Mixed plant extract-dependent exercise-induced anaphylaxis

Jin Wha Choi; Jeong Ok Lee; Jaehee Choi; Youngshin Han; Jihyun Kim; Kangmo Ahn

doi:10.4168/aard.2015.3.3.219

Journal List > Allergy Asthma Respir Dis > v.3(3) > 1059101

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Choi, Lee, Choi, Han, Kim, and Ahn: Mixed plant extract-dependent exercise-induced anaphylaxis

Case Report

Allergy, Asthma & Respiratory Disease 2015; 3(3): 219-223.

Published online: 29 May 2015

DOI: https://doi.org/10.4168/aard.2015.3.3.219

Mixed plant extract-dependent exercise-induced anaphylaxis

Jin Wha Choi¹, Jeong Ok Lee², Jaehee Choi^1,², Youngshin Han^1,², Jihyun Kim^1,², Kangmo Ahn^1,²

¹Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

²Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea.

Correspondence to: Jihyun Kim. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-1035, Fax: +82-2-3410-0805, jhlovechild@gmail.com

Received 17 November 2014 Revised 19 March 2015 Accepted 30 March 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

Food-dependent exercise-induced anaphylaxis (FDEIA) is a potentially life-threatening clinical reaction in which anaphylaxis develops when physical activity occurs within a few hours after ingesting a specific food. An 18-year-old girl experienced generalized urticaria, periorbital swelling, and dyspnea repeatedly by exercise after intake of a red ginseng health supplement. A confirmed diagnosis was established in this case by using an exercise challenge test after ingesting mixed-plant extract containing red ginseng health supplement. To the best of our knowledge, this is the first case of FDEIA caused by components in a red ginseng health supplement.

Keywords: Panax ginseng, Exercise, Anaphylaxis

Figures and Tables

Fig. 1

Specific IgE was not detected in the patient and normal control by enzyme-linked immunosorbent assay.

Fig. 2

Different sized protein bands were shown in fresh ginseng by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. On the other hand, protein bands were not identified in red ginseng powder and health product. M, marker: 1, fresh ginseng powder; 2, red ginseng powder: 3, red ginseng product.

Table 1

Results of skin prick test

Antigens	A/H ratio, wheal (mm)	Antigens	A/H ratio, wheal (mm)
Positive control	5×5	Negative control	0×0
Rice	1+, 3×3	Corn flour	1+, 3×2
Cod	1+, 3×2	Sea Eel	1+, 3×2
Plaice	1+, 3×2	Crab	1+, 3×3
Shrimp	1+, 3×2	Asparagus	1+, 3×3
Field pea	1+, 3×2	Beans-Mix	1+, 3×3
Cauliflower	1+, 3×2	Almond	1+, 3×3
Mixed-plants extract	1+, 2×1	Red ginseng powder	Negative, 0×0
Red ginseng health supplement	Negative, 0×0	Cow's milk	Negative, 0×0
Hen's egg (white)	Negative, 0×0	Yolk (yellow)	Negative, 0×0
Wheat flour	Negative, 0×0	Peanut	Negative, 0×0
Nuts-mix	Negative, 0×0	Walnut	Negative, 0×0
Shrimp	Negative, 0×0	Lobster	Negative, 0×0
Salmon	Negative, 0×0	Soybean	Negative, 0×0

A/H, ratio of the size of the wheal induced by allergen on skin-prick test to that induced by histamine.

Table 2

Results of exercise challenge test after ingestion of red ginseng product

Exercise time (min)	FVC (L)	FEV₁ (L)	Blood pressure (mmHg)	Pulse rate (/min)	SpO₂ (%)	Symptoms
Baseline	3.22	2.96	108/68	88	98	No symptoms
0	3.08	2.74	119/70	204	95	No symptoms
5	2.73	2.1	111/52	162	94	No symptoms
8			85/55		88	Urticaria, periorbital swelling,wheezing
10^*			107/64		94	Subsided symptoms
15^*			103/60		94	Subsided symptoms
30^*			107/58		94	Subsided symptoms

FVC, forced vital capacity; FEV₁, forced expiratory volume in one second.

^*After treatment.

Table 3

Results of exercise challenge test after ingestion of mixed plants extract

Exercise time (min)	FVC (L)	FEV₁ (L)	Blood pressure (mmHg)	Pulse rate (/min)	SpO₂ (%)	Symptoms
Baseline	3.16	2.68	92/58	76	96	No symptoms
0	2.63	2.42	121/68	192	96	No symptoms
5	2.95	2.67	112/65	121	97	No symptoms
10	3.00	2.63	105/71	122	96	Urticaria
15^*	2.84	2.56	101/64	124	97	Subsided symptoms
30^*	3.01	2.72	106/64	117	96	Subsided symptoms

FVC, forced vital capacity; FEV₁, forced expiratory volume in one second.

