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Torpong Thongngarm - One of the best experts on this subject based on the ideXlab platform.
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Dust mite ingestion-associated, Exercise-Induced Anaphylaxis: a case report and literature review
Allergy Asthma & Clinical Immunology, 2020Co-Authors: Mongkhon Sompornrattanaphan, Yanisa Jitvanitchakul, Nat Malainual, Chamard Wongsa, Aree Jameekornrak, Orathai Theankeaw, Torpong ThongngarmAbstract:Oral mite Anaphylaxis (OMA) is a condition characterized by severe allergic reactions after ingesting food containing dust mite-contaminated flour. Physical exertion is recognized as a common trigger factor inducing Anaphylaxis. The association of OMA with Exercise-Induced Anaphylaxis has rarely been reported. We report a 29-year-old Thai woman who had dust mite ingestion-associated, Exercise-Induced Anaphylaxis who tolerated the same bag of contaminated flour without Exercise. A sample of contaminated cooking flour was examined under a light microscope. Living mites, Dermatophagoides farinae, were detected by a medical entomologist based on the morphology. We performed skin test to both mite-contaminated and newly opened Gogi® cooking flour, common aeroallergens, food allergens, and all other ingredients in the fried coconut rice cake 5 weeks after the anaphylactic episode. Specific IgE tests, using ImmunoCAP were also performed. Dust mite ingestion-associated, Exercise-Induced Anaphylaxis may be misdiagnosed as wheat-dependent Exercise-Induced Anaphylaxis and should be suspected in patients with Anaphylaxis linked to food intake and Exercise, but who have no apparent evidence to the index food ingredients on allergy workup.
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Dust mite ingestion-associated, Exercise-Induced Anaphylaxis: a case report and literature review
Allergy Asthma & Clinical Immunology, 2020Co-Authors: Mongkhon Sompornrattanaphan, Yanisa Jitvanitchakul, Nat Malainual, Chamard Wongsa, Aree Jameekornrak, Orathai Theankeaw, Torpong ThongngarmAbstract:Background Oral mite Anaphylaxis (OMA) is a condition characterized by severe allergic reactions after ingesting food containing dust mite-contaminated flour. Physical exertion is recognized as a common trigger factor inducing Anaphylaxis. The association of OMA with Exercise-Induced Anaphylaxis has rarely been reported. Case presentation We report a 29-year-old Thai woman who had dust mite ingestion-associated, Exercise-Induced Anaphylaxis who tolerated the same bag of contaminated flour without Exercise. A sample of contaminated cooking flour was examined under a light microscope. Living mites, Dermatophagoides farinae , were detected by a medical entomologist based on the morphology. We performed skin test to both mite-contaminated and newly opened Gogi® cooking flour, common aeroallergens, food allergens, and all other ingredients in the fried coconut rice cake 5 weeks after the anaphylactic episode. Specific IgE tests, using ImmunoCAP were also performed. Conclusions Dust mite ingestion-associated, Exercise-Induced Anaphylaxis may be misdiagnosed as wheat-dependent Exercise-Induced Anaphylaxis and should be suspected in patients with Anaphylaxis linked to food intake and Exercise, but who have no apparent evidence to the index food ingredients on allergy workup.
Mario Geller - One of the best experts on this subject based on the ideXlab platform.
