Exercise-induced anaphylaxis: A serious form of physical allergy associated with mast cell degranulation

Sheffer, Albert L.; Tong, Arthur K.F.; Murphy, Gëorge F.; Lewis, Robert A.; McFadden, E.R.; Austen, K. Frank

doi:10.1016/s0091-6749(85)80021-x

Cited by 114 publications

(44 citation statements)

References 13 publications

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“…In patients with FD-EIA, the time interval between ingesting food and the exercise and anaphylaxis reaction is 1-3 hours. 6 During the event, up to 60% of patients described angioedema with breathing diffi culties, whereas 30% had symptoms of cardiovascular collapse and abdominal cramps. 7 Interestingly, a patient survey and long-term follow-up study by Shadick et al 4 found that the frequency of attacks tends to stabilise or decrease with time.…”

Section: Discussionmentioning

confidence: 99%

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Lessons about food anaphylaxis

Medveczky

2014

Clinical Medicine

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A Lessons about food anaphylaxisExercise-induced anaphylaxis (EIA) and its subtype fooddependent (FD)-EIA are uncommon and easily missed forms of physical allergy. The latter is triggered by exercise following the ingestion of specifi c 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 diffi culties. Upon admission to hospital, she was found to be hypotensive and required fl uid resuscitation, systemic corticosteroids and adrenaline. She made a full and uneventful recovery. On the basis of the clinical story and specifi c allergy markers, her presentation was attributed to FD-EIA. KEYWORDS:Exercise-induced anaphylaxis, histamine, collapse, physical allergy, urticaria Case presentationA 30-year-old woman, who had previously been fi t and well and with no history of diseases of the atopic diathesis (eczema, allergic rhinitis, food allergy or asthma) was referred to the allergy clinic after an episode of collapse associated with breathing diffi culties shortly after dinner. She reported that on the day of the collapse, she invited friends for a meal. The dinner consisted of tapas, including dairy, pasta, prawns, and red wine. After the meal, she decided to go for a run in a nearby park. She left the house within 1.5 hours of eating and started to run gently. Within minutes, she felt unwell. She gave a description of developing a generalised pruritic rash followed shortly by lip swelling, which rapidly progressed to audible wheeze and breathing diffi culties. A friend accompanying her in the park reported that she became pale and complained of colicky abdominal pain. Thereafter, she collapsed without losing consciousness. An ambulance was called, and upon arrival of the paramedics, she was found to be signifi cantly cold, sweaty, and with low blood pressure, thus requiring rapid intravenous fl uid challenge. She was transferred to a local emergency department, where further resuscitation

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Section: Discussionmentioning

confidence: 99%

“…It is suspected that this increase in mast cell releasability, combined with the better absorption of relatively intact allergen from the gut, which results from exercise soon after eating is suffi cient to trigger systemic mast cell degranulation in some patients. 10,11 …”

Section: Discussionmentioning

confidence: 99%

Lessons about food anaphylaxis

Medveczky

2014

Clinical Medicine

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“…Several mechanisms by which exercise induces this reaction are postulated: 1) exercise enhances the degranulation of mast cells and increases the serum concentration of chemical mediators, such as histamine (24,25), and 2) exercise enhances the absorption of incompletely digested or undigested allergen proteins from the gastrointestinal tract (19). Although various foods, such as shellfish, hazelnuts, celery, and corn, are reported in association with FDEIA, wheat is the most frequent provoking food in Japan (12).…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction following Food-dependent Exercise-induced Anaphylaxis

et al. 2011

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A 70-year-old man with a history of food-dependent exercise-induced anaphylaxis (FDEIA) since age 50 was admitted to the emergency department with chest pain and urticaria caused by FDEIA. Coronary angiography revealed total occlusion of the proximal left anterior descending coronary artery. After thrombus aspiration, a bare metal stent was placed into the culprit lesion, resulting in no residual stenosis. Urticaria disappeared on the second hospital day. This is the first reported case, to our knowledge, in which acute myocardial infarction followed FDEIA. Physicians should be aware of acute myocardial infarction as a rare but potential complication of FDEIA.

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“…The four with symptoms showed a rise in blood histamine concentration, implicating MC activation (109), whereas the blood histamine concentration did not change in the subjects with EIA who did not respond to this challenge. In a repeat study, cutaneous biopsies of the patients with EIA with symptoms and signs showed classical MC degranulation that was absent in the nonresponders (110). In contrast to patients with cholinergic urticaria, who experienced punctate hives, elevations in blood histamine, and pulmonary symptoms with significantly altered pulmonary function with the exercise protocol (111), pulmonary mechanics were not altered in the challenged patients with EIA.…”

Section: The Mast Cellmentioning

confidence: 93%

Doing What I Like

Austen

2008

Annu. Rev. Immunol.

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I have spent my entire professional life at Harvard Medical School, beginning as a medical student. I have enjoyed each day of a diverse career in four medical subspecialties while following the same triad of preclinical areas of investigation-cysteinyl leukotrienes, mast cells, and complement-with occasional translational opportunities. I did not envision a career with a predominant preclinical component. Such a path simply evolved because I chose instinctively at multiple junctures to follow what proved to be propitious opportunities. My commentary notes some of the highlights for each area of interest and the mentors, collaborators, and trainees whose counsel has been immensely important at particular intervals or over an extended period. EARLY CAREER DETERMINANTSIn 1946, after I graduated from high school, I was hospitalized with paralytic poliomyelitis. Although I was spared respiratory involvement, I experienced a loss and gradual recovery of strength in my extremities. I vividly recall the lumbar puncture on admission, the hospital-based management of the muscular discomfort with "hot packs," and exercising with my mother's cooking weights after discharge. Gerald Austen, a senior at MIT majoring in mechanical engineering, for the next entering class would negatively affect my academic performance. Gerry and I shared a dormitory room for the next three years and pooled our advance yearly tuition to purchase a car in the fall, which we sold in a timely manner in the spring. Our competitive natures maximized our individual performances. The second event was a rather complex episode in which I and some old friends from Amherst College acquired a sheep from the Biophysics Department late one evening, which we then slipped into the dormitory and introduced during intermission at the annual first-year dance. At 3:00 am, a security officer knocked on my door with an offer to forget what had occurred if I would quietly collect and return the sheep to its campus location. The third and most important remembrance relates to my exposure to Cliff Barger of the Physiology Department. He involved students in meaningful laboratory experimentation that required both technical skill and the ability to understand and analyze the observations being recorded. The experiments led students to an understanding of certain principles of renal physiology. Many years later, when I was preparing a presidential address to the American Association of Immunologists, I borrowed what I had learned from Dr. Barger about homeostasis. The talk, entitled "Homeostasis of Effector Systems Which Can Also Be Recruited for Immunologic Reactions," noted the remarkable array of negative regulators for the inflammatory functions of the complement pathway as well as those for activated cell types in IgE-mediated reactions (1).In 1954, after completing medical school, I became one of 12 interns in internal medicine at the Massachusetts General Hospital (MGH). In contrast to my colleagues, I had never heard of the NIH, and thus, I was the only ...

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Exercise-induced anaphylaxis: A serious form of physical allergy associated with mast cell degranulation

Cited by 114 publications

References 13 publications

Lessons about food anaphylaxis

Lessons about food anaphylaxis

Acute Myocardial Infarction following Food-dependent Exercise-induced Anaphylaxis

Doing What I Like

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