Nutr Res Pract.  2013 Oct;7(5):347-351. 10.4162/nrp.2013.7.5.347.

Combined effects of food and exercise on anaphylaxis

• Kim CW
• Figueroa A
• Park CH
• Kwak YS
• Kim KB
• Seo DY
• Lee HR

• KMID: 1841304
• DOI: http://doi.org/10.4162/nrp.2013.7.5.347

Abstract

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).

Keyword

Food; exercise; anaphylaxis; FDEIAn

MeSH Terms

Anaphylaxis
Aspirin
Chickens
Eggs
Food Hypersensitivity
Fruit
Hypersensitivity
Immunoglobulin E
Mass Screening
Mast Cells
Motor Activity
Nuts
Ovum
Shellfish
Triticum
Urticaria
Vegetables
Aspirin
Immunoglobulin E

Reference

1. 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; 56:813–824.

2. 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; 125:264–272.

3. Tang ML, Osborne N, Allen K. Epidemiology of anaphylaxis. Curr Opin Allergy Clin Immunol. 2009; 9:351–356.

4. Lieberman P. Epidemiology of anaphylaxis. Curr Opin Allergy Clin Immunol. 2008; 8:316–320.

5. 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-anaphylaxis.html#sthash.O1NYi6I6.gVZmS2os.dpbs.

6. 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; 48:236–240.

7. 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; 104:123–127.

8. 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; 97:838–850.

9. Sheffer AL, Soter NA, McFadden ER Jr, Austen KF. Exercise-induced anaphylaxis: a distinct form of physical allergy. J Allergy Clin Immunol. 1983; 71:311–316.

10. 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; 75:479–484.

11. 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.

12. 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; 49:1066–1073.

13. Hough DO, Dec KL. Exercise-induced asthma and anaphylaxis. Sports Med. 1994; 18:162–172.

14. Nichols AW. Exercise-induced anaphylaxis and urticaria. Clin Sports Med. 1992; 11:303–312.

15. Nakamizo S, Egawa G, Miyachi Y, Kabashima K. Cholinergic urticaria: pathogenesis-based categorization and its treatment options. J Eur Acad Dermatol Venereol. 2012; 26:114–116.

16. Horan RF, Sheffer AL, Briner WW Jr. Physical allergies. Med Sci Sports Exerc. 1992; 24:845–848.

17. 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; 41:709–719.

18. Kim G. Primary (idiopathic) cold urticaria and cholinergic urticaria. Dermatol Online J. 2004; 10:13.

19. Castells MC, Horan RF, Sheffer AL. Exercise-induced anaphylaxis (EIA). Clin Rev Allergy Immunol. 1999; 17:413–424.

20. Tilles S, Schocket A, Milgrom H. Exercise-induced anaphylaxis related to specific foods. J Pediatr. 1995; 127:587–589.

21. Flannagan LM, Wolf BC. Sudden death associated with food and exercise. J Forensic Sci. 2004; 49:543–545.

22. Hosey RG, Carek PJ, Goo A. Exercise-induced anaphylaxis and urticaria. Am Fam Physician. 2001; 64:1367–1372.

23. Kidd JM 3rd, Cohen SH, Sosman AJ, Fink JN. Food-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol. 1983; 71:407–411.

24. Caffarelli C, Terzi V, Perrone F, Cavagni G. Food related, exercise induced anaphylaxis. Arch Dis Child. 1996; 75:141–144.

25. 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; 36:462–468.

26. Kurowski K, Boxer RW. Food allergies: detection and management. Am Fam Physician. 2008; 77:1678–1686.

27. Gonzalez-Quintela A, Vidal C, Gude F. Alcohol, IgE and allergy. Addict Biol. 2004; 9:195–204.

28. Kjaer BN, Laursen LC. Food-dependent exercise-induced anaphylaxis. Ugeskr Laeger. 2008; 170:4058.

29. 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.

30. Lee WJ, Kwak YS, Yoo BI. Effects of different exercise intensity on FDEIA and related mechanisms. J Life Sci. 2011; 21:542–548.

31. 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; 39:1598–1604.

32. Kim CH, Kwak YS. Swim training increases ovalbumin induced active systemic anaphylaxis in mice. Immunol Invest. 2004; 33:469–480.

33. Kwak YS, Baek YH, Kim SH, Kim YI, Yoo BI. The review of environment, food and exercise on allergy anaphylaxis. J Life Sci. 2010; 20:147–152.

34. 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; 20:511–518.

35. Stratbucker WB, Sammut PH. Exercise-induced anaphylaxis. Emedicine [Internet]. 2013 March 6. cited March 27. Available from: http://emedicine.medscape.com/article/886641-overview.

36. Porebski G, Obtułowicz K, Obtułowicz P. Exercise-induced asthma and anaphylaxis. Przegl Lek. 2002; 59:442–445.

37. Barg W, Medrala W, Wolanczyk-Medrala A. Exercise-induced anaphylaxis: an update on diagnosis and treatment. Curr Allergy Asthma Rep. 2011; 11:45–51.

38. 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; 98:519–523.

39. 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; 57:97–98.

40. Wylon K, Hompes S, Worm M. Exercise-induced anaphylaxis. Hautarzt. 2013; 64:97–101.