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Diagnostic and Therapeutic Approach in Patients with Exercise-Induced Anaphylaxis
Current Treatment Options in Allergy, 2016Co-Authors: Mario GellerAbstract:The prevalence of Exercise-Induced Anaphylaxis is estimated to be about 2.36-5 % of all cases of Anaphylaxis. The clinical manifestations of Exercise-Induced Anaphylaxis include flushing, increase warmth, diffuse pruritus, urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension, and laryngeal edema. The main differential diagnosis is with cholinergic urticaria. Exercise-Induced Anaphylaxis may display food-dependence, with or without specific IgE sensitivity. The most commonly implicated foods are wheat (omega-5 gliadin), shellfish (especially shrimps), celery, corn, cow’s milk, mite-contaminated wheat flour, and peanuts. Interestingly, in these patients aerobic Exercises alone, as well as the sole ingestion of the allergenic foods without associated Exercises, do not cause Anaphylaxis. The synergistic effect of both inducing factors is necessary for the occurrence of the anaphylactic manifestations. There may be drug-dependence in Exercise-Induced Anaphylaxis. Implicated drugs and chemicals include NSAIDS, aspirin, antibiotics (cephalosporins), and the so-called anti-catabolic energizer supplements, such as beta-hydroxymethylbutyrate. Avoidance of eating the triggering foods is recommended when possible, and in temperate areas of the planet an additional preventive measure is not to Exercise when there is high environmental exposure to pollens (then exercising indoors). It is also advisable to avoid exercising in extreme weather conditions (too hot, cold, or humid environments). Monoclonal anti-IgE (omalizumab) as a mast cell stabilizer with downregulation of the high affinity IgE receptors (FcεRI) can have a potential role preventing these anaphylactic episodes. Key Points 1. Exercise-Induced Anaphylaxis may be food-dependent and independent and also drug-dependent. 2. For prevention, it is recommended to avoid exercising both 4-6 h after eating the specific food, as well as after the ingestion of aspirin and NSAIDS in drug affected patients. 3. Patients should stop exercising at the first onset of symptoms to avoid progression to the potentially fatal laryngeal edema and/or cardiocirculatory collapse. 4. Exercise always with a partner and two epinephrine auto-injectors immediately available. 5. Currently, there are no effective prophylactic medications.
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Diagnostic and Therapeutic Approach in Patients with Exercise-Induced Anaphylaxis
Current Treatment Options in Allergy, 2016Co-Authors: Mario GellerAbstract:The prevalence of Exercise-Induced Anaphylaxis is estimated to be about 2.36-5 % of all cases of Anaphylaxis. The clinical manifestations of Exercise-Induced Anaphylaxis include flushing, increase warmth, diffuse pruritus, urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension, and laryngeal edema. The main differential diagnosis is with cholinergic urticaria. Exercise-Induced Anaphylaxis may display food-dependence, with or without specific IgE sensitivity. The most commonly implicated foods are wheat (omega-5 gliadin), shellfish (especially shrimps), celery, corn, cow’s milk, mite-contaminated wheat flour, and peanuts. Interestingly, in these patients aerobic Exercises alone, as well as the sole ingestion of the allergenic foods without associated Exercises, do not cause Anaphylaxis. The synergistic effect of both inducing factors is necessary for the occurrence of the anaphylactic manifestations. There may be drug-dependence in Exercise-Induced Anaphylaxis. Implicated drugs and chemicals include NSAIDS, aspirin, antibiotics (cephalosporins), and the so-called anti-catabolic energizer supplements, such as beta-hydroxymethylbutyrate. Avoidance of eating the triggering foods is recommended when possible, and in temperate areas of the planet an additional preventive measure is not to Exercise when there is high environmental exposure to pollens (then exercising indoors). It is also advisable to avoid exercising in extreme weather conditions (too hot, cold, or humid environments). Monoclonal anti-IgE (omalizumab) as a mast cell stabilizer with downregulation of the high affinity IgE receptors (FceRI) can have a potential role preventing these anaphylactic episodes.
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Food dependent and food independent Exercise-Induced Anaphylaxis
2008Co-Authors: Mario GellerAbstract:Objective: To present and discuss the current classification of Exercise-Induced Anaphylaxis based on clinical data and on related immunological and pathophysiological mechanisms. To describe clinical symptoms, triggers and co-triggers, different diagnostic tools, and also to discuss the different therapeutic approaches and the potential benefit of scaled physical desensitization. Methods: The literature search was carried out using Medline (PubMed). Meta-analysis, case reports and reviews were evaluated. A description of the several modalities of physical allergies related to Exercises was made. Tables with differential diagnosis are presented. Results: Physical allergies are related to mast cell dysfunction with lowered threshold for the release of cytoplasmatic vasoactive anaphylactic mediators, especially histamine, triggered by external physical factors including Exercises. Conclusions: Exercise-Induced Anaphylaxis may be food dependent and independent and also IgE dependent and independent. Drug dependent Exercise-Induced Anaphylaxis is also another form of presentation of this important physical allergy. Treatment includes, after obtaining a precise and detailed diagnosis. It includes also the establishment of an operational plan for Anaphylaxis, self-administration of epinephrin, the presence of a companion with training in assistance during all Exercises, and the avoidance of eating 4-6 hours prior and after Exercises. Preventive treatment with antihistamines is currently controversial. Physical desensitization is of potential benefit in Exercise-Induced Anaphylaxis.
