Exercise-induced anaphylactic reactions to food allergens.

Exercise-induced anaphylactic reaction to food allergens is a recently individualized disorder that was described by Maulitz under the term "exercise-induced anaphylactic reaction to shellfish" before the first reports by Sheffer and Austen in 1980. Fewer than 100 cases confirmed by a positive challenge lest have been reported in the literature. Exercise-induced anaphylaxis (EIA) is a heterogeneous disorder that encompasses at least three different entities, namely pure EIA, EIA occurring only after consumption of foods responsible for an IgE-mediated allergic response (Maulitz and Kidd syndrome), and EIA occurring only after consumption of foods not responsible for an IgE-mediated response (Novey syndrome). Overlap forms probably exist. In addition to these three entities, idiopathic anaphylaxis refers to a spectrum of heterogeneous and controversial disorders. In three fourths of cases of food-dependent EIA, the symptoms occurred when the food was eaten before the physical activity was started. In patients with IgE-mediated food hypersensitivity, the most common offenders were wheat flour (bread pasta), celeri, shellfish and shrimp; tomatoes, grapes, apples, hazelnuts, chestnuts, oranges, peaches, cabbage, and other foods. induced the reaction in smaller number of cases. Food-dependent EIA was more common in males than in females (M/F ratio=2) and occurred primarily in adolescents and young adults, with cases in children younger than ten years being rare. Although the range of physical activities was broad, in one third of cases the reaction occurred after prolonged exercise such as long-distance running. Half the patients were atopic. A challenge test combining consumption of the offending food and a physical activity duplicated the patient's presenting complaints, whereas physical activity alone or ingestion of the food alone did not. The treatment rests on avoidance of suspected foods for three to five hours before all physical activities. Physicians and athletes should be educated regarding EIA.