Hospital of Erlangen Friedrich‐Alexander‐University Erlangen Erlangen Germany
| | - A. Muraro
- Department of Mother and Child Health Padua General University Hospital Padua Italy
| | | | - C. Pföhler
- Department of Dermatology Saarland University Hospital Homburg/Saar Germany
| | | | - F. Ruëff
- Department of Dermatology and Allergology Klinikum der Universität München München Germany
| | - T. Spindler
- Department of Pediatric Pneumology and Allergology Lung Centre South‐West Wangen Germany
| | - R. Treudler
- Department of Dermatology, Venerology and Allergology LICA‐Comprehensive Allergy Center Universität Leipzig Leipzig Germany
| | | | - S. Dölle
- Department of Dermatology and Allergology Charite‐Universitätsmedizin Berlin Berlin Germany
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Feldweg AM. Food-Dependent, Exercise-Induced Anaphylaxis: Diagnosis and Management in the Outpatient Setting. J Allergy Clin Immunol Pract 2017; 5:283-8. [PMID: 28283153 DOI: 10.1016/j.jaip.2016.11.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/13/2016] [Accepted: 11/23/2016] [Indexed: 11/20/2022]
Abstract
Food-dependent, exercise-induced anaphylaxis is a disorder in which anaphylaxis develops most predictably during exercise, when exercise takes place within a few hours of ingesting a specific food. IgE to that food should be demonstrable. It is the combination of the food and exercise that precipitates attacks, whereas the food and exercise are each tolerated independently. Recently, it was demonstrated that exercise is not essential for the development of symptoms, and that if enough of the culprit food is ingested, often with additional augmentation factors, such as alcohol or acetylsalicylic acid, symptoms can be induced at rest in the challenge setting. Thus, food-dependent, exercise-induced anaphylaxis appears to be more correctly characterized as a food allergy syndrome in which symptoms develop only in the presence of various augmentation factors, with exercise being the primary one. However, additional factors are not usually present when the patient exercises normally, so ongoing investigation is needed into the physiologic and cellular changes that occur during exercise to facilitate food-induced anaphylaxis.
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23
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Namiki H. Exercise-induced anaphylaxis in an elderly patient. BMJ Case Rep 2017; 2017:bcr-2017-222297. [DOI: 10.1136/bcr-2017-222297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Reported is a case of a 39-year-old male who was diagnosed with exercise-induced anaphylaxis (EIA). He was initially treated prophylactically with fexofenadine, montelukast, and ranitidine. He also used an epinephrine autoinjector as needed. He was refractory to these medications and continued to have episodes of EIA. He was then started on a trial of omalizumab, an immunoglobulin E monoclonal antibody, and had resolution of the EIA episodes. After discontinuation of the omalizumab, the EIA episodes returned. He was restarted on omalizumab and since that time, has had 5 years free of EIA episodes and can now exercise without any symptoms. To our knowledge, this is only the third case in the literature of successful treatment of EIA by using omalizumab. This case was unique because it provided successful long-term use of omalizumab for EIA. Further studies are recommended for the use of omalizumab in the treatment of EIA.
