Food-dependent exercise-induced anaphylaxis

Food allergen-induced cofactor-triggered anaphylaxis is the prototype of summation anaphylaxis. In most patients food intake followed by physical exercise triggers the reaction (food-dependent exercise-induced anaphylaxis), whereas food intake alone is tolerated. The most common food responsible for anaphylaxis in Northern Europe is wheat, whereas in Southern Europe reactions to fruit and vegetables linked to lipid-transfer-proteins (LTP) have been more commonly described. Until today, data on the actual incidence of this disease in Europe is missing and it is believed that only a fraction of patients have yet been diagnosed. Typically, the clinical symptoms of food allergen-induced cofactor-triggered anaphylaxis start with urticaria and angioedema, but may also affect airways and the cardiovascular system resulting in anaphylaxis. Patients should always carry an emergency kit including an epinephrine autoinjector for self-administration. A proper allergy workup is essential and the confirmation of the disease in an individual can be difficult. Here further research is needed as only the identification of responsible allergens and trigger factors and educational anaphylaxis training by experienced allergologists will avoid future anaphylactic episodes.