Provocation tests for the diagnosis of food‐dependent exercise‐induced anaphylaxis

Asaumi, Tomoyuki; Yanagida, Noriyuki; Sato, Sakura; Shukuya, Akinori; Nishino, Makoto; Ebisawa, Motohiro

doi:10.1111/pai.12489

Cited by 51 publications

(38 citation statements)

References 21 publications

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“…Of the remaining 19 subjects, nine (47%) were finally diagnosed with WDEIA based on the subsequent clinical course . Additionally, specific IgE and skin‐prick tests against suspected foods were often negative in children with FDEIA . Therefore, it should be borne in mind that identifying the causative foods is not easy.…”

Section: Discussionmentioning

confidence: 99%

Food‐dependent exercise‐induced anaphylaxis in Japanese elementary school children

Manabe

Norihiro²,

Aihara³

2018

Pediatrics International

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Section: Discussionmentioning

confidence: 99%

Food‐dependent exercise‐induced anaphylaxis in Japanese elementary school children

Manabe

Norihiro²,

Aihara³

2018

Pediatrics International

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“…A study by Asaumi et al illustrates the importance of confirmation by oral challenge. They noted wheat was the most common food in FDEIA (53% of positive provocation tests).…”

Section: Wheat Allergymentioning

confidence: 99%

Gluten sensitivities and the allergist: Threshing the grain from the husks

Burkhardt

Chapa-Rodríguez

Bahna

2017

Allergy

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Abstract"Gluten sensitivity" has become commonplace among the public. Wheat allergy (WA) and celiac disease (CD) are well-defined entities, but are becoming a fraction of individuals following a gluten-free diet (GFD). Wheat allergy has a prevalence of <0.5%. Wheat, specifically its omega-5 gliadin fraction, is the most common allergen implicated in food-dependent, exercise-induced anaphylaxis. CD is a non-IgE hypersensitivity to certain cereal proteins: gluten in wheat, secalin in rye, hordein in barley, and to a lesser extent avenin in oat. It is a rare disease, with an estimated prevalence that varied widely geographically, being higher in Northern Europe and the African Saharawi region than in South-East Asia. In addition to suggestive symptoms, serologic testing has high diagnostic reliability and biopsy is a confirmatory procedure. Patients with CD have extra-intestinal autoimmune comorbid conditions more frequently than expected. A third entity is nonceliac gluten sensitivity, which has been created because of the increasing number of subjects who claim a better quality of life or improvement of their variety of symptoms on switching to a GFD.The phenomenon is being fueled by the media and exploited by the industry. The lack of a specific objective test has been raising substantial controversy about this entity. Allergists and gastroenterologists need to pay attention to the multitudes of individuals who elect to follow a GFD. Many such subjects might have WA, CD, or another illness. Providing them with appropriate evaluation and specific management would be of great advantages, medically and economically. K E Y W O R D Sceliac disease, gluten sensitivity, gluten-free diet, nonceliac gluten sensitivity, wheat allergy 1 | INTRODUCTION "Gluten" has become part of everyday vocabulary by the public, a popular topic by the media, and is being exploited by the food industry. Three wheat-related disorders have been described, namely wheat allergy (WA), celiac disease (CD), and the new entity nonceliac gluten sensitivity (NCGS). The objective of this paper was to differentiate between these 3 disorders regarding epidemiology, manifestations, pathogenesis, diagnosis, and management. As a timely topic, "gluten sensitivity" stimulated the publication of multiple reviews, mainly in the gastroenterology and nutrition literatures, but not so in the allergy literature. Fueled by the media and the food industry's promotion of gluten-free products, the number of subjects claiming gluten-related illnesses has been exponentially increasing and they are seeking or referred for allergy evaluation.

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“…The first report dates back to 1979, when the case of a patient who experienced anaphylaxis after eating shellfish and performing strenuous exercise was described 20. Since then, a large series of reports have expanded the number of foods responsible, including several vegetables, cereals, nuts, fish, cow’s milk, beef, pork, chicken/turkey, snails, and mushrooms,20–70 as shown in Table 1. To diagnose food-dependent exercise-induced anaphylaxis (FDEIAn), it is required that physical exercise or food consumption alone do not cause any reaction, while their combination elicits anaphylactic symptoms 15.…”

Section: Clinical Characteristics Of Eianmentioning

confidence: 99%

“…In diagnosing food allergy, the in vivo test to be considered as a reference standard is challenge with the suspected food 70,88. In patients with suspected EIAn or FDEIAn, the challenge must be performed under strict medical control, with blood pressure and lung-function monitoring and prompt availability of drugs and equipment to manage anaphylaxis.…”

Section: In Vivo Testingmentioning

confidence: 99%

Diagnosis of exercise-induced anaphylaxis: current insights

Pravettoni¹,

Incorvaia²

2016

JAA

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Exercise-induced anaphylaxis (EIAn) is defined as the occurrence of anaphylactic symptoms (skin, respiratory, gastrointestinal, and cardiovascular symptoms) after physical activity. In about a third of cases, cofactors, such as food intake, temperature (warm or cold), and drugs (especially nonsteroidal anti-inflammatory drugs) can be identified. When the associated cofactor is food ingestion, the correct diagnosis is food-dependent EIAn (FDEIAn). The literature describes numerous reports of FDEIAn after intake of very different foods, from vegetables and nuts to meats and seafood. One of the best-characterized types of FDEIAn is that due to ω5-gliadin of wheat, though cases of FDEIAn after wheat ingestion by sensitization to wheat lipid transfer protien (LTP) are described. Some pathophysiological mechanisms underlying EIAn have been hypothesized, such as increase/alteration in gastrointestinal permeability, alteration of tissue transglutaminase promoting IgE cross-linking, enhanced expression of cytokines, redistribution of blood during physical exercise leading to altered mast-cell degranulation, and also changes in the acid–base balance. Nevertheless, until now, none of these hypotheses has been validated. The diagnosis of EIAn and FDEIAn is achieved by means of a challenge, with physical exercise alone for EIAn, and with the assumption of the suspected food followed by physical exercise for FDEIAn; in cases of doubtful results, a double-blind placebo-controlled combined food–exercise challenge should be performed. The prevention of this particular kind of anaphylaxis is the avoidance of the specific trigger, ie, physical exercise for EIAn, the assumption of the culprit food before exercise for FDEIAn, and in general the avoidance of the recognized cofactors. Patients must be supplied with an epinephrine autoinjector, as epinephrine has been clearly recognized as the first-line intervention for anaphylaxis.

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Provocation tests for the diagnosis of food‐dependent exercise‐induced anaphylaxis

Abstract: Provocation tests enabled us to confirm the diagnosis of FDEIA when positive and to exclude the diagnosis when negative. However, as severe symptoms may appear, these tests should be performed in a hospital under constant supervision of a physician.

Cited by 51 publications

References 21 publications

Food‐dependent exercise‐induced anaphylaxis in Japanese elementary school children

Food‐dependent exercise‐induced anaphylaxis in Japanese elementary school children

Gluten sensitivities and the allergist: Threshing the grain from the husks

Diagnosis of exercise-induced anaphylaxis: current insights

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