A Case Report of Food-Dependent Exercise-Induced Anaphylaxis in a Patient who was Sensitive to Pork

Sung Joon Pang; Sol Ji No; Dong Wook Kim; Sang Min Lee; Eun Joeng Lee; Cheol Hong Kim; Hyun Hee Lee; Kyung Eun Lee; Jung Yeon Hong; Kyu-Earn Kim

doi:10.7581/pard.2012.22.1.116

Journal List > Pediatr Allergy Respir Dis > v.22(1) > 1033163

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Pang, No, Kim, Lee, Lee, Kim, Lee, Lee, Hong, and Kim: A Case Report of Food-Dependent Exercise-Induced Anaphylaxis in a Patient who was Sensitive to Pork

Case Report

Pediatric Allergy and Respiratory Disease

Pediatric Allergy and Respiratory Disease 2012; 22(1): 116-121.

Published online: 31 March 2012

DOI: https://doi.org/10.7581/pard.2012.22.1.116

A Case Report of Food-Dependent Exercise-Induced Anaphylaxis in a Patient who was Sensitive to Pork

Sung Joon Pang, MD¹, Sol Ji No, MD¹, Dong Wook Kim, MD¹, Sang Min Lee, MD¹, Eun Joeng Lee, MD¹, Cheol Hong Kim, MD¹, Hyun Hee Lee, MD¹, Kyung Eun Lee, MD², Jung Yeon Hong, MD², Kyu-Earn Kim, MD²

¹Department of Pediatrics, Myongi Hospital, Kwandong University College of Medicine, Goyang, Korea.

²Department of Pediatrics, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author (hhleemd@kwandong.ac.kr)

Received 8 September 2011 Revised 10 October 2011 Accepted 11 October 2011

Abstract

Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of exercise-induced anaphylaxis that requires both vigorous physical activity and the ingestion of specific foods. In particular, it is rare occurrence for FDEIA to be associated with meat in Korea. A 15-year-old female had generalized urticaria, dyspnea, severe cough, headache, dizziness, and vomiting after singing and dancing for 1 hour and after ingesting grilled pork. Skin prick tests showed a strong positive reaction to pork, whereas the results of an oral food challenge and exercise provocation tests were negative. However, the exercise provocation test after pork ingestion showed a positive reaction manifested by generalized urticaria, cough, mild dyspnea, and a 23% decreased peak expiratory flow rate. Three allergens to pork (67 kDa, 90 kDa, and 15 kDa) reacted with the patient's serum on immunoglobulin E immunoblotting. We report a case of pork-dependent exercise-induced anaphylaxis in a patient who was sensitive to pork.

Keywords: Food allergy, Sensitization to pork, Food-dependent exercise-induced anaphylaxis (FDEIA)

Figures and Tables

Fig. 1

Plain chest X-ray shows hyperinflation in both lungs.

Fig. 2

Sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis of pork treated with heating (10 %). M, molecular weight marker; Lane 1, raw boston butt; Lane 2, boiled boston butt; Lane 3, roasted boston butt; Lane 4, raw boned rib; Lane 5, boiled boned rib; Lane 6, roasted boned rib.

Fig. 3

Imunoglobulin E Immunoblotting of pork. M, molecular weight marker; Lane 1, raw boston butt; Lane 2, boiled boston butt; Lane 3, roasted boston butt; Lane 4, raw boned rib; Lane 5, boiled boned rib; Lane 6, roasted boned rib.

Table 1

Results of Multiple Allergen Simultaneous Test

Class 0, non-detectable; Class 1, low; Class 2, increased; Class 3, significantly increased; Class 4, high; Class 5, very high; Class 6, extremely high.

Table 2

Results of Allergen Skin Prick Test

1+, R<1, wheal 1-2 mm, erythema<21 mm; 2+, R<1, wheal 1-3 mm, erythema≧21 mm; 3+, 1≦R<2, wheal 3-5 mm, erythema≧21 mm; 4+, 2≦R<3, wheal >5 mm, erythema≧21 mm; R, allergen/histamine.

Table 3

Results of Exercise Provocation Test after Ingestion of Pork

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