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Affiliation(s)
- Mark R Peterson
- From the Department of Allergy and Immunology, Wilford Hall Abulatory Surgical Center, Lackland AFB, San Antonio, Texas
| | - Christopher A Coop
- From the Department of Allergy and Immunology, Wilford Hall Abulatory Surgical Center, Lackland AFB, San Antonio, Texas
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25
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Worm M, Scherer K, Köhli-Wiesner A, Ruëff F, Mahler V, Lange L, Treudler R, Rietschel E, Szepfalusi Z, Lang R, Rabe U, Reese T, Schwerk N, Beyer K, Hompes S, Bircher A, Przybilla B, Hawranek T, Hansen G, Friedrichs F, Merk H, Tenbrock K, Lehmann S, Gerstlauer M, Kleine-Tebbe J, Niggemann B, Dickel H, Bücheler M, Bieber T, Hanfland J, Schmitt-Grohe S, Vlajnic D, Heckmann V, Nemat K, Schäkel K, Nordwig A, Schuster A, Schweitzer-Krantz S, Hillen U, Kopp M, Szliska C, Klinge J, Neustädter I, Fuchs T, Bruns R, Marsch C, Kreft B, Coors E, Rebien W, Wedi B, Pföhler C, Rett M, Henzgen M, Vöhringer P, Fölster-Holst R, Hunzelmann N, Siebenhaar G, Nestoris S, Schirpke C, Grabbe J, Stichtenoth G, Ring J, Brockow K, Brehler R, Yildiz I, Volkmuth S, Geißler M, Polz M, Riffelmann F, Thies S, Lepp U, Rabe U, Rebmann H, Spindler T, Klimek L, Pfaar O, Brosi W, Aberer W, Varga E, Reider N, Huttegger I, Kinaciyan T, Hoffmann-Sommergruber K, Eng P, Helbling A, Eigenmann P, Guggenheim R, Schmid-Grendelmeier P. Food-induced anaphylaxis and cofactors - data from the anaphylaxis registry. Allergol Select 2017; 1:21-7. [PMID: 30402598 DOI: 10.5414/ALX01401E] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 01/04/2011] [Indexed: 11/18/2022] Open
Abstract
Food allergens are frequent causes of anaphylaxis. In particular in children and adolescents they are the most frequent elicitors of severe allergic reactions, and in adults food allergens rank third behind insect venom and drugs. Since July 2006 severe allergic reactions from Germany, Austria, and Switzerland are collected in the anaphylaxis registry. Currently 78 hospitals and private practises are connected. From July 2006 until February 2009 1,156 severe allergic reactions were registered. Among children and adolescents (n = 187, age range from 3 months to 17 years) food allergens were the most frequent triggers, comprising 58% of cases. In the adult group (n = 968, 18 – 85 years) food allergens were in the third position (16.3%) behind insect venom and drugs. In children legumes (31%) and in particular peanuts were frequently responsible food allergens, followed by tree nuts (25%) with hazelnut being the most frequent elicitor. In adults fruits (13.4%) most often induced severe food-dependent anaphylaxis, but also animal products (12.2%); among these most frequently crustaceans and molluscs. Cofactors were often suspected in food-dependent anaphylaxis, namely in 39% of the adult group and in 14% of the pediatric group. In adults drugs (22%) and physical activity (10%) were reported to be the most frequent cofactors, in children physical activity was suspected in 8.7% and drugs in 2.6%. Concomitant diseases like atopic dermatitis, allergic asthma, or allergic rhinoconjunctivitis were reported in 78% of children and adolescents and in 67% of the adults. In conclusion, food-induced anaphylaxis, its cofactors and concomitant diseases are age-dependent. The data offers to identify risk factors of anaphylaxis.
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da Silva DMGSP, Vieira TMS, Pereira AMA, de Sousa Moreira AMA, Delgado JLD. Cross-reactive LTP sensitization in food-dependent exercise-induced urticaria/anaphylaxis: a pilot study of a component-resolved and in vitro depletion approach. Clin Transl Allergy 2016; 6:46. [PMID: 28031785 PMCID: PMC5180400 DOI: 10.1186/s13601-016-0136-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 11/29/2016] [Indexed: 01/06/2023] Open
Abstract
Background Challenge tests for food-dependent exercise-induced anaphylaxis (FDEIA) carry some risk and have a high rate of false negatives. Our aim was to explore the usefulness of an in vitro immunodepletion assay and an allergen microarray test in the identification of IgE-mediated cross-reactive food allergens in patients with suspected FDEIA or food-dependent exercise-induced urticaria and panallergen sensitization. Methods Three patients with a history of food dependent exercise induced urticaria/anaphylaxis and food panallergen sensitization in whom a food-exercise challenge was not feasible were selected: a 25-year-old man with cholinergic urticaria who experienced generalized urticaria and angioedema during a soccer match after drinking a peach-based soft drink; a 19-year-old woman with allergic rhinitis and controlled asthma who experienced anaphylactic shock while playing soccer, having eaten walnuts in the previous 90 min; and a 57-year-old man with baker’s asthma who experienced four episodes of anaphylaxis during exercise after ingesting wheat-containing food. All individuals underwent a diagnostic work-up with skin prick tests, specific IgE (sIgE) and ImmunoCAP ISAC test. For the in vitro immunodepletion procedure, patients’ serum was pre-incubated with the suspected native allergen (peach, walnut, or wheat) in solid phase (ImmunoCAP). The eluted serum, containing unbound IgE, was collected and samples were re-tested using Immunocap ISAC 112 and compared with baseline results. Results All individuals were sensitized to lipid transfer proteins. The first patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; after pre-incubation with peach there was 100% depletion of sIgE to all components. The second patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; immunodepletion with walnut depleted sIgE to Ara h 9 by 67%, Pru p 3 and Pla a 3 (60%), Art v 3 (75%), Jug r 3 (88%), and Cor a 8 (100%). The third patient was sensitized to Pru p 3, Jug r 3, Ara h 9, and Tri a 14; immunodepletion with wheat depleted Tri a 14 only (100%). Conclusions In vitro immunodepletion might be a useful diagnostic tool in food dependent exercise induced urticaria/anaphylaxis with panallergen sensitization, particularly for identifying the culprit allergen and guiding dietary elimination recommendations.
