Food-dependent exercise-induced reactions: lessons from a 15-year retrospective study

  • Aisling FarrellEmail author
  • Ciaran Judge
  • Vyanka Redenbaugh
  • Hanna Awad
  • Niall Conlon
Original Article



Food-dependent exercise-induced anaphylaxis (FDEIA) is a life-threatening disorder in which the signs and symptoms of anaphylaxis occur if physical exertion occurs within a few hours of exposure to a food.


The aim of this study was to characterise patients diagnosed with FDEIA and related disorders.


A retrospective review of electronic clinical data from 2001 to 2016 was carried out. Fifty-seven cases were identified and analysed to establish clinical features, triggering factors and sensitisation patterns.


The number of patients per annum diagnosed with FDEIA or related reactions increased from 1 in 2001 to 18 patients in 2016. Sixty-nine percent reported systemic symptoms consistent with anaphylaxis, and 31% had skin manifestations only. In 33% of cases, the level of triggering exercise was mild. Forty-four percent of patients were sensitised to the omega-5-gliadin fraction of wheat.


FDEIA is an increasingly recognised serious allergic disease. The clinical diagnosis is supported by targeted sensitisation testing and molecular-based allergy diagnostics. These tools allow implementation of effective dietary and lifestyle modifications that mitigate against future serious reactions. Given the limited access to physicians with specialist allergy training in Ireland, increased awareness of this condition amongst sports medicine specialists and general physicians is required.


Allergy Anaphylaxis Exercise-induced anaphylaxis Food allergy Food-dependent exercise-induced anaphylaxis 


