Journal List > Allergy Asthma Respir Dis > v.1(3) > 1058959

Im, Kwon, Ye, Park, Kim, Choi, Kim, Jang, Kim, Hur, Koh, Sohn, Kim, and KAAACI Work Group for Urticaria/Angioedema/Anaphylaxis: Food-dependent exercise-induced anaphylaxis in Korea: a multicenter retrospective case study

Abstract

Purpose

To investigate the causes, clinical features and characteristics of food-dependent exercise-induced anaphylaxis (FDEIA) in Korea.

Methods

A retrospective medical chart review was performed on the patients diagnosed with anaphylaxis between 2007 and 2011 in 14 hospitals in Korea. Cases with FDEIA were subsequently identified among anaphylaxis patients, and subgroup analyses were done to assess clinical characteristics of FDEIA.

Results

A total of 62 subjects with FDEIA (male, 72.6%; aged 16 to 70 years) were enrolled in 10 hospitals. Wheat (69.3%) was the most common cause of FDEIA, followed by meat (8.1%), seafood (6.5%), and vegetables (6.5%). The clinical manifestations were cutaneous (100%), respiratory (64.5%), cardiovascular (61.3%), and gastrointestinal (9.7%), respectively. In severity assessment, approx-imately 40% of FDEIA were classified as severe anaphylaxis. Portable epinephrine autoinjector was prescribed to 17.2% of patients, and about one fifth of the patients experienced redevelopment of anaphylactic symptoms during follow-up period. There was no significant difference of age, gender, latent period, total immunoglobulin E, and past history of allergic disease between patients with severe anaphylaxis group and patients with mild-to-moderate group.

Conclusion

Wheat is the most common cause of FDEIA in Korea. Because significant number of patients with FDEIA experienced anaphylactic symptoms after diagnosis of FDEIA, more comprehensive therapeutic and educational approaches will be required to prevent recurrent development of anaphylaxis.

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Fig. 1.
The number of patients diagnosed with food-dependent exercise-induced anaphylaxis from 2007 to 2011. Although small drop was noted in 2010, increased tendency in the number of patients diagnosed with food-dependent exercise-induced anaphylaxis was observed during this period.
aard-1-203f1.tif
Fig. 2.
The causative foods for patients with food-dependent exercise-induced anaphylaxis. Wheat was the most common cause of food-dependent exercise-induced anaphylaxis in Korea.
aard-1-203f2.tif
Table 1.
Clinical characteristics of subjects
Characteristic No. of subjects (%)
Sex  
 Male 45 (72.6)
 Female 17 (27.4)
 Age (yr)  
 16–19 10 (16.1)
 20–29 21 (33.9)
 30–39 11 (17.7)
 40–49 12 (19.4)
 ≥50 8 (12.9)
Past history of allergic disease  
 Asthma 5/48 (10.4)
 Allergic rhinitis 20/57 (35.1)
 Chronic urticaria 8/47 (17.0)
 Food allergy 25/53 (47.2)
 Family history of allergic diseases 9/39 (23.1)
Symptoms at the previous exposure  
 None to mild cutaneous symptoms 41 (66.1)
 Anaphylaxis 21 (33.9)
Table 2.
Clinical manifestation of food dependent exercise-induced anaphylaxis
Variable No. of subjects (%)
Symptom severity  
 Mild 5 (8.1)
 Moderate 32 (51.6)
 Severe 25 (40.3)
Symptom manifestation  
 Cutaneous 62/62 (100.0)
  Urticaria 51/59 (86.4)
  Angioedema 24/60 (40.0)
 Respiratory 40 (64.5)
  Dyspnea 39/60 (65.0)
  Wheezing 4/57 (7.0)
 Cardiovascular 38 (61.3)
  Dizziness 19/59 (32.2)
  Hypotension 9/58 (15.5)
 Gastrointestinal 6 (9.7)
  Nausea 5/57 (8.8)
  Vomiting 3/57 (5.3)
 General 15 (24.2)
  Weakness 14/60 (23.3)
  Anxiety 2/57 (3.5)
Loss of consciousness 15 (24.2)
Table 3.
Treatment and prognosis of food dependent exercise-induced anaphylaxis
Variable No. of subjects (%)
Hospital visit and care  
 Emergency room 26/58 (44.8)
 Ward admission 6/58 (10.3)
 ICU care 1/58 (1.7)
 Outpatient clinic 25/58 (43.1)
Treatment with  
 Epinephrine injection 6/44 (13.6)
 Systemic steroid 33/47 (70.2)
 H1 receptor antagonist 36/47 (76.6)
 H2 receptor antagonist 16/45 (35.6)
Prescription of epinephrine autoinjector 10/58 (17.2)
Recurrence during follow-up period 6/32 (18.8)

ICU, intensive care unit.

Prescription of portable epinephrine autoinjector for secondary prevention.

Table 4.
Comparison of clinical parameters between severe and mild-moderate anaphylaxis
Variable Mild to moderate anaphylaxis (n=37) Severe anaphylaxis (n=25) P-value
Age (yr) 30.2±11.6 37.2±16.1 0.069
Sex (male/female) 29/8 16/9 0.213
Log (total immunoglobulin E) (IU/mL) 2.37±0.55 2.38±0.55 0.972
Past history of allergic disease 14/25 (56.0) 14/21 (66.7) 0.460
Latent period (min) 72.7±80.5 51.6±44.9 0.370
Clinical manifestation      
 Cutaneous symptom 37 (100) 25 (100)  
 Respiratory symptom 26 (70.3) 14 (56.0) 0.249
 Cardiovascular symptom 14 (37.8) 24 (96.0) 0.001
 Gastrointestinal symptom 4 (10.8) 2 (8.0) 1.000
 General symptom 9 (24.3) 6 (24.0) 0.977
 Wheat-dependency 26 (70.3) 17 (68.0) 0.849

Values are presented as mean±standard deviation or number (%).

Time interval between intake of causative food and symptom development (min).

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