Food-Dependent Exercise-Induced Anaphylaxis: An Overview

Food-Dependent Exercise-Induced Anaphylaxis (FDEIA) is a rare condition described by the onset of anaphylaxis within a few hours after exposure to food, in association with exercise. Food and exercise is tolerated well independent of one another. Any food can cause FDEIA but the most implicated is wheat. Symptoms may begin at any stage of exercise, in the form of flushing, warmth, urticaria, hypotension and collapse. Diagnosis may be challenging as these symptoms do not necessarily occur each time the individual ingests food and exercises. History is pivotal in making a diagnosis. A careful provocation test combining food and exercise may be required if the diagnosis remains unclear. It is important to raise awareness about this rare entity, so that fatal reactions may be avoided in affected individuals by way of appropriate patient education and prompt management. This article, reports the clinical presentation of two young Omani women who were diagnosed with Food-Dependant Exercise-Induced Anaphylaxis (FDEIA) at our centre. The culprit foods associated with the FDEIA reported here are wheat and chocolate. The clinical manifestations, pathogenesis, diagnostic approach and treatment are elucidated in this article. Key words: Food; exercise; anaphylaxis; IgE mediated; allergy; prick-prick test; epinephrine auto-injecto