|LETTER TO EDITOR
|Year : 2018 | Volume
| Issue : 2 | Page : 177-178
Food-dependent exercise-induced anaphylaxis in a teenager
Department of Pediatric Dermatology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
|Date of Web Publication||26-Mar-2018|
Department of Pediatric Dermatology, Kanchi Kamakoti CHILDS Trust Hospital, No. 12-A, Nageswara Road, Nungambakkam, Chennai - 600 034, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ramamoorthy R. Food-dependent exercise-induced anaphylaxis in a teenager. Indian J Paediatr Dermatol 2018;19:177-8
A 17-year-old boy presented to us with a history of developing itchy wheals all over the body during vigorous game activity which was followed within few minutes by stridor, breathlessness, and loss of consciousness. On admission, he was found to be hypotensive with hypoxemia and was revived with the administration of intravenous fluids, hydrocortisone, oxygen, and anti-histamines. He was anxious to know whether the above-mentioned event was in any way related to intake of vegetable fried rice consumed by him about 3 h before participation in sports activity. He gave history of occurrence of hives intermittently once in a week for the past 6 months. He had also observed the occurrence of wheals about an hour after intake of wheat. However, the hives were not associated with disturbance in consciousness or speech.
The above case is a classic example of Food-dependent exercise-induced anaphylaxis (FDEIA), a rare disorder, in which anaphylaxis occurs if food intake is followed by vigorous exercise  within a time frame. A diagnosis  of anaphylaxis is made when any two of the following clinical features occur rapidly after allergen exposure: (1) Involvement of the skin/or mucosa, (2) respiratory compromise, (3) reduced blood pressure or associated symptoms, and/or (4) persistent gastrointestinal symptoms. It is important to know that in FDEIA physical exercise or food alone do not cause anaphylaxis, but a combination of both is required. The exact pathogenesis is not fully elucidated. It is considered to be due to both IgE and non-IgE-dependent mechanisms. Many food items such as celery, tomato, Apple, grapes, nuts, and shellfish are implicated. Other risk factors include amount of food intake, severity of physical activity, cold or warm temperature, and intake of nonsteroidal anti-inflammatory drugs. This disorder is usually seen in adult young females. FDEIA has been reported in children  and can be familial.
The diagnosis of FDEIA is based on recognition of the symptoms of anaphylaxis that develops in association with physical exertion following ingestion of a triggering food item. Skin prick tests and in vitro tests are useful aids for detecting sensitization to suspected food. Exercise an hour after challenge with the suspected food is considered as the gold standard test for the diagnosis of FDEIA. However, provocation testing should be undertaken only under controlled conditions with facilities for managing anaphylaxis.
All patients diagnosed with FDEIA should avoid vigorous exercise up to 4 h after intake of food items suspected to induce FDEIA, alcohol, and aspirin. It is best to avoid all prick test positive food items before exercise. Patients are advised to keep self-injectable epinephrine if available. We stress the need for early diagnosis of this disorder in clinical practice because of its association with life-threatening anaphylactic reaction which can be prevented by educating the patient to avoid the possible triggers.
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