Introduction: Food-dependent exercise-induced anaphylaxis (FDEIA) is an uncommon and under-recognised syndrome that clinicians may not consider in a patient presenting with anaphylaxis. Clinical Picture: We describe here 5 patients aged 9 to 20 years old who presented at a local tertiary hospital over a 2-year period from August 2006 to July 2008. All presented with urticaria, 4 were hypotensive, 2 had angioedema and another 2 had dyspnoea. The symptoms occurred between 15 and 150 minutes (mean, 81) after exercising and consuming various food. All had consumed shellfish. All patients were admitted with the diagnosis of anaphylaxis of undefined aetiology. Diagnosis of FDEIA was only reached upon referral to an allergist. Treatment and Outcome: Patients were treated with standard medicines for anaphylaxis including adrenaline, antihistamines, steroids and fluid flushes. Symptoms resolved in 2 to 3 days with no further episodes. At discharge, patients were prescribed epinephrine auto-injectors and given written anaphylaxis management plans. Conclusions: More public awareness and strategies to ensure accurate diagnosis and management of this condition are necessary.
Anaphylaxis is a severe, potentially fatal, systemic reaction that occurs suddenly after contact with an allergy-causing substance, typically involving 2 or more systems: skin/mucosal, gastrointestinal, cardiovascular or respiratory systems.1-4 It is an increasingly important emergency, notably in Western countries, especially among children.5,6 The age-sex standardised incidence of anaphylaxis was 6.7 per 100,000 person-years in 2001 and increased by 19% to 7.9 in 2005.7 In a large published series, the causes of anaphylaxis were found to be drugs (35.3%), food (21.3%), food-dependent exercise-induced (13.2%), idiopathic (13.2%), insect stings (11.8%), exercise-induced (2.9%), blood products (1.5%) and latex (0.7%).8
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