Food-Dependent Exercise-Induced Anaphylaxis: A Case Related to Chickpea Ingestion and Review

Abstract

Food-dependent exercise-induced anaphylaxis (FDEIA) is recognized as a distinct category of exercise-induced anaphylaxis (EIA) but is very likely underdiagnosed. This report describes a 41-year-old Indian woman who experienced two separate episodes of anaphylaxis while dancing after she had eaten chickpea-containing foods. The chickpea, a small legume, is a staple ingredient in culinary traditions from around the world, especially in India, the Middle East, and North Africa. Chickpea-containing dishes are also becoming more widespread in the Western world with the growing popularity of South Asian, Middle Eastern, and African cuisines. It is important to consider FDEIA in cases of unexplained anaphylaxis as reactions can occur several hours after ingesting the culprit food(s). Furthermore, no reaction occurs if a sensitized individual eats the culprit food(s) without exercising afterward; therefore, triggering foods can easily be overlooked. Current ideas on the pathophysiology, predisposing factors, workup, and treatment of FDEIA are also summarized here.

Food-dependent exercise-induced anaphylaxis to chickpea in a 17-year-old female: a case report

“…To the best of our knowledge, this is the first case demonstrating FDEIA due to chickpea in an adolescent patient, and only the second case overall reporting FDEIA due to chickpea. The first case was identified in a 41-year-old woman after dancing [ 11 ]. Legumes are not a common food associated with FDEIA, and there are minimal reports in the literature.…”

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

“…When anaphylaxis is triggered by a specific food, the condition is called specific FDEIA; however, in unspecific FDEIA, susceptible individuals develop anaphylaxis when exercise after food regardless of what food has been eaten. [ 7 ]…”

“…Looking for evidence of food-specific IgE to the implicated food, either by skin testing or in vitro assays is essential in the evaluation of patients with FDEIA because sensitization to the precipitating food(s) is usually demonstrable. [ 7 ]…”

Food-dependent exercise-induced anaphylaxis occurred only in a warm but not in a cold environment

“…Food-dependent exercise-induced anaphylaxis (FDEIA) is a type of exercise-induced anaphylaxis (EIA) that occurs only when a sensitized individual ingests food allergens and proceeds to exercise within 2 to 6 h [ 5 ]. Physical exercise without ingestion of the causative food, as well as ingestion of food allergens without postprandial exercise, is well tolerated [ 6 ].…”