title: Cows milk-dependent exercise-induced anaphylaxis under the condition of a premenstrual or ovulatory phase following skin sensitization.
abstract: BACKGROUND
  A 24 year-old woman with atopic dermatitis occasionally developed symptoms, including dyspnea and generalized urticaria, following ingestion of food containing cows milk. Similar episodes had continued, and had been treated empirically since the age of 16 years.
  
  
  METHODS
  Although a skin test and IgE RAST showed positive reactions to cows milk, a provocation test with cows milk alone did not induce any symptoms. Therefore, food-dependent exercise-induced anaphylaxis (FDEIA) was suspected, but examination using various combinations of cows milk, aspirin and exercise failed to elicit any symptoms. Finally, a provocation test during the ovulatory phase with cows milk followed by aspirin and exercise evoked systemic urticaria, dyspnea and hypotension.
  
  
  CONCLUSIONS
  The symptoms against cows milk began when she took baths with bath salts containing cows milk as its main ingredient for one year at the age 15 years. Sensitization to cows milk through eczematous skin is indicated from this history. Hormonal change during a premenstrual or ovulatory phase is also an important factor for the development of FDEIA in this case.
authors.affiliation: Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. bito@med.kobe-u.ac.jp
authors.forename: Toshinori
authors.initials: T
authors.lastname: Bito
authors.forename: Eriko
authors.initials: E
authors.lastname: Kanda
authors.forename: Minako
authors.initials: M
authors.lastname: Tanaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fukunaga
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Horikawa
authors.forename: Chikako
authors.initials: C
authors.lastname: Nishigori
mesh_terms: D000707:Anaphylaxis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D000818:Animals; D001250:Asthma, Exercise-Induced / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D001494:Baths; D002909:Chronobiology Phenomena / Q000276:immunology; D003876:Dermatitis, Atopic / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004417:Dyspnea; D005260:Female; D006728:Hormones / Q000235:genetics / Q000276:immunology / Q000378:metabolism*; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D008183:Luteal Phase / Q000276:immunology; D016269:Milk Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012492:Salts; D012882:Skin Tests; D014581:Urticaria; D055815:Young Adult
chemical_list: D006728:Hormones; D012492:Salts; D007073:Immunoglobulin E