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Affiliation(s)
| | | | - Ana Maria Alves Pereira
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, Porto University, Porto, Portugal ; Department of Clinical Pathology, Centro Hospitalar São João, Porto, Portugal
| | - André Miguel Afonso de Sousa Moreira
- Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal ; Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, Porto University, Porto, Portugal ; ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
| | - José Luís Dias Delgado
- Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal ; Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, Porto University, Porto, Portugal ; Unidade de Imunoalergologia, Unidade Local de Saúde do Alto Minho, Viana Do Castelo, Portugal ; Department of Clinical Pathology, Centro Hospitalar São João, Porto, Portugal ; CINTESIS and Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto, Porto, Portugal
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Abstract
Exercise-induced anaphylaxis (EIAn) is defined as the occurrence of anaphylactic symptoms (skin, respiratory, gastrointestinal, and cardiovascular symptoms) after physical activity. In about a third of cases, cofactors, such as food intake, temperature (warm or cold), and drugs (especially nonsteroidal anti-inflammatory drugs) can be identified. When the associated cofactor is food ingestion, the correct diagnosis is food-dependent EIAn (FDEIAn). The literature describes numerous reports of FDEIAn after intake of very different foods, from vegetables and nuts to meats and seafood. One of the best-characterized types of FDEIAn is that due to ω5-gliadin of wheat, though cases of FDEIAn after wheat ingestion by sensitization to wheat lipid transfer protien (LTP) are described. Some pathophysiological mechanisms underlying EIAn have been hypothesized, such as increase/alteration in gastrointestinal permeability, alteration of tissue transglutaminase promoting IgE cross-linking, enhanced expression of cytokines, redistribution of blood during physical exercise leading to altered mast-cell degranulation, and also changes in the acid–base balance. Nevertheless, until now, none of these hypotheses has been validated. The diagnosis of EIAn and FDEIAn is achieved by means of a challenge, with physical exercise alone for EIAn, and with the assumption of the suspected food followed by physical exercise for FDEIAn; in cases of doubtful results, a double-blind placebo-controlled combined food–exercise challenge should be performed. The prevention of this particular kind of anaphylaxis is the avoidance of the specific trigger, ie, physical exercise for EIAn, the assumption of the culprit food before exercise for FDEIAn, and in general the avoidance of the recognized cofactors. Patients must be supplied with an epinephrine autoinjector, as epinephrine has been clearly recognized as the first-line intervention for anaphylaxis.
