Analysis of clinical characteristics of food-dependent exercise-induced anaphylaxis at a single tertiary hospital

Soo Jie Chung; Jisu Shim; Hyung-Jun Kim; Kyoung-Hee Sohn; Sung-Yoon Kang; Min-Gyu Kang; Han-Ki Park; Hye-Ryun Kang

doi:10.4168/aard.2016.4.6.436

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Chung, Shim, Kim, Sohn, Kang, Kang, Park, and Kang: Analysis of clinical characteristics of food-dependent exercise-induced anaphylaxis at a single tertiary hospital

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(6): 436-441.

Published online: 30 November 2016

DOI: https://doi.org/10.4168/aard.2016.4.6.436

Analysis of clinical characteristics of food-dependent exercise-induced anaphylaxis at a single tertiary hospital

Soo Jie Chung^1,², Jisu Shim^1,², Hyung-Jun Kim¹, Kyoung-Hee Sohn^1,², Sung-Yoon Kang^1,², Min-Gyu Kang³, Han-Ki Park^1,², Hye-Ryun Kang^1,²

¹Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.

²Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.

³Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.

Correspondence to: Hye-Ryun Kang. Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-0820, Fax: +82-2-742-3291, helenmed@snu.ac.kr

Received 15 July 2016 Revised 18 August 2016 Accepted 2 September 2016

(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/4.0/).

Abstract

Purpose

Food-dependent exercise-induced anaphylaxis (FDEIA) is a rare subtype of food allergy in which both sensitization to food allergen and exercise as a trigger contribute to its development. However, its pathogenesis is still under investigation. This study compared clinical features, the causative foods, and the degree of sensitization to food between FDEIA and food anaphylaxis to characterize FDEIA more clearly.

Methods

We retrospectively reviewed the medical records of patients who were diagnosed with FDEIA (n=89) or food anaphylaxis (n=115) between 2003 and 2015 at Seoul National University Hospital.

Results

Subjects with FDEIA more frequently had urticaria than those with food anaphylaxis (88.8% vs. 76.5%, P=0.024). Whereas patients with FDEIA had less laryngeal edema than those with food anaphylaxis (12.4% vs. 30.4%, P=0.02). Wheat (67.4%) was the most common causative food allergen in FDEIA, whereas seafood (40.9%) was the most common culprit food allergen in food anaphylaxis. Also, subjects with FDEIA showed a lower atopic index score than those with food anaphylaxis (0.55±1.07 vs. 1.21±1.82, P=0.006).

Conclusion

There were significant differences in clinical manifestation, causative food allergens and the degree of sensitization to food between FDEIA and food anaphylaxis.

Keywords: Hypersensitivity, Immediate, Anaphylaxis, Food hypersensitivity, Allergens, Exercise

Figures and Tables

Fig. 1

The causative foods for patients with FDEIA (A) and food anaphylaxis (B).

Table 1

Comparison of clinical parameters between FDEIA and food anaphylaxis

Variable	FDEIA (n = 89)	Food anaphylaxis (n = 115)	P-value
Age (yr)	31.67 ± 14.27	41.36 ± 16.69	< 0.001
Male sex	57 (51.4)	54 (48.6)	0.015
Past history of allergic disease
Asthma	3 (3.4)	7 (6.1)	0.373
Allergic rhinitis	16 (18.0)	27 (23.5)	0.339
Clinical manifestation
Cutaneous	86 (96.6)	105 (91.3)	0.123
Urticaria	79 (88.8)	88 (76.5)	0.024
Angioedema	41 (46.1)	68 (59.1)	0.064
Respiratory	54 (60.7)	75 (65.2)	0.505
Laryngeal edema	11 (12.4)	35 (30.4)	0.002
Dyspnea	54 (60.7)	69 (62.5)	0.505
Gastrointestinal	16 (18.0)	27 (23.5)	0.339
Nausea/vomiting	12 (13.5)	17 (14.8)	0.792
Abdominal pain	4 (4.5)	18 (15.7)	0.011
Diarrhea	3 (3.4)	7 (6.1)	0.373
Cardiovascular	62 (69.7)	44 (38.3)	< 0.001
Hypotension	37 (41.6)	37 (32.2)	0.166
Syncope	27 (30.3)	24 (20.9)	0.121
Dizziness	17 (19.1)	13 (11.3)	0.119
Genitourinary	0 (0)	4 (3.5)	0.076
Incontinency	0 (0)	4 (3.5)	0.076
Eosinophil (/mm³)	163.79 ± 273.41	184.70 ± 187.77	0.548
Serum total IgE (IU/mL)	340.12 ± 348.43	333.07 ± 398.75	0.912
A/H ratio ≥ 1.0 to causative food	2 (5.9)	25 (40.0)	< 0.001

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

FDEIA, food dependent exercise induced anaphylaxis; A/H ratio, allergen histamine ratio.

Table 2

Atopic index and atopic score of skin prick test

Variable	FDEIA (n = 89)	Food anaphylaxis (n = 115)	P-value
Inhalant allergens
Atopic index	1.77 ± 4.90	2.24 ± 2.59	0.488
Atopic score	5.45 ± 10.97	8.00 ± 7.75	0.994
Food allergens
Atopic index	0.55 ± 1.07	1.21 ± 1.82	0.006
Atopic score	3.44 ± 3.92	5.15 ± 5.98	0.061

Values are presented as mean±standard deviation.

FDEIA, food dependent exercise induced anaphylaxis.

Table 3

The degree of sensitization measurement by radioallergosorbent test

Class	FDEIA	Food anaphylaxis
0	17 (37.8)	11 (20.8)
1	9 (20.0)	3 (5.7)
2	13 (28.9)	30 (56.6)
3	5 (11.1)	7 (13.2)
4	1 (2.2)	1 (1.9)
5	0 (0)	1 (1.9)
6	0 (0)	0 (0)
≥ 1	28 (62.2)	42 (79.2)^*

Values are presented as number (%).

FDEIA, food dependent exercise induced anaphylaxis.

Class 0, < 0.35 IU/mL; class 1, 0.35–0.69 IU/mL; class 2, 0.70–3.49 IU/mL; class 3, 3.50–17.49 IU/mL; class 4, 17.50–49.99 IU/mL; class 5, 50.00–100 IU/mL; class 6, > 100 IU/mL.

^*P= 0.074.

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ORCID iDs: Hye-Ryun Kang
https://orcid.org/http://orcid.org/0000-0002-2317-4201
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