Asia Pac Allergy.  2012 Apr;2(2):161-164. 10.5415/apallergy.2012.2.2.161.

Food-dependent exercise-induced anaphylaxis occurred only in a warm but not in a cold environment

• Jo EJ
• Yang MS
• Kim YJ
• Kim HS
• Kim MY
• Kim SH
• Cho SH
• Min KU
• Chang YS

• KMID: 2397370
• DOI: http://doi.org/10.5415/apallergy.2012.2.2.161

Abstract

Food-dependent exercise-induced anaphylaxis (FDEIA) is a type of exercise-induced anaphylaxis associated with postprandial exercise. We describe a 19-year-old man with FDEIA. Our patient complained of urticaria, angioedema, dizziness and hypotension associated with exercise after ingestion of walnut-containing foods in a warm environment. Skin prick test and prick to prick test were positive for walnut antigen. The attack didn't occur by free running outside for 10 min 2 h after taking walnuts, and the temperature was about -2℃. Food-exercise test was done again in a warm environment based on prior history. Anaphylaxis was developed after exercise for 10 min in a warm environment after taking walnuts. Some environmental factors such as high temperature and high humidity or cold temperature may influence exercise-induced anaphylaxis. In our case, the cofactor was a warm environment: the challenge test done in a cold environment was negative, but positive in a warm environment. Physicians should be aware that the challenge test of FDEIA can show different results depending on temperature.

Keyword

Anaphylaxis; Exercise; Food; Heat

MeSH Terms

Anaphylaxis*
Angioedema
Cold Temperature
Dizziness
Eating
Hot Temperature
Humans
Humidity
Hypotension
Juglans
Running
Skin
Urticaria
Young Adult

Figure

• 

  Fig. 1 Prick to prick test for walnuts. The positive control was histamine (4 × 4 mm, arrow), and negative control was normal saline (0 × 0 mm, arrow head). Prick to prick test for walnuts was positive (6 × 5 mm, bold arrow).

• 

  Fig. 2 Symptoms over time at food-exercise test in different temperature. The patient developed severe urticaria, angioedema and dyspnea only in a warm environment but not in a cold environment.

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