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Affiliation(s)
- Valerio Pravettoni
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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28
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Lieberman P, Nicklas RA, Randolph C, Oppenheimer J, Bernstein D, Bernstein J, Ellis A, Golden DBK, Greenberger P, Kemp S, Khan D, Ledford D, Lieberman J, Metcalfe D, Nowak-Wegrzyn A, Sicherer S, Wallace D, Blessing-Moore J, Lang D, Portnoy JM, Schuller D, Spector S, Tilles SA. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol 2016; 115:341-84. [PMID: 26505932 DOI: 10.1016/j.anai.2015.07.019] [Citation(s) in RCA: 288] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/12/2015] [Indexed: 12/12/2022]
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Chung SJ, Shim J, Kim HJ, Sohn KH, Kang SY, Kang MG, Park HK, Kang HR. Analysis of clinical characteristics of food-dependent exercise-induced anaphylaxis at a single tertiary hospital. Allergy Asthma Respir Dis 2016. [DOI: 10.4168/aard.2016.4.6.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Soo Jie Chung
- Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jisu Shim
- Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Jun Kim
- Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Hee Sohn
- Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Gyu Kang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Han-Ki Park
- Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Food allergies are increasing in prevalence. In order for pediatric clinicians to appropriately diagnose and manage food allergies, the characteristic signs and symptoms of these potentially severe reactions must be recognized. Unlike nonimmunologic adverse food reactions (such as lactose intolerance and food poisoning), food allergies by definition are immune-mediated responses that occur reproducibly on food ingestion. The varying clinical presentations of food allergy include IgE-mediated disorders, mixed IgE- and cell-mediated disorders, and cell-mediated food allergies. This review describes the clinical manifestations of each of these categories of food allergy, with special emphasis on recognition of food-induced anaphylaxis.
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Affiliation(s)
- Hemant P Sharma
- Division of Allergy and Immunology, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Shweta Bansil
- Division of Allergy and Immunology, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Burcin Uygungil
- Division of Allergy and Immunology, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Macchia D, Melioli G, Pravettoni V, Nucera E, Piantanida M, Caminati M, Campochiaro C, Yacoub MR, Schiavino D, Paganelli R, Di Gioacchino M; Food Allergy Study Group (ATI) of the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Guidelines for the use and interpretation of diagnostic methods in adult food allergy. Clin Mol Allergy 2015; 13:27. [PMID: 26441488 DOI: 10.1186/s12948-015-0033-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/15/2015] [Indexed: 12/27/2022] Open
Abstract
Food allergy has an increasing prevalence in the general population and in Italy concerns 8 % of people with allergies. The spectrum of its clinical manifestations ranges from mild symptoms up to potentially fatal anaphylactic shock. A number of patients can be diagnosed easily by the use of first- and second-level procedures (history, skin tests and allergen specific IgE). Patients with complex presentation, such as multiple sensitizations and pollen-food syndromes, frequently require a third-level approach including molecular diagnostics, which enables the design of a component-resolved sensitization profile for each patient. The use of such techniques involves specialists' and experts' skills on the issue to appropriately meet the diagnostic and therapeutic needs of patients. Particularly, educational programs for allergists on the use and interpretation of molecular diagnostics are needed.
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32
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de Silva NR, Dasanayake WMDK, Karunatilleke C, Malavige GN. Food dependant exercise induced anaphylaxis a retrospective study from 2 allergy clinics in Colombo, Sri Lanka. Allergy Asthma Clin Immunol 2015. [PMID: 26213534 PMCID: PMC4513746 DOI: 10.1186/s13223-015-0089-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The aetiology of anaphylaxis ranges from food, insect venom, drugs and various chemicals. Some individuals do not develop anaphylaxis with the offending agent unless ingestion is related temporally to physical exertion, namely food dependent exercise induced anaphylaxis (FDEIA). The foods implicated are wheat, soya, peanut, milk and sea food. A retrospective study on patients with FDEIA from two Allergy clinics in Sri Lanka from 2011 to 2015 is reported. Patients were selected who fulfilled the following criteria: clinical diagnosis of anaphylaxis according to the World Allergy Organization (WAO) criteria, where the onset of symptoms was during exertion, within 4 h of ingesting a food, the ability to eat the implicated food independent of exercise, or exercise safely, if the food was not ingested in the preceding 4 h and an in vitro (ImmunoCap serum IgE to the food) or in vivo (skin prick test) test indicating evidence of sensitivity to the food. There were 19 patients (12 males: 7 females). The ages ranged from 9 to 45 (mean 22.9, median 19 years). Eight patients (42.1%) were in the 9-16 age group. Those below 16 years had a male:female ratio of 3:5, while for those above 16 years it was 9:2. Wheat was the only food implicated in FDEIA in all patients and was confirmed by skin prick testing, or by ImmunoCap specific IgE to wheat or ω - 5 gliadin. All patients had urticaria, while 5/19 (26.3%) had angioedema of the lips. Fifteen patients (78.9%) had shortness of breath or wheezing, while 8 (42.1%) had lost consciousness. Nine patients (47. 3%) had hypotension. Fourteen (73.6%) of our patients had severe reactions, with loss of consciousness or hypotension, while 5 (26.3%) had symptoms related to the gastrointestinal tract. One patient developed anaphylaxis on two occasions following inhalation of ganja, a local cannabis derivative along with the ingestion of wheat and exertion. Wheat is the main food implicated in FDEIA in Sri Lanka. A local cannabis derivative, ganja has been implicated as a cofactor for the first time.
