Apple-dependent exercise-induced anaphylaxis

Dong Hyun Kim; Kyung Hee Park; Young Joo Kim; Jun Ho Kim; Hee Jae Han; Hye Jung Park; Jung-Won Park; Jae-Hyun Lee

doi:10.4168/aard.2015.3.3.224

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Kim, Park, Kim, Kim, Han, Park, Park, and Lee: Apple-dependent exercise-induced anaphylaxis

Case Report

Allergy, Asthma & Respiratory Disease 2015; 3(3): 224-227.

Published online: 29 May 2015

DOI: https://doi.org/10.4168/aard.2015.3.3.224

Apple-dependent exercise-induced anaphylaxis

Dong Hyun Kim¹, Kyung Hee Park^1,², Young Joo Kim¹, Jun Ho Kim¹, Hee Jae Han², Hye Jung Park^1,², Jung-Won Park^1,², Jae-Hyun Lee^1,²

¹Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

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

Correspondence to: Jae-Hyun Lee. http://orcid.org/0000-0002-0760-0071, Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-1987, Fax: +82-2-393-6884, jhleemd@yuhs.ac

Received 23 March 2015 Revised 5 April 2015 Accepted 16 April 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 specific variant of anaphylaxis that requires both vigorous physical activity and the ingestion of specific causative foods. In particular, occurrence for FDEIA is rarely associated with apples. A 17-year-old male experienced generalized urticaria, dyspnea, headache, vomiting, and presyncope after ingestion of an apple and then 2 hours of exercise. The skin prick test showed a strong positive reaction to apple crude allergen extract, whereas the results of an open food challenge and exercise provocation tests were negative. However, the exercise test after apple consumption provoked a positive reaction with generalized urticaria, dyspnea, and presyncope. We detected 17 kD IgE-reactive protein band in immunoblotting assay with apple crude extract and patient's serum.

Keywords: Anaphylaxis, Food hypersensitivity, Immunoblotting

Figures and Tables

Fig. 1

Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and IgE immunoblotting of apple antigen. (A) Negative control, (B) apple allergy patient, and (C) apple dependent exercise induced anaphylaxis patient.

Table 1

Skin prick test results of multiple food allergens

Allergen	Wheal (mm)	Erythema (mm)
Milk	0	0
Egg. whole	0	0
Shrimp	0	0
Soybean whole	4×2	5×5
Peanut	0	0
Wheat flour	0	0
Chicken	0	0
Pork	0	0
Beef	0	0
Apple	6×5	8×8
Peach	0	0
Histamine	3×3	3×4
Saline (0.9%)	0	0

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ORCID iDs: Jae-Hyun Lee
https://orcid.org/http://orcid.org/0000-0002-0760-0071
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