Food-dependent exercise-induced anaphylaxis - a review of 5 cases.
BACKGROUND
Food-dependent exercise-induced anaphylaxis (FDEIA) is an uncommon and under-recognised syndrome that clinicians may not consider in a patient presenting with anaphylaxis.


METHODS
We describe here 5 patients aged 9 to 20 years old who presented at a local tertiary hospital over a 2-year period from August 2006 to July 2008. All presented with urticaria, 4 were hypotensive, 2 had angioedema and another 2 had dyspnoea. The symptoms occurred between 15 and 150 minutes (mean, 81) after exercising and consuming various food. All had consumed shellfish. All patients were admitted with the diagnosis of anaphylaxis of undefined aetiology. Diagnosis of FDEIA was only reached upon referral to an allergist.


RESULTS
Patients were treated with standard medicines for anaphylaxis including adrenaline, antihistamines, steroids and fluid flushes. Symptoms resolved in 2 to 3 days with no further episodes. At discharge, patients were prescribed epinephrine auto-injectors and given written anaphylaxis management plans.


CONCLUSIONS
More public awareness and strategies to ensure accurate diagnosis and management of this condition are necessary.
Teo
Shu-Lin
SL
Department of Paediatrics, National University of Singapore, Singapore.
Gerez
Irvin Francis A
IF
Ang
Elizabeth Y
EY
Shek
Lynette P
LP
D000293:Adolescent; D000707:Anaphylaxis / Q000188:drug therapy / Q000209:etiology*; D000799:Angioedema / Q000209:etiology; D000818:Animals; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D004417:Dyspnea / Q000209:etiology; D004837:Epinephrine / Q000627:therapeutic use; D015444:Exercise; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D017747:Seafood / Q000009:adverse effects* / Q000633:toxicity; D013577:Syndrome; D014581:Urticaria / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D055815:Young Adult
D001993:Bronchodilator Agents; D014662:Vasoconstrictor Agents; D004837:Epinephrine