Food-dependent exercise-induced anaphylaxis in Korean children: a single-center retrospective case study

ABSTRACT

PURPOSE: Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific clinical syndrome requiring both ingestion of an allergenic food and exercise to induce anaphylaxis. It may be underdiagnosed due to insufficient history taking in terms of the causes of anaphylaxis. This study aims to describe clinical characteristics and diagnostic results of FDEIA in children. METHODS: We retrospectively reviewed the medical records of patients under 18 years old who were diagnosed with FDEIA at Asan Medical Center between January 2003 and August 2014. RESULTS: Of the 170 children with anaphylaxis, 11 (6.5%) had FDEIA. The mean age at the onset of symptoms was 14.8+/-1.5 years. The causative foods were wheat (n=4), meat (n=1), mung beans (n=1), rice (n=1), celery (n=1), cabbage (n=1), fish (n=1), and soy (n=1). The numbers of symptom development were 7 (n=1), 6 (n=1), 3 (n=4), 2 (n=2), and 1 (n=3). The geometric mean (range of 1 standard deviation) of total serum IgE levels was 131.6 kU/L (53.5-324.2 kU/L). The skin prick test and immununoCAP were positive for causative foods in 3 of 6 patients (50.0%) and 7 of 10 patients (70.0%), respectively. The provocation test was performed in 8 of 11 patients and showed positive results except 1 patient. The interval between exercise and symptoms was 21.6+/-7.3 minutes. CONCLUSION: It is important to suspect FDEIA and take a detailed history in children with anaphylaxis. Provocation test should be considered to confirm the diagnosis. Further studies on disease course and long-term prognosis are warranted.