ABSTRACT
Food-dependent, exercise-induced anaphylaxis (FDEIA) is a potentially life-threatening disorder that often occurs with exercise, and patients typically have eaten a specific food within hours before disease onset. This disease is exceedingly rare, with a prevalence of 0.02%. No well-recognized prevention or treatment strategy has been available for FDEIA except avoiding triggers strictly. Here we report an 11-year-old boy with a history of recurrent anaphylaxis of unknown etiology more than 10 times within two years. As the anaphylactic symptoms had not been controlled after traditional treatments, the patient was given subcutaneous injection of dupilumab seven times within 33 weeks. During dupilumab treatments, the patient was exposed to culprit mushrooms plus exercises at least twice a month but without notable anaphylaxis. Thus, Dupilumab may improve the allergic reactions in FDEIA patients.
Subject(s)
Male , Humans , Child , Anaphylaxis/etiology , Food Hypersensitivity/diagnosis , Exercise-Induced Allergies , Antibodies, Monoclonal, Humanized/therapeutic useABSTRACT
Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of exercise-induced anaphylaxis that requires both vigorous physical activity and the ingestion of specific foods. In particular, it is rare occurrence for FDEIA to be associated with meat in Korea. A 15-year-old female had generalized urticaria, dyspnea, severe cough, headache, dizziness, and vomiting after singing and dancing for 1 hour and after ingesting grilled pork. Skin prick tests showed a strong positive reaction to pork, whereas the results of an oral food challenge and exercise provocation tests were negative. However, the exercise provocation test after pork ingestion showed a positive reaction manifested by generalized urticaria, cough, mild dyspnea, and a 23% decreased peak expiratory flow rate. Three allergens to pork (67 kDa, 90 kDa, and 15 kDa) reacted with the patient's serum on immunoglobulin E immunoblotting. We report a case of pork-dependent exercise-induced anaphylaxis in a patient who was sensitive to pork.
Subject(s)
Adolescent , Female , Humans , Allergens , Anaphylaxis , Cough , Dancing , Dizziness , Dyspnea , Eating , Food Hypersensitivity , Headache , Immunoblotting , Immunoglobulin E , Immunoglobulins , Korea , Meat , Motor Activity , Peak Expiratory Flow Rate , Singing , Skin , Urticaria , VomitingABSTRACT
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.
Subject(s)
Female , Humans , Young Adult , Anaphylaxis , Dyspnea , Eating , Exercise , Hypersensitivity , Ketotifen , Triticum , UrticariaABSTRACT
Food-dependent exercise-induced anaphylaxis(FDEIAn), first reported in 1979, is a rare condition characterized by acute cutaneous, gastrointestinal, cardiovascular, and respiratory symptoms occurring on exertion after certain meals. This article describes 3 patients who developed urticaria, dizziness, abdominal pain, and loss of consciousness if the ingestion of wheat flour-food was followed by exercise within 2 hours. But either exercise or wheat intake alone did not induce any symptoms. Skin prick test showed strong positive responses to wheat flour and bread in all patients. We could diagnose FDEIAn with specific food-exercise challenges.