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Affiliation(s)
| | | | | | - Gathsauri Neelika Malavige
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenapura, Nugegoda, Sri Lanka
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33
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Carsin A, Agabriel-parent C, Boudard IC, Dubus J. Démarche diagnostique en allergie alimentaire. Arch Pediatr 2015; 22:122-123. [DOI: 10.1016/s0929-693x(15)30060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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34
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35
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Rance K, Goldberg P. Anaphylaxis Overview: Addressing Unmet Patient Needs. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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36
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Skypala IJ, Venter C, Meyer R, deJong NW, Fox AT, Groetch M, Oude Elberink JN, Sprikkelman A, Diamandi L, Vlieg-Boerstra BJ. The development of a standardised diet history tool to support the diagnosis of food allergy. Clin Transl Allergy 2015; 5:7. [PMID: 25741437 PMCID: PMC4349299 DOI: 10.1186/s13601-015-0050-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/30/2015] [Indexed: 01/26/2023] Open
Abstract
The disparity between reported and diagnosed food allergy makes robust diagnosis imperative. The allergy-focussed history is an important starting point, but published literature on its efficacy is sparse. Using a structured approach to connect symptoms, suspected foods and dietary intake, a multi-disciplinary task force of the European Academy of Allergy and Clinical Immunology developed paediatric and adult diet history tools. Both tools are divided into stages using traffic light labelling (red, amber and green). The red stage requires the practitioner to gather relevant information on symptoms, atopic history, food triggers, foods eaten and nutritional issues. The amber stage facilitates interpretation of the responses to the red-stage questions, thus enabling the practitioner to prepare to move forward. The final green stage provides a summary template and test algorithm to support continuation down the diagnostic pathway. These tools will provide a standardised, practical approach to support food allergy diagnosis, ensuring that all relevant information is captured and interpreted in a robust manner. Future work is required to validate their use in diverse age groups, disease entities and in different countries, in order to account for differences in health care systems, food availability and dietary norms.
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Affiliation(s)
| | - Carina Venter
- The David Hide 6. Asthma and Allergy Research Centre, Isle of Wight, UK
| | - Rosan Meyer
- Great Ormond Street NHS Foundation Trust, London, UK
| | | | - Adam T Fox
- Guy's and St Thomas' Hospitals NHS Foundation Trust and Kings College, London, UK
| | - Marion Groetch
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - J N Oude Elberink
- Department of Allergology, University Medical Centre of Groningen, University of Groningen, Groningen, NL Netherlands
| | - Aline Sprikkelman
- Emma Children's Hospital Academic Medical Centre, Amsterdam, NL Netherlands
| | | | - Berber J Vlieg-Boerstra
- Emma Children's Hospital, Paediatric Respiratory Medicine and Allergy, Academic Medical Centre, University of Amsterdam, Amsterdam, NL Netherlands
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37
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Abstract
Anaphylaxis is an unanticipated, acute, and sometimes life-threatening systemic reaction with variable clinical presentations that is typically mediated by immunoglobulin E and causes degranulation of mast cells and basophils. The onset of symptoms can occur within minutes or hours after exposure to a known or suspected trigger, and reactions sometimes progress very rapidly, which can lead to death. One trigger of anaphylaxis in younger adults is moderately intense physical exercise, which has been termed exercise-induced anaphylaxis (EIA). Although rare, EIA should be recognized as a distinct and potentially life-threatening form of physical allergy, and is often undetected or inadequately treated. The ingestion of specific foods, including seafood, tree nuts, and wheat, or a nonspecific meal consisting of multiple food components shortly before or after physical exertion, is sometimes, but not always, the principal precipitant of EIA. This article briefly explores the current hypotheses on the role of immunoglobulin E, response mediators, and physiologic changes that bring on EIA, and discusses the current recommendations for diagnosis, including allergen challenge and laboratory testing, emergency care, and long-term prevention and patient follow-up. Accurate diagnosis of EIA is critical to providing lifesaving therapy and care plans to patients at risk. With respect to the medical management of EIA, mainstay therapy with epinephrine is described. For those with a known history of EIA, a comprehensive anaphylaxis action plan is central to successful patient management. Furthermore, patient education is necessary to heighten awareness of the signs and symptoms of EIA and appropriate strategies for allergen avoidance and self-management of anaphylactic episodes with self-injectable epinephrine.
