Food dependant exercise induced anaphylaxis a retrospective study from 2 allergy clinics in Colombo, Sri Lanka

Abstract

The aetiology of anaphylaxis ranges from food, insect venom, drugs and various chemicals. Some individuals do not develop anaphylaxis with the offending agent unless ingestion is related temporally to physical exertion, namely food dependent exercise induced anaphylaxis (FDEIA). The foods implicated are wheat, soya, peanut, milk and sea food. A retrospective study on patients with FDEIA from two Allergy clinics in Sri Lanka from 2011 to 2015 is reported. Patients were selected who fulfilled the following criteria: clinical diagnosis of anaphylaxis according to the World Allergy Organization (WAO) criteria, where the onset of symptoms was during exertion, within 4 h of ingesting a food, the ability to eat the implicated food independent of exercise, or exercise safely, if the food was not ingested in the preceding 4 h and an in vitro (ImmunoCap serum IgE to the food) or in vivo (skin prick test) test indicating evidence of sensitivity to the food. There were 19 patients (12 males: 7 females). The ages ranged from 9 to 45 (mean 22.9, median 19 years). Eight patients (42.1%) were in the 9–16 age group. Those below 16 years had a male:female ratio of 3:5, while for those above 16 years it was 9:2. Wheat was the only food implicated in FDEIA in all patients and was confirmed by skin prick testing, or by ImmunoCap specific IgE to wheat or ω − 5 gliadin. All patients had urticaria, while 5/19 (26.3%) had angioedema of the lips. Fifteen patients (78.9%) had shortness of breath or wheezing, while 8 (42.1%) had lost consciousness. Nine patients (47. 3%) had hypotension. Fourteen (73.6%) of our patients had severe reactions, with loss of consciousness or hypotension, while 5 (26.3%) had symptoms related to the gastrointestinal tract. One patient developed anaphylaxis on two occasions following inhalation of ganja, a local cannabis derivative along with the ingestion of wheat and exertion. Wheat is the main food implicated in FDEIA in Sri Lanka. A local cannabis derivative, ganja has been implicated as a cofactor for the first time.

Comorbidities and Cofactors of Anaphylaxis in Patients with Moderate to Severe Anaphylaxis. Analysis of Data from the Anaphylaxis Registry for West Pomerania Province, Poland

“…We recorded only one case in 236 women where menstruation was a cofactor. Nevertheless, single cases have been reported, indicating beyond any doubt, a significant effect of menstruation on the onset of anaphylaxis [ 66 ].…”

Aetiology of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka

“…Data on the aetiology of anaphylaxis from South Asian countries is not available. The demographics or aetiology of anaphylaxis in Sri Lanka has not been systematically studied with the only available data being the aetiology of anaphylaxis due to specific triggers such as food dependent exercise induced anaphylaxis (FDEIA) and anaphylaxis to vaccines [ 9 , 10 ]. Since the prevalence of allergy related diseases are reported to be on the rise in many countries including Sri Lanka [ 11 ], the study of causes of anaphylaxis in South Asian countries such as Sri Lanka is necessary.…”

Food-dependent exercise-induced anaphylaxis

“…The role of accelerants and cofactors is important in FDEIAn (see box 1). A broad set of contributors have been reported in cases of FDEIAn including seasonal aeroallergens, perimenstruation, opioids, stress, infection, increased ambient temperature and cannabis 10. The most commonly identified accelerants in reported cases are NSAIDs and alcohol.…”