Food‐dependent exercise‐induced anaphylaxis: a case related to the amount of food allergen ingested

Abstract

A 24-year-old Japanese woman had suffered for 2 years from attacks of urticaria, dyspnoea and syncope associated with exercise after the ingestion of wheat. Specific IgE measurements revealed RAST class 2 for wheat and gluten (a major wheat protein), and class 3 for rye. Skin prick tests with wheat, bread, gluten and udon (a Japanese noodle made of wheat) were all positive. Food-dependent exercise-induced anaphylaxis (FDEIA) caused by wheat was suspected. Challenge tests with bread were performed. Exercise following ingestion of 64 g, but not 45 g, of bread induced generalized urticaria. Challenge tests with udon also triggered allergic reaction in a dose-dependent manner: 200 g, but not 100 g or 150 g, of udon elicited wealing and erythema with exercise. Ingestion of bread or udon alone failed to elicit any allergic reaction. This is the first case of FDEIA in which the dependence of the triggering allergic reaction on the amount of allergen ingested was clearly confirmed.

Wheat-dependent, Exercise-induced Anaphylaxis: A Successful Case of Prevention with Ketotifen

“…Exercise enhances the degranulation of mast cells and the absorption of allergens from the gastrointestinal tract, so the plasma histamine level rises in patients with exercise-induced anaphylaxis [10][11][12] . Recently, there were some reports that omega-5 gliadin and high-molecular weight (HMW) glutenin, which are the proteins consisting of wheat, are the most common allergens involved in wheat-dependent, exercise-induced anaphylaxis (WDEIA) 5,[13][14][15] .…”

Síndrome de anafilaxia inducida por ejercicio

“…Los alimentos más frecuentemente implicados son de origen vegetal, y entre éstos destacan los cereales (fundamentalmente el trigo) (16,17,21,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38), las frutas frescas (16,17,39,40) y los frutos secos (33,34,41,42). Se han descrito casos relacionados con distintos tipos de verduras y especias (7,17,21,34,(43)(44)(45) (3,16,47,48). Existen casos puntuales de reacciones consecutivas a la ingesta de huevo (48,49), leche de vaca (50) o moluscos cefalópodos (51).…”

“…Es posible encontrar sensibilizaciones múltiples a distintos alimentos en el mismo paciente (37), lo que conlleva mayores dificultades de manejo. También la cantidad de alergeno ingerido puede condicionar el grado de reacción (34). En algunos ataques se ha comunicado el consumo asociado de ciertos fármacos antiinflamatorios no esteroideos (17), e incluso ha sido descrito un caso directamente inducido por la ingestión de naproxeno seguido de ejercicio (52).…”

Role of Adverse Reactions to Food in Urticaria and Exercise-Induced Anaphylaxis

“…Reasons for false-negative test results may depend on the method of provocation. Suko et al proposed that insufficient amounts of food allergen ingested or inappropriate exercise could be the cause of false-negative clinical responses to challenge tests [31]. Hanakawa et al [31]published a case of a young woman whose positive reaction of FDEIA depended on the amount of wheat allergen ingested.…”