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Affiliation(s)
- John R Bennett
- Internal Medicine/Hospitalist, Effingham Health System , Springfield, GA , USA
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Kim DH, Park KH, Kim YJ, Kim JH, Han HJ, Park HJ, Park JW, Lee JH. Apple-dependent exercise-induced anaphylaxis. Allergy Asthma Respir Dis 2015. [DOI: 10.4168/aard.2015.3.3.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Dong Hyun Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Young Joo Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Ho Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jae Han
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jung Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
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39
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Lee E, Kim MJ, Yang SI, Yu J, Hong SJ. Food-dependent exercise-induced anaphylaxis in Korean children: a single-center retrospective case study. Allergy Asthma Respir Dis 2015. [DOI: 10.4168/aard.2015.3.3.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Eun Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Ju Kim
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song-I Yang
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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40
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Turnbull JL, Adams HN, Gorard DA. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther 2015; 41:3-25. [PMID: 25316115 DOI: 10.1111/apt.12984] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 05/23/2014] [Accepted: 09/16/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adverse reactions to food include immune mediated food allergies and non-immune mediated food intolerances. Food allergies and intolerances are often confused by health professionals, patients and the public. AIM To critically review the data relating to diagnosis and management of food allergy and food intolerance in adults and children. METHODS MEDLINE, EMBASE and the Cochrane Database were searched up until May 2014, using search terms related to food allergy and intolerance. RESULTS An estimated one-fifth of the population believe that they have adverse reactions to food. Estimates of true IgE-mediated food allergy vary, but in some countries it may be as prevalent as 4-7% of preschool children. The most common food allergens are cow's milk, egg, peanut, tree nuts, soy, shellfish and finned fish. Reactions vary from urticaria to anaphylaxis and death. Tolerance for many foods including milk and egg develops with age, but is far less likely with peanut allergy. Estimates of IgE-mediated food allergy in adults are closer to 1-2%. Non-IgE-mediated food allergies such as Food Protein-Induced Enterocolitis Syndrome are rarer and predominantly recognised in childhood. Eosinophilic gastrointestinal disorders including eosinophilic oesophagitis are mixed IgE- and non-IgE-mediated food allergic conditions, and are improved by dietary exclusions. By contrast food intolerances are nonspecific, and the resultant symptoms resemble other common medically unexplained complaints, often overlapping with symptoms found in functional disorders such as irritable bowel syndrome. Improved dietary treatments for the irritable bowel syndrome have recently been described. CONCLUSIONS Food allergies are more common in children, can be life-threatening and are distinct from food intolerances. Food intolerances may pose little risk but since functional disorders are so prevalent, greater efforts to understand adverse effects of foods in functional disorders are warranted.
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Affiliation(s)
- J L Turnbull
- Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford, UK
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41
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Abstract
Exercise-induced anaphylaxis (EIA) and its subtype food-dependent (FD)-EIA are uncommon and easily missed forms of physical allergy. The latter is triggered by exercise following the ingestion of specific food products. Treatment is identical to that for IgE-mediated allergic reactions. The disease is potentially fatal. In this case, 30-year-old woman was seen in the allergy clinic at the request of her general practitioner. She reported an episode when she had gone to a local park to exercise after dinner. 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 uneventful recovery. On the basis of the clinical story and specific allergy markers, her presentation was attributed to FD-EIA.
