Aspirin enhances the induction of type I allergic symptoms when combined with food and exercise in patients with food-dependent exercise-induced anaphylaxis.

Abstract

We examined the effect of aspirin as a substitute for exercise in inducing urticaria/anaphylaxis in three patients with food-dependent exercise-induced anaphylaxis (FDEIA). Two of the patients had specific IgE antibodies to wheat and the other had antibodies to shrimp. Administration of aspirin before ingestion of food allergens induced urticaria in one patient and urticaria and hypotension in another, while aspirin alone or food alone elicited no response. The third patient developed urticaria only when he took all three items, i.e. aspirin, food and additional exercise, whereas provocation with any one or or two of these did not induce any symptoms. These findings suggest that aspirin upregulates type I allergic responses to food in patients with FDEIA, and further shows that aspirin synergizes with exercise to provoke symptoms of FDEIA. This is the first report of a synergistic effect of aspirin in inducing urticaria/anaphylaxis, which was confirmed using challenge tests in patients with FDEIA.

Chronic Headaches and Sleepiness Caused by Facial Soap (Containing Hydrolyzed Wheat Proteins)-Induced Wheat Allergy

“…We speculated that the NSAID did not block the allergic reactions, but rather adversely affected the patient's allergic reactions. Aspirin itself, with or even without exercise, induces wheat-dependent anaphylaxis (18,19). Blocking the COX-1 pathway with NSAIDs precipitates histamine release from mast cells and basophils (20).…”

Facteurs de risque d’anaphylaxie alimentaire sévère

“…Ces derniers avaient été dénoncés dans le cadre des chocs anaphylactiques survenant au cours d'anesthésies, sans exclure la possibilité qu'ils soient aussi impliqués dans l'aggravation d'anaphylaxies alimentaires [17][18][19]. Le rôle de l'aspirine en prises orales dans l'anaphylaxie alimentaire avait été établi par l'étude des effets de l'allergène isolé ou associé à la prise d'aspirine [20,21]. Une étude cas-contrôle menée sur 76 cas de chocs anaphylactiques comparés à 235 cas d'allergies alimentaires d'intensité modérée à moyenne a pu non seulement confirmer ces connaissances mais, en outre, incriminer formellement les inhibiteurs de l'ECA (IEC) et les anti-inflammatoires non stéroïdiens (AINS) en chiffrant le risque relatif d'anaphylaxie induit par ces classes pharmacologiques [22] (Tableau I).…”

“…L'aspirine, prise de manière isolée, est bien tolérée par les patients, ce qui exclut son rôle direct [20,21]. Même les faibles doses utilisées en prévention d'accidents cardiovasculaires semblent présenter un risque [31].…”

“…On sait que l'exercice, associé à l'ingestion d'un allergène alimentaire, peut déclencher une anaphylaxie [20,21,35]. Parmi les causes, probablement multiples, l'induction d'une hyperperméabilité intestinale pour l'allergène a été démontrée chez l'animal comme chez l'homme [33,36].…”

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

“…The diagnosis of this disorder it is often missed, because neither the exercise nor the ingested food alone induces the symptoms. There are many reports supporting the fact that, aspirin intake is a contribution factor in some patients with FDEIA [2,8,9]. The risk to develop anaphylaxis in these patients depends not only on the presence, but in some cases, also on the amount of cofactors of anaphylaxis [5].…”