2018 Volume 32 Issue 2 Pages 271-276
In the 2016 Japanese Pediatric Guidelines for Food Allergy, food-dependent exercise-induced anaphylaxis (FDEIA) was defined as anaphylaxis that is provoked by a combination of specific food ingestion and physical exercise, and excluded cases with past history of immediate food allergy (i. e., after oral immunotherapy).
FDEIA is IgE-dependent, and can be associated with several factors other than food and exercise. FDEIA occurs rarely and first onset is generally between the ages of 10 and 30 years. The main causative foods are wheat and crustaceans. FDEIA tends to occur during vigorous exercise, such as running and ball games, and within 2 hours of eating the causative food.
The causative food can be identified by investigating the clinical history and performing an allergy test. In addition, further provocation tests may be required to confirm diagnosis. Provocation tests have a low success rate, which can be improved by administering acetylsalicylic acid (ASA) prior to test. However, ASA may induce severe symptoms, and its use is therefore not recommended in a first provocation test.
Consumption of the causative food should be avoided for 2 hours prior to physical exercise. However, the quality of life of the patient should not be impaired by inappropriate meal and exercise restrictions.
