EXERCISE-INDUCED ANAPHYLAXIS - USEFUL SCREENING OF FOOD SENSITIZATION

Background and objectives: Exercise-induced anaphylaxis is a well-defi ned entity as described by Sheffer and Austen. Exercise-induced anaphy laxis can be associated with ingestion of a specific food. We report o ur experience with a series of cases of exercise-induced anaphylaxis i n which anaphylaxis was considered to be associated with food allergy. Methods: We observed 19 patients in whom severe systemic signs of ana phylaxis occurred during or immediately after exercise, while the seve rity of reactions excluded challenge testing. The causal relationship with various foods was systematically investigated in all cases, even in the absence of any history of allergy. Results: Sensitization to wh eat flour was demonstrated in 12 patients, to peanut in seven, and to tree nuts in six cases with skin tests and/or RAST. Sensitivity to var ious other foods was found less often. Further, avoidance of specific foods according to results of skin tests and RAST was systematically o bserved during the five hours prior to exercise and no symptom occurre d, suggesting a role of specific food intake in the pathogenesis of ex ercise-induced anaphylaxis. With such elimination diets, most of these young patients were able to engage in regular vigorous exercises (mor e than twice a week in some cases) without any clinical manifestation with a median followup of 2 years. In two patients, however, recurrenc e of exercise-induced anaphylaxis was subsequently explained by concom itant ingestion of other foods such as rice and peanut. Additional avo idance of these foods before exercise was then effective in 14 cases ( median follow up: 2 years). Conclusions: Investigations to detect food sensitization, in particular to wheat, peanut and/or tree nuts, and s pecific avoidance of these foods five hours before exercise appear ess ential in cases of exercise-induced anaphylaxis.