Mongkhon Sompornrattanaphan - One of the best experts on this subject based on the ideXlab platform.
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Dust mite ingestion-associated, Exercise-Induced Anaphylaxis: a case report and literature review
Allergy Asthma & Clinical Immunology, 2020Co-Authors: Mongkhon Sompornrattanaphan, Yanisa Jitvanitchakul, Nat Malainual, Chamard Wongsa, Aree Jameekornrak, Orathai Theankeaw, Torpong ThongngarmAbstract:Oral mite Anaphylaxis (OMA) is a condition characterized by severe allergic reactions after ingesting food containing dust mite-contaminated flour. Physical exertion is recognized as a common trigger factor inducing Anaphylaxis. The association of OMA with Exercise-Induced Anaphylaxis has rarely been reported. We report a 29-year-old Thai woman who had dust mite ingestion-associated, Exercise-Induced Anaphylaxis who tolerated the same bag of contaminated flour without Exercise. A sample of contaminated cooking flour was examined under a light microscope. Living mites, Dermatophagoides farinae, were detected by a medical entomologist based on the morphology. We performed skin test to both mite-contaminated and newly opened Gogi® cooking flour, common aeroallergens, food allergens, and all other ingredients in the fried coconut rice cake 5 weeks after the anaphylactic episode. Specific IgE tests, using ImmunoCAP were also performed. Dust mite ingestion-associated, Exercise-Induced Anaphylaxis may be misdiagnosed as wheat-dependent Exercise-Induced Anaphylaxis and should be suspected in patients with Anaphylaxis linked to food intake and Exercise, but who have no apparent evidence to the index food ingredients on allergy workup.
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Dust mite ingestion-associated, Exercise-Induced Anaphylaxis: a case report and literature review
Allergy Asthma & Clinical Immunology, 2020Co-Authors: Mongkhon Sompornrattanaphan, Yanisa Jitvanitchakul, Nat Malainual, Chamard Wongsa, Aree Jameekornrak, Orathai Theankeaw, Torpong ThongngarmAbstract:Background Oral mite Anaphylaxis (OMA) is a condition characterized by severe allergic reactions after ingesting food containing dust mite-contaminated flour. Physical exertion is recognized as a common trigger factor inducing Anaphylaxis. The association of OMA with Exercise-Induced Anaphylaxis has rarely been reported. Case presentation We report a 29-year-old Thai woman who had dust mite ingestion-associated, Exercise-Induced Anaphylaxis who tolerated the same bag of contaminated flour without Exercise. A sample of contaminated cooking flour was examined under a light microscope. Living mites, Dermatophagoides farinae , were detected by a medical entomologist based on the morphology. We performed skin test to both mite-contaminated and newly opened Gogi® cooking flour, common aeroallergens, food allergens, and all other ingredients in the fried coconut rice cake 5 weeks after the anaphylactic episode. Specific IgE tests, using ImmunoCAP were also performed. Conclusions Dust mite ingestion-associated, Exercise-Induced Anaphylaxis may be misdiagnosed as wheat-dependent Exercise-Induced Anaphylaxis and should be suspected in patients with Anaphylaxis linked to food intake and Exercise, but who have no apparent evidence to the index food ingredients on allergy workup.
Eishin Morita - One of the best experts on this subject based on the ideXlab platform.
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Food-dependent Exercise-Induced Anaphylaxis -importance of omega-5 gliadin and HMW-glutenin as causative antigens for wheat-dependent Exercise-Induced Anaphylaxis-.
