Lessons about food anaphylaxis

Abstract

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