Journal Mobile Options
Table of Contents
Vol. 125, No. 3, 2001
Issue release date: July 2001
Int Arch Allergy Immunol 2001;125:264–272

Food-Dependent Exercise-Induced Anaphylaxis: Clinical and Laboratory Findings in 54 Subjects

Romano A. · Di Fonso M. · Giuffreda F. · Papa G. · Artesani M.C. · Viola M. · Venuti A. · Palmieri V. · Zeppilli P.
aDepartment of Internal Medicine and Geriatrics, UCSC-Allergy Unit, Complesso Integrato Columbus and bDepartment of Internal Medicine and Geriatrics, UCSC-Sports Medicine Unit, Rome, and cIRCCS Oasi Maria SS, Troina, Italy

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: In some subjects, specific foods trigger anaphylaxis when exercise follows ingestion (specific food-dependent exercise-induced anaphylaxis, FDEIAn). Skin test and/or RAST positivity to foods suggest an IgE-mediated pathogenic mechanism. Others suffer from anaphylaxis after all meals followed by exercise, regardless of the food eaten (nonspecific FDEIAn). We sought to identify the culprit foods with a diagnostic protocol. Methods: We collected detailed histories and performed skin prick tests (SPT) with 26 commercial food allergens, prick plus prick tests (P+P) with 15 fresh foods (including 9 assessed with SPT), and RAST for 31 food allergens. Treadmill stress tests were administered after a meal without any positive food (food plus exercise challenge, FEC). Results: Among the 54 patients, 6 could not recall any suspect food. The other 48 suspected a specific food in at least one episode. The most frequent were tomatoes, cereals and peanuts. Fifty-two subjects were positive to at least one food (22 to more than 20), whereas 2 showed no positive results. All suspect foods were positive. SPT, P+P and RAST displayed different degrees of sensitivity. Each test disclosed some positivities not discovered by others. Two subjects reacted to FEC. Overall, 48 patients probably had specific FDEIAn and the other 6 nonspecific FDEIAn. Conclusions: It is useful to test both in vivo and in vitro an extensive panel of foods. Avoidance of foods associated with skin test and/or RAST positivity for at least 4 h before exercise has prevented further episodes in all our patients with specific FDEIAn.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Maulitz RM, Pratt DS, Schocket AL: Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol 1979;63:433–434.

    External Resources

  2. Du Buske LM, Horan RF, Sheffer AL: Exercise-induced allergy syndromes; in Weiler JM (ed): Allergic and Respiratory Disease in Sports Medicine. New York, Dekker, 1997, pp 253–278.
  3. Romano A, Di Fonso M, Giuffreda F, Quaratino D, Papa G, Palmieri V, Zeppilli P, Venuti A: Diagnostic work-up for food-dependent, exercise-induced anaphylaxis. Allergy 1995;50:817–824.
  4. Caffarelli C, Cavagni G, Giordano S, Terzi V, Perrone F: Reduced pulmonary function in multiple food-induced, exercise-related episodes of anaphylaxis. J Allergy Clin Immunol 1996;98:762–765.
  5. Shadick NA, Liang MH, Partridge AJ, Bingham C, Wright E, Fossel AH, Sheffer AL: The natural history of exercise-induced anaphylaxis: Survey results from a 10-year follow-up study. J Allergy Clin Immunol 1999;104:123–127.
  6. Kidd JM III, Cohen SH, Sosman AJ, Fink JN: Food-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol 1983;71:407–411.
  7. Novey HS, Fairshter RD, Salness K, Simon RA, Curd JG: Postprandial exercise-induced anaphylaxis. J Allergy Clin Immunol 1983;71:498–504.
  8. Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Juji F, Okudaira H, Sano Y, Ito K, Miyamoto T: Food-dependent, exercise-induced anaphylaxis: A study on 11 Japanese cases. J Allergy Clin Immunol 1991;87:34–40.
  9. Fukutomi O, Kondo N, Agata H, Shinoda S, Shinbara M, Orii T: Abnormal responses of the autonomic nervous system in food-dependent exercise-induced anaphylaxis. Ann Allergy 1992;68:438–445.

