Aspirin enhances the induction of type I allergic symptoms when combined with food and exercise in patients with food-dependent exercise-induced anaphylaxis

We examined the effect of aspirin as a substitute for exercise in inducing urticaria/anaphylaxis in three patients with food-dependent exercise-induce d anaphylaxis (FDEIA). Two of the patients had specific IgE antibodies to w heat and the other had antibodies to shrimp. Administration of aspirin befo re ingestion of food allergens induced urticaria in one patient and urticar ia and hypotension in another. while aspirin alone or food alone elicited n o response. The third patient developed urticaria only when he took all thr ee items, i.e. aspirin, food and additional exercise, whereas provocation w ith any one or or two of these did not induce any symptoms. These findings suggest that aspirin upregulates type I allergic responses to food in patie nts with FDEIA, and further shows that aspirin synergizes with exercise to provoke symptoms of FDEIA. This is the first report of a synergistic effect of aspirin in inducing urticaria/anaphylaxis, which was confirmed using ch allenge tests in patients with FDEIA.