- Volume 7 Issue 5
DOI QR Code
Combined effects of food and exercise on anaphylaxis
- Kim, Cheol Woo ;
- Figueroa, Arturo ;
- Park, Chan Ho ;
- Kwak, Yi Sub ;
- Kim, Kwi Baek ;
- Seo, Dae Yun ;
- Lee, Hyung Rock
- Received : 2013.03.12
- Accepted : 2013.07.26
- Published : 2013.10.01
Food-dependent exercise-induced anaphylaxis (FDEIAn) is induced by different types and various intensities of physical activity, and is distinct from food allergies. It has been shown that consumption of allergenic food followed by exercise causes FDEIAn symptoms. Intake of allergenic food or medication before exercise is a major predisposing factor for FDEIAn. Urticaria and severe allergic reactions are general symptoms of FDEIAn. Dermatological tests and serum IgE assays are the typical prescreening methods, and have been used for several decades. However, these screening tests are not sufficient for detecting or preventing FDEIAn. It has been found that exercise may stimulate the release of mediators from IgE-dependent mast cells that can result in FDEIAn when a certain threshold level has been exceeded. Mast cell degradation might be a major factor to induce FDEIAn but this has not been determined. A number of foods have been reported to be involved in the onset of FDEIAn including wheat, eggs, chicken, shrimp, shellfish, nuts, fruits, and vegetables. It is also known that aspirin increases the occurrence of type I allergy symptoms when combined with specific foods. Moreover, high intensity and frequent exercise are more likely to provoke an attack than low intensity and less frequent exercise. In this paper, we present the current views of the pathophysiological mechanisms underlying FDEIAn within the context of exercise immunology. We also present a detailed FDEIAn definition along with etiologic factors and medical treatment for cholinergic urticaria (UC) and exercise-induced anaphylaxis (EIA).
- Thong BY, Cheng YK, Leong KP, Tang CY, Chng HH. Immediate food hypersensitivity among adults attending a clinical immunology/allergy centre in Singapore. Singapore Med J 2007; 48:236-40.
- Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P, van Hage-Hamsten M, Wuthrich B; EAACI (the European Academy of Allergology and Cinical Immunology) nomenclature task force. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001;56:813-24. https://doi.org/10.1034/j.1398-9995.2001.t01-1-00001.x
- Romano A, Di Fonso M, Giuffreda F, Papa G, Artesani MC, Viola M, Venuti A, Palmieri V, Zeppilli P. Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol 2001;125:264-72. https://doi.org/10.1159/000053825
- Tang ML, Osborne N, Allen K. Epidemiology of anaphylaxis. Curr Opin Allergy Clin Immunol 2009;9:351-6. https://doi.org/10.1097/ACI.0b013e32832db95a
- Lieberman P. Epidemiology of anaphylaxis. Curr Opin Allergy Clin Immunol 2008;8:316-20. https://doi.org/10.1097/ACI.0b013e3283036a69
- Horne NS, Lin RY. Food-dependent exercise-induced anaphylaxis. Internet J Asthma Allergy Immunol [Internet]. 2008 October 6 [cited 2013 March 12]. Available from: http://archive.ispub.com/ journal/the-internet-journal-of-asthma-allergy-and-immunology/ volume-6-number-2/food-dependent-exercise-induced-anaphylaxi s.html#sthash.O1NYi6I6.gVZmS2os.dpbs.
- Shadick NA, Liang MH, Partridge AJ, Bingham C, Wright E, Fossel AH, Sheffer AL. The natural history of exercise-induced anaphylaxis: survey results from a 10-year follow-up study. J Allergy Clin Immunol 1999;104:123-7. https://doi.org/10.1016/S0091-6749(99)70123-5
- Stellato C, de Crescenzo G, Patella V, Mastronardi P, Mazzarella B, Marone G. Human basophil/mast cell releasability. XI. Heterogeneity of the effects of contrast media on mediator release. J Allergy Clin Immunol 1996;97:838-50. https://doi.org/10.1016/S0091-6749(96)80162-X
- Sheffer AL, Soter NA, McFadden ER Jr, Austen KF. Exerciseinduced anaphylaxis: a distinct form of physical allergy. J Allergy Clin Immunol 1983;71:311-6. https://doi.org/10.1016/0091-6749(83)90085-4
- 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;75:479-84. https://doi.org/10.1016/S0091-6749(85)80021-X
- Nichols AW. Exercise-induced anaphylaxis and urticaria. Clin Sports Med 1992;11:303-12.
