Two cases of food-dependent exercise-induced anaphylaxis with different culprit foods
A 15-year-old Qatari male student was referred to the allergy clinic on January 2011 because of a suspected peanut allergy. He reported three episodes of anaphylaxis associated with the ingestion of peanut in the last 8 months. The first occurred while jogging 3 h, following eating a bar of peanut-containing chocolate. He developed flushing, large plaques of urticarial rash all over the body associated with periorbital facial swelling, shortness of breath, and wheezing. He was brought to the ED and treated for anaphylaxis attack. The second and the third episodes also occurred when he started running 2 h after having a piece of sweet that contains mixed nuts. He can tolerate eating nuts if no exercise is performed and he does not develop any symptoms if he exercises without eating nuts. Medical history is significant for childhood atopic dermatitis, bronchial asthma, and allergic rhinitis. He has strong family history of atopy. His father as well as three of his siblings has asthma and seasonal allergic rhinitis. Physical examination was unremarkable. Allergy skin prick testing for food showed positive reaction to peanut, almond, and hazelnut. A supervised graded oral challenges with peanut, almond, and hazelnut at rest were negative. He was advised to avoid any exercise for 4 h, following food ingestions particularly nuts. He has no attacks of anaphylaxis over the last 1 year of follow-up.