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42
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Christensen MJ, Eller E, Mortz CG, Bindslev-Jensen C. Patterns of suspected wheat-related allergy: a retrospective single-centre case note review in 156 patients. Clin Transl Allergy 2014; 4:39. [PMID: 25905008 PMCID: PMC4405838 DOI: 10.1186/2045-7022-4-39] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/06/2014] [Indexed: 12/25/2022] Open
Abstract
Background Allergy to wheat can present clinically in different forms: Sensitization to ingested wheat via the gastrointestinal tract can cause traditional food allergy or in combination with exercise, Wheat-Dependent Exercise-Induced Anaphylaxis (WDEIA). Sensitization to inhaled wheat flour may lead to occupational rhinitis and/or asthma. Methods We retrospectively reviewed the case notes of 156 patients (age 0.7 – 73.3 years) with a case history of wheat allergy. The population was divided into three groups, 1: Wheat allergy elicited by ingestion, 2: By inhalation and 3: WDEIA. All patients were examined with detailed case history, specific IgE (sIgE), Skin Prick Test (SPT) and wheat challenge (nasal or oral ± exercise). Details of the case history were extracted from the patients´ case records. Results Group 1: Twenty one of 95 patients were challenge positive (15 children, 6 adults). All children had atopic dermatitis, and most (13/15) outgrew their wheat allergy. Most children (13/15) had other food allergies. Challenge positive patients showed significantly higher levels of sIgE to wheat and significantly more were SPT positive than challenge negative. Group 2: Eleven out of 13 adults with occupational asthma or rhinitis were challenge positive. None outgrew their allergy. Seven had positive sIgE and 10 had positive SPT to wheat. Group 3: Ten of 48 (adolescent/adults) were positive when challenged during exercise. Challenge positive patients showed significantly higher levels of sIgE to ω-5-gliadin. The natural course is presently unknown. Conclusion Wheat allergy can manifest in different disease entities, rendering a detailed case history and challenge mandatory. Patient age, occupation, concomitant allergies (food or inhalant) and atopic dermatitis are important factors for evaluation.
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Affiliation(s)
- Morten J Christensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark
| | - Esben Eller
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark
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43
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Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016-25.e43. [PMID: 25174862 DOI: 10.1016/j.jaci.2014.05.013] [Citation(s) in RCA: 508] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update-2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
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44
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Staikuniene J, Staneviciute J, Adamonis K, Serapinas D. Wheat-dependent exercise-induced anaphylaxis following laparoscopic adjustable gastric banding procedure associated with Helicobacter pylori infection. Eat Weight Disord 2014; 19:267-70. [PMID: 24385412 DOI: 10.1007/s40519-013-0093-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022] Open
Abstract
Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a special form of adult food allergy when allergic symptoms are elicited when triggering factor such as exercise is added after ingestion of wheat. Besides the molecular characteristics of wheat proteins, the gastric function is decisive for the allergenic potential. Alterations in the gastric milieu are frequently experienced during a lifetime either physiologically or as a result of gastrointestinal pathologies. Helicobacter pylori infection can lead to hypoacidity and enhance the sensitization risk for food allergens in adults. Gastric transit of food proteins and alterations in the gastric secretion can be disturbed after bariatric surgery such as the laparoscopic adjustable gastric binding (LAGB) procedure used commonly as therapy for morbid obesity. We report a case of WDEIA in a 42-year-old man with H. pylori positive gastritis, 2 years after bariatric surgery and no history of allergy previously. Our presented case strongly suggests that H. pylori-associated gastritis and gastric anatomy and functional changes after adjustable gastric banding lead to the alterations in gastric milieu and may contribute to a development of food allergy in previously non-sensitized patients.
