Food-dependent exercise-induced anaphylaxis.

A 58-year-old farmer was admitted to our hospital because of repeated episodes of anaphylaxis. He had experienced 12 episodes of anaphylactic shock over the previous 17 years. These attacks included three episodes of bee sting. In general, the episodes occurred during farm work (exercise) and within two hours of eating cake in the afternoon. Because an immediate skin reaction to wheat flour was highly positive, a diagnosis of wheat allergy was considered. These findings suggested that his illness was consistent with food-dependent exercise-induced anaphylaxis.     

哮喘和食物依赖性运动诱导性变态反应

目的对食物依赖性运动诱导性变态反应（Food-dependent exercise-induced anaphylaxis,FDE IA）进行调查研究。方法采用问卷调查方法,对每一个调查对象在门诊进行询问。结果①21名患者是13-25岁青少年,平均年龄为17.4岁。其中男性17例（80.95%）,女性4例（19.05%）,男性明显多于女性,差异有统计学意义（P〈0.05）。②小麦和鱼虾是引起FDE IA的主要食物,病例中进食与运动的间隔时间均在10-120 min以内,平均为67 m in。③21名患者除了均有呼吸道症状如呼吸困难和喘息（100%）外,不同程度伴随有皮肤表现如荨麻疹和血管性水肿（76.8%）,消化道症状如呕吐和腹痛（47.6%）,低血压（61.9%）。讨论 FDEIA是不常见且常常不能正确识别的综合征,了解FDE IA对因哮喘症状就诊的患者可以立即做出正确鉴别。     

Food-dependent exercise-induced anaphylaxis to flaxseed

The present paper reports on a 26-year-old atopic patient suffering from seasonal rhinoconjunctivitis and flexural eczemas. On two occasions, he experienced nausea, generalized urticaria and dyspnea within 2 h after consumption of a wholemeal roll and subsequent exercise (football training or walking). In each case, the episode necessitated intravenous emergency therapy with an antihistamine and a corticosteroid. In order to elucidate the two exercise-induced anaphylactic events we performed prick tests and the radioallergosorbent test (RAST) with the ingredients of the wholemeal roll. Only flaxseed gave positive results. In addition, we performed an exercise test on a bicycle ergometer (15 min at 150 W) and an oral challenge test with foods, using a double-blind and placebo-controlled study. Only oral challenge with a teaspoon of flaxseed with additional exercise on the bicycle ergometer elicited itching, urticaria, nausea, coughing and dyspnea. The oral challenge with flaxseed followed by exercise induced immediate-type reactions and, thus, led to the diagnosis of food-dependent exercise- induced anaphylaxis to flaxseed.     

Food-dependent exercise-induced anaphylaxis to pistachio.

We report the case of a 16-year-old male who, 30 minutes after beginning to play football with previous ingestion of pistachio nuts, experienced an anaphylactic reaction. Prick-by-prick test with roasted pistachios was negative. Specific IgE antibodies to pistachio, cashew nuts and mango were negative. An open oral challenge test with pistachio in resting conditions was negative. Treadmill ergonometric stress in a fasting state and 60 minutes after a meal without pistachio gave negative results. A specific food exercise challenge 60 minutes after ingestion of 50 g pistachio nuts was positive, showing mild diffuse erythema and small wheals in face and thorax. To the best of our knowledge, this is the first described case of specific food dependent exercise-induced anaphylaxis to pistachio. Negative allergologic tests is an unusual condition, since most cases appear to be IgE-mediated. In this case, a positive specific food exercise challenge test provided a definite diagnosis.     

食物依赖运动诱发性过敏反应一例并文献复习

目的 提高临床医师对食物依赖运动诱发性过敏反应(FDEIA)的认识.方法 2007年12月至2009年10月通过对1例FDEIA患者的诊断、治疗经过以及随访结果的分析,结合文献复习,详细阐述该病的病冈、临床表现、诊断方法、治疗及预防方法.结果 患者男,18岁,反复出现荨麻疹、呼吸困难及意识障碍8个月,每次发作均是在进食小麦面食后由运动诱发,经抗组胺、肾卜腺素药物和(或)地塞米松治疗后快速缓解.血清食物特异性lgE检测,发现虾、蟹特异性lgE阳性,但临床上无相关过敏症状.小麦-运动激发试验结果阳性,诊断为FDEIA.此后患者禁食小麦面食1年多,期间未发生过敏反应.恢复进食小麦面食后,运动再次诱发FDEIA.结论 FDEIA发病率低,小麦是常见的致敏食物.进食过敏食物后4h内避免剧烈运动有可能避免本病的发生,禁食致敏食物是预防FDEIA的可靠方法.     

Food-dependent exercise-induced anaphylaxis induced by low dose aspirin therapy.

