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Food related, exercise induced anaphylaxis
C Caffarelli1, V Terzi, F Perrone
1Department of Paediatrics, University of Parma, Italy.
Insights
Food-dependent exercise-induced anaphylaxis (EIAn) can occur in young children. Diagnosing this condition requires considering specific food triggers alongside exercise challenges when other causes are unknown.
Area of Science:
- Allergy and Immunology
- Pediatric Medicine
- Clinical Investigation
Background:
- Exercise-induced anaphylaxis (EIAn) is a condition that can be triggered by physical activity.
- Food-dependent EIAn is a specific subtype where food intake precedes exercise, leading to anaphylactic reactions.
- Investigating EIAn in young children necessitates understanding potential food triggers.
Observation:
- Four children under 12 with suspected food-dependent EIAn underwent controlled exercise challenges.
- Challenges involved exercise after fasting and after meals, with and without specific suspected foods.
- Three positive food-exercise challenge combinations were identified, with no reactions occurring without suspected food intake.
Findings:
- Positive reactions were exclusively observed when exercise followed the intake of specific suspected foods.
- Skin prick tests and RAST (serum specific IgE) showed positive results in two out of three evaluated cases.
- One patient did not exhibit a clinical reaction during food-exercise combination challenges.
Implications:
- Food-dependent EIAn should be considered in the differential diagnosis of EIAn in young children, especially when the cause is unclear.
- This subtype of EIAn requires careful diagnostic evaluation involving specific food challenges.
- Identifying food triggers is crucial for managing and preventing future anaphylactic episodes in affected children.
Abstract:
Four children under 12 years of age with food dependent, exercise induced anaphylaxis (EIAn) were investigated. These children and five controls performed exercise challenges when fasting and one hour after a meal without food suspected to predispose to the reaction. Patients then performed exercise tests after intake of each suspected food. Three out of 15 food-exercise combination challenges were positive, but no reactions were provoked after exercise without prior intake of suspected foods. Patients underwent skin prick tests to foods and serum total and specific IgE antibodies were measured. Skin prick test results were positive and RAST results were positive in two of three instances. In case 3, food-exercise combination challenges did not provoke any clinical reaction. The diagnosis of food dependent EIAn should be considered in young children with EIAn of unknown origin.