Food-dependent exercise-induced anaphylaxis (FDEIA) Current status and issues

Abstract

 In our epidemiological studies at 14-year interval, there was no increase in the prevalence of FDEIA in junior-high school students. In the recent study all cases were diagnosed clinically as FDEIA, and at the school nurses the familiarity of FDEIA was improved significantly. However, there was no decrease in the recurrence rate of FDEIA cases. Furthermore, we noticed an emergence of secondary FDEIA cases who had been treated with oral immunotherapy (OIT).

 Recently, OIT is often applied to refractory food allergy patients. And desensitization but not tolerance to the causative food is achieved in many cases. Therefore, once they would acquire the desensitization they could eat the food without problems. However, they still might develop anaphylaxis after taking the desensitized food followed by exercise.

 In the Japanese Pediatric Guideline for food allergy 2016 the definition of FDEIA was revised partially for excluding secondary FDEIA.

 Finally, there are a lot of issues to be resolved in near future. That is, a dissemination of adequate knowledge and direction to reduce the recurrence and the over-diagnosis, an improvement of the provocation test to increase a positivity rate, and an establishment of medicine to prevent the onset should be achieved.