EXERCISE-INDUCED ANAPHYLAXIS IS FREQUENTL Y ASSOCIATED WITH SENSITIZATION TO CEREALS

Introduction : Exercise is a rare cause of anaphylaxis. The pathogenic role of food sensitisation is revealed in many of these cases. Our ex perience is based on 51 cases in which the hypothesis of food allergy was systematically investigated as predisposing aetiological agent. Ma terial and methods : 51 consecutive subjects presented signs, mostly s evere, of anaphylaxis occurring during or just after often intense eff ort. Diagnostic methods of food allergy included skin tests, with fres h foods when prick-tests to commercial allergens were negative, and sp ecific IgE assays. Results : Among the foods reported to be responsibl e for sensitisations, previously undiagnosed in these subjects, there was a high frequency of cereals, particularly wheat flour. Peanuts and dry fruit were not exceptional causes, but many other foods have also been reported to be aetiological agents for serious episodes. No food should therefore be neglected in the aetiological survey. In all thes e severe cases, the exercise test is ethically difficult to perform : it is therefore recommended to avoid one or several foods, according t o the clinical history and sensitisations detected, for 5 hours preced ing any intense effort. Application of these eviction measures allowed most subjects to perform physical efforts of comparable intensity to those which previously induced signs of anaphylaxis without the slight est symptom, reflecting the role of diet in the induction of this exer cise-related disease. An aetiological diagnosis was established in 80 per cent of cases based on repeated tests over a prolonged follow-up. Conclusion : In exercise-related anaphylaxis, investigations designed to demonstrate a food allergy are essential. In particular, this surve y must include a systemic search for cereals and fruit, very often pre sent in preparations used by sportsmen. The exclusion of sensitising f oods for 5 hours allows symptom-free effort, in our experience.