Allergology International, 2009Co-Authors: Eishin Morita, Hiroaki Matsuo, Yuko Chinuki, Hitoshi Takahashi, Jörgen Dahlström, AkiratanakaAbstract:Food-dependent Exercise-Induced Anaphylaxis (FDEIA) is a special form of food allergy where a food-intake alone does not induce any symptoms. However, allergic symptoms are elicited when triggering factors such as Exercise or aspirin-intake are added after ingestion of the causative food. The most frequent causative foodstuff in Japan is wheat. The triggering factors, both Exercise and aspirin-intake, facilitate allergen absorption from the gastrointestinal tract, resulting in allergic symptoms in the patients with wheat-dependent Exercise-Induced Anaphylaxis (WDEIA). Analysis using purified wheat proteins revealed that approximately 80% of the patients with WDEIA have IgE reacting to omega-5 gliadin and the remaining of the patients to high molecular weight glutenin (HMW-glutenin). Simultaneous measurement of specific IgE to omega-5 gliadin and HMW-glutenin was found to be highly useful in diagnosing WDEIA compared with the routine diagnostic system for wheat.
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food dependent Exercise Induced Anaphylaxis Induced by low dose aspirin therapy
Allergology International, 2008Co-Authors: Hiroko Fujii, Eishin Morita, Naotomo Kambe, Akihiro Fujisawa, Kunie Kohno, Yoshiki MiyachiAbstract:Background: Food-dependent Exercise-Induced Anaphylaxis (FDEIA) is a distinct form of common food allergy characteristically Induced by a combination of causative food ingestion and physical Exercise. Recent investigations have documented that aspirin consumption, in place of Exercise, also induces allergic symptoms. Case Summary: A 63-year-old man began low dose aspirin therapy on September 2005. Since January 2006, he had repeated episodes of generalized urticaria and lost consciousness while he was exercising after eating wheat. He was strongly positive for ω-5 gliadin in a cap-system fluorescent enzyme immunoassay. Therefore, a diagnosis of wheat-dependent Exercise-Induced Anaphylaxis was made. Discussion: Patients with aspirin-provoked FDEIA have been reported previously as taking ordinary doses of aspirin for reducing pain, inflammation and fever. However, in our patient, low dose aspirin therapy for reducing cardiovascular risk possibility Induced FDEIA. Growing numbers of elderly people take low doses of aspirin for prevention of cerebral or myocardial infarction. Therefore, physicians should remember that aspirin consumption, even at low doses, is a risk factor for FDEIA.
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Food-dependent Exercise-Induced Anaphylaxis
Journal of Dermatological Science, 2007Co-Authors: Eishin Morita, Kohno Kunie, Hiroaki MatsuoAbstract:Food-dependent Exercise Induced Anaphylaxis (FDEIA) is a distinct form of food allergy Induced by physical Exercise. Symptoms are typically generalized urticaria and severe allergic reactions such as shock or hypotension. Whereas various food items are responsible for the development of FDEIA, wheat is reported to be the allergen with the highest frequency in Japan. Recently aspirin has been known to be an additional exacerbating factor. Skin tests and in vitro serum food-specific IgE assays are currently used, however their sensitivity and specificity are not always satisfactory. A challenge test consisting of ingestion of assumed food followed by intense physical Exercise is the only reliable method to determine the causative food and to diagnose the disease. The challenge test is not always safe because in some cases the test induces an anaphylactic shock. So a reliable in vitro diagnostic method is necessary for the patients with FDEIA. We revealed that wheat omega-5 gliadin and high molecular weight glutenin subunit are major allergens in wheat-dependent Exercise-Induced Anaphylaxis (WDEIA). A simultaneous detection of specific IgE to epitope sequences of both omega-5 gliadin and high molecular weight glutenin is found to achieve higher sensitivity and specificity compared with the in vitro serum food-specific IgE assays currently used for diagnosis of WDEIA. On the other hand, immunoreactive gliadins appeared in the sera of patients during the provocation test with both wheat-Exercise and wheat-aspirin challenges in parallel with allergic symptoms. These findings suggest that FDEIA is IgE-mediated hypersensitivity reaction to foods and both Exercise and aspirin facilitate allergen absorption from the gastrointestinal tract.