    External Resources

  10. Sheffer AL, Tong AKF, Murphy GF, Lewis RA, McFadden ER Jr, Austen KF: Exercise-induced anaphylaxis: A serious form of physical allergy associated with mast cell degranulation. J Allergy Clin Immunol 1985;75:479–484.
  11. Kivity S, Sneh E, Greif J, Topilsky M, Mekori YA: The effect of food and exercise on the skin response to compound 48/80 in patients with food-associated exercise-induced urticaria-angioedema. J Allergy Clin Immunol 1988;81:1155–1158.
  12. Buchbinder EM, Bloch KJ, Moss J, Guiney TE: Food-dependent, exercise-induced anaphylaxis. JAMA 1983;250:2973–2974.
  13. Katsunuma T, Iikura Y, Akasawa A, Iwasaki A, Hashimoto K, Akimoto K: Wheat-dependent exercise-induced anaphylaxis: Inhibition by sodium bicarbonate. Ann Allergy 1992;68:184–188.
  14. Romano A, Fanales-Belasio E, Di Fonso M, Giuffreda F, Palmieri V, Zeppilli P, Ansotegui IJ, Venuti A, Paganelli R, Aiuti F: Eosinophil-derived proteins in post-prandial (food-dependent) exercise-induced anaphylaxis. Int Arch Allergy Immunol 1997;113:505–511.
  15. Tharp MD, Thirlby R, Sullivan TJ: Gastrin induces histamine release from human cutaneous mast cells. J Allergy Clin Immunol 1984;74:159–165.
  16. Sheffer AL, Austen KF: Exercise-induced anaphylaxis. J Allergy Clin Immunol 1980;66:106–111.

    External Resources

  17. Sheffer AL, Soter NA, McFadden ER Jr, Austen KF: Exercise-induced anaphylaxis: A distinct form of physical allergy. J Allergy Clin Immunol 1983;71:311–316.
  18. Dreborg S, Foucard T: Allergy to apple, carrot, and potato in children with birch pollen allergy. Allergy 1983;38:167–172.
  19. Dreborg S, Backman A, Basomba A, Bousquet J, Dieges P, Malling HJ: Skin tests used in type I allergy testing. Position paper. EAACI Sub-Committee on Skin Tests. Allergy 1989;44(suppl 10):1–59.
  20. Ortolani C, Ispano M, Pastorello EA, Ansaloni R, Magri GC: Comparison of results of skin prick tests (with fresh foods and commercial food extracts) and RAST in 100 patients with oral allergy syndrome. J Allergy Clin Immunol 1989;83:683–690.
  21. Rosen JP, Selcow JE, Mendelson LM, Grodofsky MP, Factor JM, Sampson HA: Skin testing with natural foods in patients suspected of having food allergies: Is it necessity? J Allergy Clin Immunol 1994;93:1068–1070.

    External Resources

  22. Rancé F, Juchet A, Brémont F, Dutau G: Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges. Allergy 1997;52:1031–1035.
  23. Stricker WE, Anorve-Lopez E, Reed CE: Food skin testing in patients with idiopathic anaphylaxis. J Allergy Clin Immunol 1986;77:516–519.
  24. Yman L: Standardization of IgE antibody assays. J Int Fed Clin Chem 1991;3:198–203.
  25. Sampson HA, Ho DG: Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997;100:444–451.
  26. Wade JP, Liang MH, Sheffer AL: Exercise-induced anaphylaxis: Epidemiologic observations. Prog Clin Biol Res 1989;297:175–182.

    External Resources

  27. Shimizu T, Furumoto H, Kinoshita E, Ogasawara Y, Nakamura C, Hashimoto Y, Nagai K, Muto M: Food-dependent exercise-induced anaphylaxis occurring only in winter. Dermatology 2000;200:279.
  28. Bjarnason I, Smethurst P, Clark P, Menzies I, Levi J, Peters T: Effects of prostaglandin on indomethacin-induced increased intestinal permeability in man. Scand J Gastroenterol 1989;24(suppl 164):97–103.
  29. Petersen A, Vieths S, Aulepp H, Schlaak M, Becker WM: Ubiquitous structures responsible for IgE cross-reactivity between tomato fruit and grass pollen allergens. J Allergy Clin Immunol 1996;98:805–815.
  30. Valenta R, Kraft D: Type I allergic reactions to plant-derived food: A consequence of primary sensitization to pollen allergens. J Allergy Clin Immunol 1996;97:893–895.
  31. Lehach JG, Rosenstreich DL: Clinical aspects of chronic urticaria. Clin Rev Allergy 1992;10:281–301.
  32. Hanakawa Y, Tohyama M, Shirakata Y, Murakami S, Hashimoto K: Food-dependent exercise-induced anaphylaxis: A case related to the amount of food allergen ingested. Br J Dermatol 1998;138:898–900.

    External Resources

  33. Guinnepain M-T, Eloit C, Raffard M, Brunet-Moret M-J, Rassemont R, Laurent J: Exercise-induced anaphylaxis: Useful screening of food sensitization. Ann Allergy Asthma Immunol 1996;77:491–496.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50