EXERCISE-INDUCED ANAPHYLAXIS
DOI:
https://doi.org/10.52340/jecm.2025.06.02Keywords:
Exercise-induced anaphylaxis (EIA), food-dependent EIA (FDEIA)Abstract
Exercise-induced anaphylaxis (EIA) is a disorder in which anaphylaxis occurs in response to physical exertion. In the majority of patients, symptoms only develop if exercise takes place within a few hours of eating a specific food to which the patient is allergic, but the food allergy is asymptomatic unless there is associated exertion. This is called food-dependent EIA (FDEIA). A more accurate term for FDEIA would be "cofactor-dependent food allergy" because research has demonstrated that there are cofactors other than exercise that can lower a patient's threshold for developing symptoms.
Typical manifestations of EIA and FDEIA include generalized pruritus, warmth, flushing, urticaria and angioedema, and sudden fatigue, progressing to gastrointestinal symptoms, upper airway obstruction, and collapse in some cases. Symptoms usually begin during exercise or just after stopping exercise. The diagnosis of EIA/FDEIA is usually based upon the clinical history and exclusion of other disorders. The prognosis of patients with EIA and FDEIA is generally favorable once the diagnosis has been clarified, especially if a food allergy can be identified.
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Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006; 117:391.
Brockow K, Kneissl D, Valentini L, et al. Using a gluten oral food challenge protocol to improve diagnosis of wheat-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol 2015; 135:977.
Romano A, Di Fonso M, Giuffreda F, et al. Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol 2001; 125:264.
Pérez-Rangel I, Gonzalo-Garijo MA, Pérez-Calderón R, et al. Wheat-dependent exerciseinduced anaphylaxis in elderly patients. Ann Allergy Asthma Immunol 2013; 110:121.
Aihara Y, Kotoyori T, Takahashi Y, et al. The necessity for dual food intake to provoke food-dependent exercise-induced anaphylaxis (FEIAn): a case report of FEIAn with simultaneous intake of wheat and umeboshi. J Allergy Clin Immunol 2001; 107:1100.
Matsuo H, Morimoto K, Akaki T, et al. Exercise and aspirin increase levels of circulating gliadin peptides in patients with wheat-dependent exercise-induced anaphylaxis. Clin Exp Allergy 2005; 35:461.
Farrell A, Judge C, Redenbaugh V, et al. Food-dependent exercise-induced reactions: lessons from a 15-year retrospective study. Ir J Med Sci 2019; 188:815.
Schwartz HJ. Elevated serum tryptase in exercise-induced anaphylaxis. J Allergy Clin Immunol 1995; 95:917.
Loibl M, Schwarz S, Ring J, et al. Definition of an exercise intensity threshold in a challenge test to diagnose food-dependent exercise-induced anaphylaxis. Allergy 2009; 64:1560.
Kaplan AP, Natbony SF, Tawil AP, et al. Exercise-induced anaphylaxis as a manifestation of cholinergic urticaria. J Allergy Clin Immunol 1981; 68:319.
Kulthanan K, Ungprasert P, Jirapongsananuruk O, et al. Food-Dependent ExerciseInduced Wheals, Angioedema, and Anaphylaxis: A Systematic Review. J Allergy Clin.Immunol Pract 2022; 10:2280.
Tomsitz D, Biedermann T, Brockow K. Sublingual immunotherapy reduces reaction threshold in three patients with wheat-dependent exercise-induced anaphylaxis. Allergy 2021; 76:3804.
Christensen MJ, Eller E, Mortz CG, et al. Wheat-Dependent Cofactor-Augmented Anaphylaxis: A Prospective Study of Exercise, Aspirin, and Alcohol Efficacy as Cofactors. J Allergy Clin Immunol Pract 2019; 7:114.
Shadick NA, Liang MH, Partridge AJ, et al. The natural history of exercise-induced anaphylaxis: survey results from a 10-year follow-up study. J Allergy Clin Immunol 1999; 104:123.
Ausdenmoore RW. Fatality in a teenager secondary to exercise-induced anaphylaxis. Pediatr Asthma Allergy Immunol 1991; 5:21.
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