BACKGROUND: Food-dependent exercise-induced anaphylaxis (FDEIA) is a distinct form of common food allergy characteristically induced by a combination of causative food ingestion and physical exercise. Recent investigations have documented that aspirin consumption, in place of exercise, also induces allergic symptoms. CASE SUMMARY: A 63-year-old man began low dose aspirin therapy on September 2005. Since January 2006, he had repeated episodes of generalized urticaria and lost consciousness while he was exercising after eating wheat. He was strongly positive for omega-5 gliadin in a cap-system fluorescent enzyme immunoassay. Therefore, a diagnosis of wheat-dependent exercise-induced anaphylaxis was made. DISCUSSION: Patients with aspirin-provoked FDEIA have been reported previously as taking ordinary doses of aspirin for reducing pain, inflammation and fever. However, in our patient, low dose aspirin therapy for reducing cardiovascular risk possibility induced FDEIA. Growing numbers of elderly people take low doses of aspirin for prevention of cerebral or myocardial infarction. Therefore, physicians should remember that aspirin consumption, even at low doses, is a risk factor for FDEIA.     

Food-dependent exercise-induced anaphylaxis occurred only in a warm but not in a cold environment

Food-dependent exercise-induced anaphylaxis (FDEIA) is a type of exercise-induced anaphylaxis associated with postprandial exercise. We describe a 19-year-old man with FDEIA. Our patient complained of urticaria, angioedema, dizziness and hypotension associated with exercise after ingestion of walnut-containing foods in a warm environment. Skin prick test and prick to prick test were positive for walnut antigen. The attack didn't occur by free running outside for 10 min 2 h after taking walnuts, and the temperature was about -2℃. Food-exercise test was done again in a warm environment based on prior history. Anaphylaxis was developed after exercise for 10 min in a warm environment after taking walnuts. Some environmental factors such as high temperature and high humidity or cold temperature may influence exercise-induced anaphylaxis. In our case, the cofactor was a warm environment: the challenge test done in a cold environment was negative, but positive in a warm environment. Physicians should be aware that the challenge test of FDEIA can show different results depending on temperature.     

Food-dependent exercise-induced anaphylaxis: possible impact of increased basophil histamine releasability in hyperosmolar conditions

We present a case of anaphylactic shock induced by exercise following celery ingestion.The possible mechanism of food-dependent exercise-induced anaphylaxis (FDEIA) and the laboratory tests for its diagnosis are discussed.We evaluated spontaneous, celery-allergen-induced, and anti-FcepsilonRI-antibody-induced histamine release from basophils obtained from the patient, 2 celery-allergic controls, and 3 healthy controls. Buffers of increasing osmolarity were used to mimic conditions of vigorous physical exercise. Only the patient's basophils showed an increase in spontaneous, anti-FcepsilonRI antibody-induced and allergen-induced histamine release under physiological conditions and with slightly increased medium osmolarity. To our knowledge, this is the first report on the possible role of increased histamine releasability in the pathogenic mechanism of FDEIA. We suggest that FDEIA results from increased histamine releasability triggered by physical effort after exposure to a sensitizing food allergen.     

The current data on nanoparticles and pleura

Nanoparticle is the general name given to particles with a size between 0.1 nm and 100 nm. Carbon nanotubes, which have been the focus of many studies recently, are a new type of technological crystal carbon, having specific physical and chemical properties and being used in a wide array of fields from electronics to medicine. To date, the effects of carbon nanotubes over various organs including the lungs have been investigated by many studies, while their influence on pleura has been analyzed only by a limited number of animal and in vitro studies. The current data on the effects of nanoparticles and particularly carbon nanotubes to pleura is reviewed in this article.     

Prospects and current data in antiviral chemotherapy

The advances achieved in our knowledge on the virus multiplication cycle and the challenge created by the advent of AIDS have resulted in a rational development of new antiviral agents. However, antiviral chemotherapy is hindered by several obstacles: (1) most antiviral drugs are cytotoxic, with the exception of acyclovir which owes its remarkable safety to its activation by the thymidine kinase of the herpes simplex viruses and of the varicella-zoster virus; (2) the risk of selecting resistant strains by mutation of viral enzymes is the unavoidable price to pay for the specificity of new antiviral agents which interfere with these enzymes; so far, this risk seems to apply only to immunocompromised patients; (3) latent viral infection, defined as the lack of active multiplication of the virus, cannot be eradicated by the antiviral drugs available at present since these drugs are inhibitors of viral multiplication. However, anti-sens oligonucleotides could, at least in theory, be used to treat this type of infection which is not limited to the Retroviridae or Herpesviridae families. Finally, antiviral drugs active against life-threatening infections that are as common as rabies and the severe forms of measles or viral hepatitis remain to be discovered.     

运动与运动诱发支气管痉挛的关系

运动与运动诱发支气管痉挛（exerciseinducedbronchoconstriction,EIB）的关系错综复杂,缺乏运动的生活方式有可能是EIB的易患因素,不恰当的过度运动容易导致EIB的发生,低一中等强度的有氧运动及热身运动有可能成为EIB的非药物治疗方法。深入研究不同运动与EIB的关系及其机制,对于EIB的筛查及治疗有重要的意义。