Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at NSU
Food-dependent exercise-induced anaphylaxis (FDEIA) is a special form of food allergy where a food-intake alone does not induce any symptoms. Anaphylaxis occurs only when triggering factors such as exercise or aspirin-intake are added after ingestion of the causative food.
Clinical features of FDEIA
In FDEIA, patients develop anaphylaxis after eating and exercising. They have no symptoms are rest.
Sequence of events: eating --> exercise --> anaphylaxis
There are two types of patients with food-dependent EIA ("generalists" and "specialists"):
- Patients who develop anaphylaxis when exercising in temporal proximity to ingestion of any
type of food ("generalists")
- Patients who develop anaphylaxis with exercise only with ingestion of a specific food ("specialists")
Foods associated with FDEIA
Wheat is the most common food associated with food-dependent exercise-induced anaphylaxis (FDEIA). Both exercise and aspirin-intake facilitate allergen absorption from the gastrointestinal tract.
80% of the patients with wheat-induced FDEIA have IgE reacting to omega-5 gliadin and the remaining of the patients to high molecular weight glutenin (HMW-glutenin).
Foods associated with FDEIA
- Wheat. Prevalence of wheat allergy in Japan is 0.2% - the assessment was based on questionnaire-based exam, skin prick test, and omega-5 gliadin sIgE (http://goo.gl/Mp4nW).
- Buckwheat
- Crustaceans
- Cephalopods
- Celery
- Chicken
- Grapes
- Tomato
- Dairy products
- Mushrooms
Management of FDEIA
Management of FDEIA
Management of food-dependent EIA includes:
- avoiding exercising in proximity to food consumption (4-6 hours)
- carrying self-injectable epinephrine (EpiPen)
- exercising with a partner
- wearing a medical alert bracelet which lists the condition FDEIA and treatment (EpiPen)
Which of the following foods is often associated with food-dependent exercise-induced anaphylaxis (FDEIA)?
(A) peanut
(B) fish
(C) wheat
(D) soy
(E) egg
(F) milk
Answer: C.
Please note that FDEIA is different from exercise-induced bronchospasm (EIB) (click to enlarge the image):
References
Food-Dependent Exercise-Induced Anaphylaxis-Importance of Omega-5 Gliadin and HMW-Glutenin as Causative Antigens for Wheat-Dependent Exercise-Induced Anaphylaxis. Morita E, Matsuo H, Chinuki Y, Takahashi H, Dahlström J, Tanaka A. Allergol Int. 2009 Oct 25;58(4).
LTP and PG2A are tomato allergens http://goo.gl/C4Hhv
Anaphylaxis guidelines by World Allergy Organization. JACI, 2011.
Key figures: New nomenclature and classification of gluten-related disorders and Algorithm for the differential diagnosis of gluten-related disorders, including celiac disease, gluten sensitivity and wheat allergy. BMC Medicine 2012.
Published: 05/09/2010
Updated: 02/09/2012
Key figures: New nomenclature and classification of gluten-related disorders and Algorithm for the differential diagnosis of gluten-related disorders, including celiac disease, gluten sensitivity and wheat allergy. BMC Medicine 2012.
Published: 05/09/2010
Updated: 02/09/2012
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