Food-dependent exercise-induced anaphylaxis in Korean children: a single-center retrospective case study

Eun Lee; Min-Ju Kim; Song-I Yang; Jinho Yu; Soo-Jong Hong

doi:10.4168/aard.2015.3.3.194

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Lee, Kim, Yang, Yu, and Hong: Food-dependent exercise-induced anaphylaxis in Korean children: a single-center retrospective case study

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(3): 194-199.

Published online: 29 May 2015

DOI: https://doi.org/10.4168/aard.2015.3.3.194

Food-dependent exercise-induced anaphylaxis in Korean children: a single-center retrospective case study

Eun Lee, Min-Ju Kim, Song-I Yang, Jinho Yu, Soo-Jong Hong

¹Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Soo-Jong Hong. Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3379, Fax: +82-2-473-3725, sjhong@amc.seoul.kr

Received 19 December 2014 Revised 21 February 2015 Accepted 24 February 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific clinical syndrome requiring both ingestion of an allergenic food and exercise to induce anaphylaxis. It may be underdiagnosed due to insufficient history taking in terms of the causes of anaphylaxis. This study aims to describe clinical characteristics and diagnostic results of FDEIA in children.

Methods

We retrospectively reviewed the medical records of patients under 18 years old who were diagnosed with FDEIA at Asan Medical Center between January 2003 and August 2014.

Results

Of the 170 children with anaphylaxis, 11 (6.5%) had FDEIA. The mean age at the onset of symptoms was 14.8±1.5 years. The causative foods were: wheat (n=4), meat (n=1), mung beans (n=1), rice (n=1), celery (n=1), cabbage (n=1), fish (n=1), and soy (n=1). The numbers of symptom development were: 7 (n=1), 6 (n=1), 3 (n=4), 2 (n=2), and 1 (n=3). The geometric mean (range of 1 standard deviation) of total serum IgE levels was 131.6 kU/L (53.5-324.2 kU/L). The skin prick test and immununoCAP were positive for causative foods in 3 of 6 patients (50.0%) and 7 of 10 patients (70.0%), respectively. The provocation test was performed in 8 of 11 patients and showed positive results except 1 patient. The interval between exercise and symptoms was 21.6±7.3 minutes.

Conclusion

It is important to suspect FDEIA and take a detailed history in children with anaphylaxis. Provocation test should be considered to confirm the diagnosis. Further studies on disease course and long-term prognosis are warranted.

Keywords: Anaphylaxis, Food, Exercise, Child

Figures and Tables

Fig. 1

Symptoms of food-dependent exercise induced anaphylaxis.

Table 1

Clinical characteristics

Patient No.	Age at the onset (yr)	Sex	Other allergic diseases	Causative food	Causative exercise	No. of FDEIA episode before diagnosis
1	13	M	Allergic rhinitis	Wheat	Soccer	1
2	13	F	(-)	Meat	Walking	4
3	14	F	History of asthma^*	Mung beans	Running, Jumping rope	2
4	13	M	Allergic rhinitis, history of asthma^*	Rice	Walking, running, cycling	7
5	16	M	Allergic rhinitis	Celery	Running	6
6	14	M	Allergic rhinitis	Cabbage	Badminton	3
7	15	F	(-)	Soy	Running, jumping rope	3
8	17	M	Atopic dermatitis, history of egg allergy^*	Fish	Basketball	1
9	16	M	(-)	Wheat	Basketball	3
10	17	M	(-)	Wheat	Basketball	1
11	15	M	(-)	Wheat	Walking	2

FDEIA, Food-dependent exercise-induced anaphylaxis.

^*History of asthma or egg allergy were defined as subjects who had diagnosis asthma or egg allergy before but did not have symptoms during last 12 months.

Table 2

Results of serum IgE/skin prick test for causative food and exercise provocation test after causative food intake

Patient No.	Total IgE (kU/L)	Specific IgE (kAU/L)	Skin prick test	Symptoms after provocation test	Time interval^* (min)
1	189	ω-5 gliadin, 1.37	Wheat (-)	Urticaria	30
2	372	(-)	Meat was not tested	ND
3	295	Soy, 4.05	Soy was not tested	ND
4	43.9	Rice, 0.58	Rice was not tested	Urticaria	10
5	ND	ND	Celery (+)	Urticaria, angioedema, dyspnea	30
6	214	Cabbage, 26.2	Cabbage (+)	Urticaria, dyspnea, vomiting, hypotension	16
7	206	Soy, 8.49	ND	ND
8	288	Fish, 1.00	Fish was not tested	(-)
9	106	(-)	(-)	Urticaria, dizziness	25
10	60.4	(-)	(-)	Urticaria	20
11	21.2	ω-5 gliadin, 3.60	Wheat (+)	Urticaria, angioedema, nausea, hypotension	20

ND, not done.

^*Time interval between exercise and symptom onset.

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