Anaphylaxis induced by exercise and related to multiple food intake

In some patients, exercise-induced anaphylactic (EIAn) reactions occur only when a particular food is eaten before exercise. We describe three patients with EIAn induced by different foods. Patients who presented episodes of EIAn performed exercise challenges after fasting and 1 hour after a meal without foods suspected of predisposing the reaction. Subsequently, patients performed exercises after separate intake of each suspected food. Patients underwent skin prick tests (SPT) with food extracts. Serum total and specific IgE antibodies to food were determined. No reactions were provoked by exercise tests without prior intake of suspected foods. Eight of 30 food-exercise combination challenges were positive. In Patient 1, tomato, zucchini, and wheat resulted in adverse reactions: in Patient 2, potato, peanuts, and tomato; in Patient 3, rice and peanuts. SPTs and RASTs to foods predisposing the reaction were positive. Food-exercise combined challenge may be useful in identifying foods that favor EIAn in children with multiple food-dependent EIAn.