- Beaudouin E, Renaudin JM, Morisset M, Codreanu F, Kanny G, Moneret-Vautrin DA. Food-dependent exercise-induced anaphylaxis-- update and current data. Eur Ann Allergy Clin Immunol 2006; 38:45-51.
- Harada S, Horikawa T, Icihashi M. A study of food-dependent exercise-induced anaphylaxis by analyzing the Japanese cases reported in the literature. Arerugi 2000;49:1066-73.
- Hough DO, Dec KL. Exercise-induced asthma and anaphylaxis. Sports Med 1994;18:162-72. https://doi.org/10.2165/00007256-199418030-00003
- Nakamizo S, Egawa G, Miyachi Y, Kabashima K. Cholinergic urticaria: pathogenesis-based categorization and its treatment options. J Eur Acad Dermatol Venereol 2012;26:114-6. https://doi.org/10.1111/j.1468-3083.2011.04017.x
- Horan RF, Sheffer AL, Briner WW Jr. Physical allergies. Med Sci Sports Exerc 1992;24:845-8.
- Tlougan BE, Mancini AJ, Mandell JA, Cohen DE, Sanchez MR. Skin conditions in figure skaters, ice-hockey players and speed skaters: part I - mechanical dermatoses. Sports Med 2011;41: 709-19. https://doi.org/10.2165/11590540-000000000-00000
- Kim G. Primary (idiopathic) cold urticaria and cholinergic urticaria. Dermatol Online J 2004;10:13.
- Castells MC, Horan RF, Sheffer AL. Exercise-induced anaphylaxis (EIA). Clin Rev Allergy Immunol 1999;17:413-24. https://doi.org/10.1007/BF02737646
- Tilles S, Schocket A, Milgrom H. Exercise-induced anaphylaxis related to specific foods. J Pediatr 1995;127:587-9. https://doi.org/10.1016/S0022-3476(95)70118-4
- Flannagan LM, Wolf BC. Sudden death associated with food and exercise. J Forensic Sci 2004;49:543-5.
- Lin RY, Curry A, Pesola GR, Knight RJ, Lee HS, Bakalchuk L, Tenenbaum C, Westfal RE. Improved outcomes in patients with acute allergic syndromes who are treated with combined H1 and H2 antagonists. Ann Emerg Med 2000;36:462-8. https://doi.org/10.1016/S0196-0644(00)43749-2
- Hosey RG, Carek PJ, Goo A. Exercise-induced anaphylaxis and urticaria. Am Fam Physician 2001;64:1367-72.
- Kidd JM 3rd, Cohen SH, Sosman AJ, Fink JN. Food-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol 1983;71: 407-11. https://doi.org/10.1016/0091-6749(83)90070-2
- Caffarelli C, Terzi V, Perrone F, Cavagni G. Food related, exercise induced anaphylaxis. Arch Dis Child 1996;75:141-4. https://doi.org/10.1136/adc.75.2.141
- Kurowski K, Boxer RW. Food allergies: detection and management. Am Fam Physician 2008;77:1678-86.
- Gonzalez-Quintela A, Vidal C, Gude F. Alcohol, IgE and allergy. Addict Biol 2004;9:195-204. https://doi.org/10.1080/13556210412331292235
- Kjaer BN, Laursen LC. Food-dependent exercise-induced anaphylaxis. Ugeskr Laeger 2008;170:4058.
- Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Juji F, Okudaira H, Sano Y, Ito K, Miyamoto T. Food-dependent, exercise-induced anaphylaxis: a study on 11 Japanese cases. J Allergy Clin Immunol 1991;87:34-40. https://doi.org/10.1016/0091-6749(91)90210-F
- Lee WJ, Kwak YS, Yoo BI. Effects of different exercise intensity on FDEIA and related mechanisms. J Life Sci. 2011;21:542-8. https://doi.org/10.5352/JLS.2011.21.4.542
- Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Okudaira H, Ito K, Miyamoto T. 3 cases of food-dependent exercise-induced anaphylaxis in which aspirin intake exacerbated anaphylactic symptoms. Arerugi 1990;39:1598-604.
- Stratbucker WB, Sammut PH. Exercise-induced anaphylaxis. Emedicine [Internet]. 2013 March 6 [cited March 27]. Available from: http://emedicine.medscape.com/article/886641-overview.
- Kim CH, Kwak YS. Swim training increases ovalbumin induced active systemic anaphylaxis in mice. Immunol Invest 2004;33: 469-80. https://doi.org/10.1081/IMM-200039190
- Kwak YS, Baek YH, Kim SH, Kim YI, Yoo BI. The review of environment, food and exercise on allergy anaphylaxis. J Life Sci. 2010;20:147-52. https://doi.org/10.5352/JLS.2010.20.1.147
- Kwak YS. Studies of exercise-induced allergy anaphylaxis mechanisms and the effects of vitamin C and catalase supplementation in exercise-induced allergy anaphylaxis models. J Life Sci. 2010;20:511-8. https://doi.org/10.5352/JLS.2010.20.4.511
- Porebski G, Obtułowicz K, Obtułowicz P. Exercise-induced asthma and anaphylaxis. Przegl Lek 2002;59:442-5.
- Barg W, Medrala W, Wolanczyk-Medrala A. Exercise-induced anaphylaxis: an update on diagnosis and treatment. Curr Allergy Asthma Rep 2011;11:45-51. https://doi.org/10.1007/s11882-010-0150-y
- Lieberman P, Decker W, Camargo CA Jr, Oconnor R, Oppenheimer J, Simons FE. SAFE: a multidisciplinary approach to anaphylaxis education in the emergency department. Ann Allergy Asthma Immunol 2007;98:519-23. https://doi.org/10.1016/S1081-1206(10)60729-6
- Fujii H, Kambe N, Fujisawa A, Kohno K, Morita E, Miyachi Y. Food-dependent exercise-induced anaphylaxis induced by low dose aspirin therapy. Allergol Int 2008;57:97-8. https://doi.org/10.2332/allergolint.C-07-53
- Wylon K, Hompes S, Worm M. Exercise-induced anaphylaxis. Hautarzt 2013;64:97-101. https://doi.org/10.1007/s00105-012-2451-7
- An alternative method to reduce anaphylaxis by moxibustion vol.4, pp.2, 2014, https://doi.org/10.5667/tang.2014.0011
- Food dependant exercise induced anaphylaxis a retrospective study from 2 allergy clinics in Colombo, Sri Lanka vol.11, pp.1, 2015, https://doi.org/10.1186/s13223-015-0089-6
- The Clinical Evaluation between Overtraining Syndrome and Exercise-related Immunity vol.25, pp.11, 2015, https://doi.org/10.5352/JLS.2015.25.11.1324
- Can we identify patients at risk of life-threatening allergic reactions to food? vol.71, pp.9, 2016, https://doi.org/10.1111/all.12924
- Mite-Induced Asthma and IgE Levels to Shrimp, Mite, Tropomyosin, Arginine Kinase, and Der p 10 Are the Most Relevant Risk Factors for Challenge-Proven Shrimp Allergy vol.174, pp.3-4, 2017, https://doi.org/10.1159/000481985
- Food-Dependent Exercise-Induced Anaphylaxis vol.5, pp.2, 2018, https://doi.org/10.1007/s40521-018-0171-7
- Exercise-induced anaphylaxis: causes, consequences, and management recommendations vol.15, pp.3, 2019, https://doi.org/10.1080/1744666X.2019.1562904
Supported by : Dong-Eui University Foundation