title: Provocation tests for the diagnosis of food-dependent exercise-induced anaphylaxis.
abstract: BACKGROUND
  Little has been reported regarding provocation tests for the diagnosis of food-dependent exercise-induced anaphylaxis (FDEIA), especially in children and adolescents. Hence, we here aimed to examine the usefulness and safety of such tests for FDEIA.
  
  
  METHODS
  We retrospectively analyzed 41 patients with 184 provocation tests. The patients underwent ergometer stress tests after ingesting the suspected foods along with aspirin. When one or more allergic symptoms appeared, we judged the provocation test as positive.
  
  
  RESULTS
  Based on 30 positive test results (16%), we diagnosed 20 patients (49%) as FDEIA. The major causative foods were as follows: wheat alone (five patients), combination of wheat and shrimp (three patients), combination of wheat and apple (two patients), and peach alone (two patients). The symptoms appeared within 45 min after initiating exercise in 29 tests (97%). The most frequent symptoms were cutaneous symptoms, which appeared in 25 tests (83%). Of the 30 positive tests, 6 (20%) required administration of adrenaline. After discharge, the patients with negative test results had no episodes of FDEIA due to the suspected foods that they had been tested for.
  
  
  CONCLUSIONS
  Provocation tests enabled us to confirm the diagnosis of FDEIA when positive and to exclude the diagnosis when negative. However, as severe symptoms may appear, these tests should be performed in a hospital under constant supervision of a physician.
authors.affiliation: Department of Pediatrics, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Asaumi
authors.affiliation: Department of Pediatrics, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yanagida
authors.affiliation: Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
authors.forename: Sakura
authors.initials: S
authors.lastname: Sato
authors.affiliation: Futaba kids' clinic, Tokyo, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Shukuya
authors.affiliation: Department of Pediatrics, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishino
authors.affiliation: Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Ebisawa
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000485:Allergens / Q000008:administration & dosage* / Q000276:immunology; D000707:Anaphylaxis / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D018926:Anti-Allergic Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage; D015444:Exercise; D005080:Exercise Test; D005260:Female; D005512:Food Hypersensitivity / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007159:Immunologic Tests; D007428:Intradermal Tests; D008168:Lung / Q000187:drug effects / Q000276:immunology* / Q000503:physiopathology; D008297:Male; D010366:Peak Expiratory Flow Rate; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012698:Serologic Tests; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D000485:Allergens; D018926:Anti-Allergic Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D007073:Immunoglobulin E; D001241:Aspirin; D004837:Epinephrine
keywords: Provocation test; food-dependent exercise-induced anaphylaxis