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

Abstract

Food-dependent, exercise-induced anaphylaxis (FDEIA) is the triggering of anaphylaxis after ingestion of certain foods when followed by physical exercise. Symptoms vary from the typical generalized urticaria to severe allergic reactions. We report the case of a 20-year-old woman who had a 7-year history of recurrent wheals and dyspnea after ingesting several kinds of food (wheat, pork, and beef) along with physical exercise. Based on a provocation test, she was diagnosed with wheat-dependent, exercise-induced anaphylaxis. She was instructed to take 2 mg of ketotifen 2 hours before ingestion of wheat to prevent the symptoms, and subsequently the provocation test did not elicit wheals. We therefore prescribed ketotifen (1 mg twice a day). She has not had recurrent wheals or dyspnea for 6 months. We herein report an interesting case of wheat-dependent, exercise-induced anaphylaxis with successful prevention by ketotifen.

Wheat‐dependent exercise‐induced anaphylaxis

“…A case report demonstrated that olopatadine hydrochloride and ketotifen completely inhibited anaphylaxis [40,89]. A case report demonstrated that olopatadine hydrochloride and ketotifen completely inhibited anaphylaxis [40,89].…”

Diagnostic and Therapeutic Approach in Patients with Exercise-Induced Anaphylaxis

“…• How effective are disodium cromoglycate and ketotifen (mast cell stabilizers) as pretreatment preventive strategies [14,15]?…”

Exercise-Induced Anaphylaxis: A Food-Dependent Variant

“…22,[24][25][26][27][28] Reports of 6 cases suggest that some medications may prevent FDEIA symptoms, even after ingesting a trigger food prior to exercise (Table 3). In 2 cases, no FDEIA recurrences were experienced during the 6-12 months that followed the intervention.…”

“…Food avoidance has been successful in managing FDEIA in many cases, 6,9,16 but a treatment kit containing antihistamines, corticosteroids, and an epinephrine autoinjector be readily available, and the patient should be instructed in proper procedures for administration of the medication. 3,22 Antihistamines are effective in managing skin reactions, but they are not effective in managing respiratory or cardiovascular symptoms. 4 Individuals with FDEIA should be discouraged from exercising alone, due to the potential for development of a life-threatening condition.…”

“…In 2 cases, no FDEIA recurrences were experienced during the 6-12 months that followed the intervention. 22,24 For individuals who are unwilling or unable to modify dietary and exercise behaviors, pharmacologic treatment may provide an alternative means to manage FDEIA.…”