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45
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Tanaka M, Nagano T, Yano H, Matsuda T, Ikeda TM, Haruma K, Kato Y. Impact of ω-5 Gliadin on Wheat-Dependent Exercise-Induced Anaphylaxis in Mice. Biosci Biotechnol Biochem 2014; 75:313-7. [DOI: 10.1271/bbb.100695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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46
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Medveczky T. A dangerous exercise lessons from food-dependent anaphylaxis for the physician. Am J Emerg Med 2014; 32:1296.e5-7. [PMID: 24816061 DOI: 10.1016/j.ajem.2014.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/17/2014] [Indexed: 11/30/2022] Open
Abstract
Exercise-induced anaphylaxis (EIA) and its subtype, food dependent exercise-induced anaphylaxis are uncommon and therefore underdiagnosed forms of physical allergy. Triggers include various degrees of exercise in combination with ingestion of specific food products. Treatment remains identical to that of IgE-mediated allergic reactions. The presentation is commonly underdiagnosed and caries significant fatality risk, and this case should raise the awareness of the attending physician.
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Affiliation(s)
- Thomas Medveczky
- Guy's Hospital Chest and Allergy Clinic, Guy's and St Thomas' Hospital, London, UK.
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47
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Abstract
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.
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48
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Abstract
Food-dependent exercise-induced anaphylaxis (FDEIA) is a disorder where exercise following allergen ingestion triggers anaphylaxis although exercise and allergen exposure are independently tolerated. The diagnosis of FDEIA is based on a characteristic clinical history. The culprit allergen is usually confirmed through the use of skin prick testing (SPT) serum-specific IgE levels and a food-exercise challenge. We present a case of FDEIA suggested by clinical history and open food-exercise challenge with negative specific IgE levels and SPT that highlights the challenges involved in diagnosing and managing this rare disorder.
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Affiliation(s)
- Jacob Kleiman
- Department of Medicine, McGill University, Montreal, Canada
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49
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Abstract
Food allergy is a serious health issue affecting roughly 4% of children, with a substantial effect on quality of life. Prognosis is good for the most frequent allergens with almost all children outgrowing their allergy. However, the long-term implications for disease burden are substantial for children with persistent allergies (eg, peanuts, tree nuts, fish, and shellfish) and for those with high concentrations of milk, egg, and wheat IgE. Antigen avoidance has been the time-honoured approach both for prevention and treatment. However, findings from studies done in the past 5 years show that early contact with food can induce tolerance and desensitisation to foods. We review the epidemiology, natural history, and management of food allergy, and discuss the areas of controversy and future directions in research and clinical practice.
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Affiliation(s)
- Giorgio Longo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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50
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Kim CW, Figueroa A, Park CH, Kwak YS, Kim KB, Seo DY, Lee HR. Combined effects of food and exercise on anaphylaxis. Nutr Res Pract 2013; 7:347-51. [PMID: 24133612 PMCID: PMC3796658 DOI: 10.4162/nrp.2013.7.5.347] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 07/05/2013] [Accepted: 07/26/2013] [Indexed: 12/05/2022] Open
Abstract
Food-dependent exercise-induced anaphylaxis (FDEIAn) is induced by different types and various intensities of physical activity, and is distinct from food allergies. It has been shown that consumption of allergenic food followed by exercise causes FDEIAn symptoms. Intake of allergenic food or medication before exercise is a major predisposing factor for FDEIAn. Urticaria and severe allergic reactions are general symptoms of FDEIAn. Dermatological tests and serum IgE assays are the typical prescreening methods, and have been used for several decades. However, these screening tests are not sufficient for detecting or preventing FDEIAn. It has been found that exercise may stimulate the release of mediators from IgE-dependent mast cells that can result in FDEIAn when a certain threshold level has been exceeded. Mast cell degradation might be a major factor to induce FDEIAn but this has not been determined. A number of foods have been reported to be involved in the onset of FDEIAn including wheat, eggs, chicken, shrimp, shellfish, nuts, fruits, and vegetables. It is also known that aspirin increases the occurrence of type I allergy symptoms when combined with specific foods. Moreover, high intensity and frequent exercise are more likely to provoke an attack than low intensity and less frequent exercise. In this paper, we present the current views of the pathophysiological mechanisms underlying FDEIAn within the context of exercise immunology. We also present a detailed FDEIAn definition along with etiologic factors and medical treatment for cholinergic urticaria (UC) and exercise-induced anaphylaxis (EIA).
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Affiliation(s)
- Cheol Woo Kim
- Division of Police and Security Administration, Dong-Eui Institute of Technology, Busan 614-715, Korea
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