Food-Dependent Exercise-Induced Anaphylaxis A Case Related to Chickpea Ingestion and Review.docVIP

CASE REPORT Food-DependentExercise-InducedAnaphylaxis:ACase RelatedtoChickpeaIngestionandReview ChetG.Wong,HonBScandSeanR.Mace,MB,BCh,FRCPC Food-dependentexercise-inducedanaphylaxis(FDEIA)isrecognizedasadistinctcategoryofexercise-inducedanaphylaxis(EIA)but is very likely underdiagnosed. This report describes a 41-year-old Indian woman who experienced two separate episodes of anaphylaxis while dancing after she had eaten chickpea-containing foods. The chickpea, a small legume, is a staple ingredient in culinarytraditionsfromaroundtheworld,especiallyinIndia,theMiddleEast,andNorthAfrica.Chickpea-containingdishesarealso becomingmorewidespreadintheWesternworldwiththegrowingpopularityofSouthAsian,MiddleEastern,andAfricancuisines. ItisimportanttoconsiderFDEIAincasesofunexplainedanaphylaxisasreactionscanoccurseveralhoursafteringestingtheculprit food(s). Furthermore, no reaction occurs if a sensitized individual eats the culprit food(s) without exercising afterward; therefore, triggering foods can easily be overlooked. Current ideason the pathophysiology, predisposing factors, workup, and treatment of FDEIAarealsosummarizedhere. Keywords: anaphylaxis,exercise,foodallergy CaseReport F ood-dependentexercise-induced anaphylaxis(FDEIA) is a type of exercise-induced anaphylaxis (EIA) that The patient was a 41-year-old Indian saleswoman who works from home and was referred to the allergy clinic because of asuspected chickpea allergy. She reported two episodes of anaphylaxis associated with the ingestion of chickpeas.Thefirstoccurredduringapartyinthesummer of2005;thepatientateadishcontaining chickpeaflourat approximately 7 pm, and within half an hour, she developedgeneralizedurticariawithfacialswelling,mostly in the periorbital region, while dancing. She did not experience anydysphagia, wheezing, orbreathing difficul- ties. At midnight that same evening, the patient felt lightheaded and, after standing up, lost consciousness for less than 30 seconds. After regaining consci