Compliance with ethical standards

Ethical statement

This study was approved by the research ethics committee in St James’s Hospital and informed consent was obtained. The authors state full compliance with ethical standards in completing this study.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Barg W, Medrala W, Wolanczyk-Medrala A (2011) Exercise-induced anaphylaxis: an update on diagnosis and treatment. Curr Allergy Asthma Rep 11(1):45–51CrossRefGoogle Scholar
  2. 2.
    Pravettoni V, Incorvaia C (2016) Diagnosis of exercise-induced anaphylaxis: current insights. J Asthma Allergy 9:191–198CrossRefGoogle Scholar
  3. 3.
    Feldweg AM (2017) Food-dependent, exercise-induced anaphylaxis: diagnosis and management in the outpatient setting. J Allergy Clin Immunol Pract 5(2):283–288CrossRefGoogle Scholar
  4. 4.
    Minty B (2017) Food-dependent exercise-induced anaphylaxis. Can Fam Physician 63(1):42–43Google Scholar
  5. 5.
    Wood RA, Camargo CA, Lieberman P et al (2014) Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol 133(2):461–7.7CrossRefGoogle Scholar
  6. 6.
    Gaspar A, Santos N, Piedade S et al (2015) One-year survey of paediatric anaphylaxis in an allergy department. Eur Ann Allergy Clin Immunol 47:197–205Google Scholar
  7. 7.
    Toit GD (2007) Food-dependent exercise-induced anaphylaxis in childhood. Pediatr Allergy Immunol 18:455–463CrossRefGoogle Scholar
  8. 8.
    Aihara Y, Takahashi Y, Kotoyori T, Mitsuda T, Ito R, Aihara M, Ikezawa Z, Yokota S (2001) Frequency of food-dependent, exercise-induced anaphylaxis in Japanese junior-high-school students. J Allergy Clin Immunol 108(6):1035–1039CrossRefGoogle Scholar
  9. 9.
    De Silva NR, Dasanayake WMDK, Karunatilleke C et al (2015) Food dependant exercise induced anaphylaxis a retrospective study from 2 allergy clinics in Colombo, Sri Lanka. Allergy Asthma Clin Immunol 11(1):22CrossRefGoogle Scholar
  10. 10.
    Romano A, Di Fonso M, Giuffreda F et al (2001) Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol 125(3):264–272CrossRefGoogle Scholar
  11. 11.
    Povesi-Dascola C, Caffarelli C (2012) Exercise-induced anaphylaxis: a clinical view. Ital J Pediatr 38:43CrossRefGoogle Scholar
  12. 12.
    Shadick NA, Liang MH, Partridge AJ, Bingham C, Wright E, Fossel AH, Sheffer AL (1999) The natural history of exercise-induced anaphylaxis: survey results from a 10-year follow-up study. J Allergy Clin Immunol 104(1):123–127CrossRefGoogle Scholar
  13. 13.
    Sheffer AL, Austen KF (1980) Exercise induced anaphylaxis. J Allergy Clin Immunol 66(2):106–111CrossRefGoogle Scholar
  14. 14.
    Robson-Ansley P, Toit GD (2010) Pathophysiology, diagnosis and management of exercise-induced anaphylaxis. Curr Opin Allergy Clin Immunol 10(4):312–317CrossRefGoogle Scholar
  15. 15.
    Aihara M, Miyazawa M, Osuna H et al (2002) Food-dependent exercise-induced anaphylaxis: influence of concurrent aspirin administration on skin testing and provocation. Br J Dermatol 46(3):466–472CrossRefGoogle Scholar
  16. 16.
    Gomulka K, Wolanczk-Medrala A, Barg W et al (2017) Food-dependent, exercise-induced anaphylaxis triggered by co-incidence of culprit food, physical effort and a very high dose of ibuprofen or menstruation: a case report. Advances in Dermatology and Allergology 34(1):87–88CrossRefGoogle Scholar
  17. 17.
    Harada S, Horikawa T, Ashida M, Kamo T, Nishioka E, Ichihashi M (2001) Aspirin enhances the induction of type I allergic symptoms when combined with food and exercise in patients with food-dependent exercise-induced anaphylaxis. Br J Dermatol 145(2):336–339CrossRefGoogle Scholar
  18. 18.
    Jo EJ, Yang MS, Kim YL et al (2012) Food-dependent exercise-induced anaphylaxis occurred only in a warm but not a cold environment. Asia Pac Allergy 2(2):161–164CrossRefGoogle Scholar
  19. 19.
    Shimizu T, Furumoto H, Kinoshita E, Ogasawara Y, Nakamura C, Hashimoto Y, Nagai K, Muto M (2000) Food-dependent exercise-induced anaphylaxis occurring only in winter. Dermatology 200:279CrossRefGoogle Scholar
  20. 20.
    Wölbing F, Fischer J, Köberle M, Kaesler S, Biedermann T (2013) About the role and underlying mechanisms of cofactors in anaphylaxis. Allergy 68(9):1085–1092Google Scholar
  21. 21.
    Gaillard J, Borgeat-Kaeser A, Buss G et al (2017) Food-dependent exercise-induced anaphylaxis: a stepwise diagnosis. Rev Med Suisse 13(557):734–738Google Scholar
  22. 22.
    Morita E, Kunie K, Matsuo H (2007) Food-dependent exercise-induced anaphylaxis. J Dermatol Sci 47(2):109–117CrossRefGoogle Scholar
  23. 23.
    Pedersen BK, Steensberg A, Schjerling P (2001) Exercise and interleukin-6. Curr Opin Hematol 8(3):137–141CrossRefGoogle Scholar
  24. 24.
    Nurminskay MV, Belkin AM (2012) Cellular functions of tissue transglutaminase. Int Rev Cell Mol Biol 294:1–97CrossRefGoogle Scholar
  25. 25.
    Palosuo K, Varjonen E, Nurkkala J, Kalkkinen N, Harvima R, Reunala T, Alenius H (2003) Transglutaminase-mediated cross-linking of a peptic fraction of omega-5 gliadin enhances IgE reactivity in wheat-dependent, exercise-induced anaphylaxis. J Allergy Clin Immunol 111(6):1386–1392CrossRefGoogle Scholar
  26. 26.
    Matsuo H, Morimoto K, Akaki T, Kaneko S, Kusatake K, Kuroda T, Niihara H, Hide M, Morita E (2005) Exercise and aspirin increase levels of circulating gliadin peptides in patients with wheat-dependent exercise-induced anaphylaxis. Clin Exp Allergy 35(4):461–466CrossRefGoogle Scholar
  27. 27.
    Wasserman K, Cox TA, Sietsema KE (2014) Ventilatory regulation of arterial H(+) (pH) during exercise. Respir Physiol Neurobiol 190:142–148CrossRefGoogle Scholar
  28. 28.
    Welle M (1997) Development, significance, and heterogeneity of mast cells with particular regard to the mast cell-specific proteases chymase and tryptase. J Leukoc Biol 61(3):233–245CrossRefGoogle Scholar
  29. 29.
    Jensen-Jarolim E, Jensen AN, Canonica GW (2017) Debates in allergy medicine: molecular allergy diagnosis with ISAC will replace screenings by skin prick test in the future. World Allergy Organ J 10(1):33CrossRefGoogle Scholar
  30. 30.
    Mothes-Luksch N, Raith M, Stingl G, Focke-Tejkl M, Razzazi-Fazeli E, Zieglmayer R, Wöhrl S, Swoboda I (2017) Pru p 3, a marker allergen for lipid transfer protein sensitization also in Central Europe. Allergy 72(9):1415–1418CrossRefGoogle Scholar
  31. 31.
    Palacin A, Quirce S, Armentia A, Fernández-Nieto M, Pacios LF, Asensio T, Sastre J, Diaz-Perales A, Salcedo G (2007) Wheat lipid transfer protein is a major allergen associated with baker’s asthma. J Allergy Clin Immunol 120(5):1132–1138CrossRefGoogle Scholar
  32. 32.
    Lieberman P, Decker W, Camargo CA et al (2007) SAFE: a multidisciplinary approach to anaphylaxis education in the emergency department. Ann Allergy Asthma Immunol 98(6):519–523CrossRefGoogle Scholar
  33. 33.
    Simons FE, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, Lockey RF, el-Gamal YM, Brown SG, Park HS, Sheikh A (2015) 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J 8(1):32CrossRefGoogle Scholar
  34. 34.
    Soyer OU, Sekerel BE (2008) Food dependent exercise induced anaphylaxis or exercise induced anaphylaxis? Allergol Immunopathol (Madr) 36(4):242–243CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Department of ImmunologySt. James’s HospitalDublinIreland
  2. 2.Department of ImmunologyTrinity College DublinDublinIreland

Personalised recommendations