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Fast ω-gliadin is a major allergen in wheat-dependent Exercise-Induced Anaphylaxis
Journal of Dermatological Science, 2003Co-Authors: Eishin Morita, Hiroaki Matsuo, Shoji Mihara, K. Morimoto, A.w.j. Savage, A.s. TathamAbstract:Abstract Background: Wheat-dependent Exercise-Induced Anaphylaxis is an anaphylaxy Induced by physical Exercise after ingestion of wheat. An immediate-type hypersensitivity to water/salt-insoluble fraction of wheat proteins (gluten) has been considered to underlie in this disease. Objective: The aim of the study is to determine the major allergen in Japanese patients with wheat-dependent Exercise-Induced Anaphylaxis by using a panel of purified wheat gliadins and glutenins. Methods: Water/salt-insoluble wheat proteins, α-gliadin, β-gliadin, γ-gliadin, fast ω-gliadin, slow ω-gliadin, high molecular weight glutenin and low molecular weight glutenin, were purified, and five patients with wheat-dependent Exercise-Induced Anaphylaxis, whose diagnose had been determined by positive-challenge test, were evaluated for skin prick test, dot-blotting test and CAP–RAST inhibition test by using these purified wheat proteins. Results: The fast ω-gliadin was the most potent allergen among these water/salt-insoluble proteins when evaluated by skin prick test and dot-blotting test. Fast and slow ω-gliadin, and γ-gliadin caused dose-dependent inhibition of the serum IgE-binding to solid-phase gluten in the patients. The incubation with fast ω-gliadin of the patient's serum caused dose-dependent inhibition in the IgE-binding to γ-gliadin as well as slow ω-gliadin, indicating a cross-reactivity of these proteins in IgE-binding. Conclusion: We concluded that fast ω-gliadin is a major allergen among these water/salt-insoluble proteins for wheat-dependent Exercise-Induced Anaphylaxis in Japanese patients, and IgE against fast ω-gliadin cross-reacts to γ-gliadin and slow ω-gliadin.
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Food-dependent Exercise-Induced Anaphylaxis: a report of two cases and determination of wheat-γ-gliadin as the presumptive allergen
British Journal of Dermatology, 2000Co-Authors: Eishin Morita, Y. Yamamura, S. Mihara, Y. Kameyoshi, Shoso YamamotoAbstract:Water/salt-insoluble wheat proteins have been identified as the most frequent allergenic foodstuffs in patients with food-dependent Exercise-Induced Anaphylaxis (FDEIA) in Japan. However, the specific allergenic proteins in wheat-dependent Exercise-Induced Anaphylaxis have not been well defined. Challenge testing, skin testing and a fluoroenzyme immunoassay were used for diagnosis in two patients suspected by history of having wheat-dependent Exercise-Induced Anaphylaxis. Gel chromatography and IgE immunoblotting followed by N-terminal amino acid sequencing were used to identify the allergenic wheat protein. The challenge test revealed that both patients had FDEIA. The skin tests and the immunoassay results suggested that wheat gluten was the allergen in both patients. Gel chromatography of wheat gluten revealed that the antigens had molecular weights ranging from 40 to 250 kDa. IgE immunoblotting and subsequent N-terminal amino acid sequencing revealed that wheat-gamma-gliadin was the antigen predominantly bound by IgE in the two patients.
Torsten Zuberbier - One of the best experts on this subject based on the ideXlab platform.
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Role of adverse reactions to food in urticaria and Exercise-Induced Anaphylaxis
International Archives of Allergy and Immunology, 2002Co-Authors: Sie Uen Chong, Margitta Worm, Torsten ZuberbierAbstract:In urticaria, adverse reactions to food are only a frequent finding in the subset of patients with chronic continuous urticaria. Mostly these reactions are of pseudoallergic nature, directed against artificial additives as well as naturally occurring aromatic components. IgE-mediated allergic reactions are a rare cause in acute urticaria as well as in recurrent chronic urticaria. In other types of urticaria, e.g. physical urticaria, food plays hardly any role as an eliciting agent with the exception of ice-cold drinks in cold urticaria. By contrast, Exercise-Induced Anaphylaxis is frequently food-dependent. Two subtypes are distinguished: unspecific food-dependent Exercise-Induced Anaphylaxis (FDEIA), where the filling of the stomach independently of the kind of food ingested prior to Exercise is responsible for the symptoms. In specific FDEIA, an IgE-mediated food allergy causes symptoms only in combination with Exercise. In the latter group, wheat is an important allergen