Food-dependent exercise-induced anaphylaxis in childhood

Authors

  • George Du Toit

    1. Children's Allergy Service, Evelina Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
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George Du Toit, Children's Allergy Service, Evelina Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
Tel.: +44(0) 207 188 3300
Fax: +44(0) 207 188 9782
E-mail: georgedutoit@gmail.com

Abstract

The clinical syndrome of food-dependent exercise-induced anaphylaxis (FDEIA) is typified by the onset of anaphylaxis during (or soon after) exercise which was preceded by the ingestion of the causal food allergen/s. In FDEIA, both the food allergen/s and exercise are independently tolerated. FDEIA is an uncommon allergic condition in childhood, but nonetheless is an important differential diagnosis to be considered when faced by a child who has experienced exercise-associated anaphylaxis. The diagnosis of FDEIA is heavily dependent on the clinical history. Allergy tests may need to be performed to a broad panel of food and food additives. Modified exercise challenges (performed with and without prior ingestion of food) are frequently required as allergy test results frequently return low-positive results. A diagnosis of FDEIA facilitates the safe independent return to exercise and reintroduction of foods for patients who otherwise may unnecessarily avoid exercise and/or restrict their diet. The natural history of FDEIA is unknown; however, a safe return is usually achieved when the ingestion of the causal food allergen/s and exercise are separated.

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