^*After treatment.

References

1. Sharma R, Sinha R, Menon PS, Sirohi D. Management protocol for anaphylaxis. J Oral Maxillofac Surg. 2010; 68:855–862.

2. Radlińska A, Barg W, Wolanczyk-Medrala A, Medrala W. Food-dependent exercise-induced anaphylaxis: current concepts in pathogenesis, diagnostics and treatment. Pol Merkur Lekarski. 2011; 30:49–51.

3. Du Toit G. Food-dependent exercise-induced anaphylaxis in childhood. Pediatr Allergy Immunol. 2007; 18:455–463.

4. Kiefer D, Pantuso T. Panax ginseng. Am Fam Physician. 2003; 68:1539–1542.

5. Kim YK, Oh SY, Jung JW, Min KU, Kim YY, Cho SH. IgE binding components in Tetranychus urticae and Panonychus ulmi-derived crude extracts and their cross-reactivity with domestic mites. Clin Exp Allergy. 2001; 31:1457–1463.

6. Lee JY, Jin HJ, Park JW, Jung SK, Jang JY, Park HS. A case of korean ginseng-induced anaphylaxis confirmed by open oral challenge and basophil activation test. Allergy Asthma Immunol Res. 2012; 4:110–111.

7. Maulitz RM, Pratt DS, Schocket AL. Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol. 1979; 63:433–434.

8. Sheffer AL, Tong AK, Murphy GF, Lewis RA, McFadden ER Jr, Austen KF. Exercise-induced anaphylaxis: a serious form of physical allergy associated with mast cell degranulation. J Allergy Clin Immunol. 1985; 75:479–484.

9. Matsuo H, Morimoto K, Akaki T, Kaneko S, Kusatake K, Kuroda T, et al. Exercise and aspirin increase levels of circulating gliadin peptides in patients with wheat-dependent exercise-induced anaphylaxis. Clin Exp Allergy. 2005; 35:461–466.

10. Qamar MI, Read AE. Effects of exercise on mesenteric blood flow in man. Gut. 1987; 28:583–587.

11. Cheng CX, Li YN, Ohno H, Sawanobori K, Li YC, Shimada O, et al. Mast cells appearing in long-term skeletal muscle cell cultures of rat. Anat Rec (Hoboken). 2007; 290:1424–1430.

12. Wolanczyk-Medrala A, Barg W, Gogolewski G, Panaszek B, Liebhart J, Litwa M, et al. Influence of hyperosmotic conditions on basophil CD203c upregulation in patients with food-dependent exercise-induced anaphylaxis. Ann Agric Environ Med. 2009; 16:301–304.

13. Katsunuma T, Iikura Y, Akasawa A, Iwasaki A, Hashimoto K, Akimoto K. Wheat-dependent exercise-induced anaphylaxis: inhibition by sodium bicarbonate. Ann Allergy. 1992; 68:184–188.

14. Palosuo K, Varjonen E, Nurkkala J, Kalkkinen N, Harvima R, Reunala T, et al. Transglutaminase-mediated cross-linking of a peptic fraction of omega-5 gliadin enhances IgE reactivity in wheat-dependent, exercise-induced anaphylaxis. J Allergy Clin Immunol. 2003; 111:1386–1392.

15. Pedersen BK, Steensberg A, Schjerling P. Exercise and interleukin-6. Curr Opin Hematol. 2001; 8:137–141.

16. Morita E, Kunie K, Matsuo H. Food-dependent exercise-induced anaphylaxis. J Dermatol Sci. 2007; 47:109–117.

17. Kleiman J, Ben-Shoshan M. Food-dependent exercise-induced anaphylaxis with negative allergy testing. BMJ Case Rep. 2014; 02. 06. [E-pub] http://dx.doi.org/10.1136/bcr-2013-202057.

18. Oh JW. Food additives and allergic diseases in childhood. Hanyang Med Rev. 2011; 31:261–268.

19. Hawkes C. Nutrition labels and health claims: the global regulatory environment. Geneva: World Health Organization;2004.

20. Sanz ML, Gamboa PM, De Weck AL. In vitro tests: basophil activation tests. In : Pichler WJ, editor. Drug hypersensitivity. Basel: Karger;2007. p. 391–402.

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