Food Dependent Exercise-Induced Anaphylaxis in pediatric age. Can we trust the oral food challenge with exercise and acetylsalicylic acid? FDEIA, can we trust augmented OFC?

Main Article Content

Stefano Miceli Sopo
Mariannita Gelsomino
Ester Del Vescovo
Giulia Bersani


Diagnosis; Food allergy; Food-dependent exercise-induced anaphylaxis; Oral Food Challenge


Food-dependent exercise-induced anaphylaxis (FDEIA) is an IgE-mediated allergy resulting from the combination of the ingestion of an offending food and physical exercise. According literature, oral food challenge (OFC) followed by physical exercise (OFCPE) should be considered the diagnostic gold standard. In the absence of adverse reactions, other cofactors should be added (e.g. acetylsalicylic acid, alcohol in adulthood), one at a time. But many other factors increase patient’s reactivity. This could reduce the sensitivity of the OFCPE and, consequently, make instructions for patients less reliable. On the other hand, the addition of cofactors not reported by the patient may reduce test specificity. With the help of two exemplary stories, that present opposite outcomes, diagnostic difficulties of FDEIA are discussed.


Download data is not yet available.
Abstract 471 | PDF Downloads 182


1. Asaumi T, Ebisawa M. How to manage food dependent exercise induced anaphylaxis (FDEIA). Curr Opin Allergy Clin Immunol. 2018;18(3):243-247.
2. Cipriani F, Mastrorilli C, Tripodi S, Ricci G, Perna S, Panetta V, Asero R, Dondi A, Bianchi A, Maiello N, Miraglia Del Giudice M, Frediani T, Macrì F, Lucarelli S, Dello Iacono I, Patria MF, Varin E, Peroni D, Chini L, Moschese V, Bernardini R, Pingitore G, Pelosi U, Tosca M, Paravati F, Sfika I, Businco ADR, Povesi Dascola C, Comberiati P, Frediani S, Lambiase C, Verga MC, Faggian D, Plebani M, Calvani M, Caffarelli C, Matricardi PM; Italian Pediatric Allergy Network (I-PAN). Diagnostic relevance of IgE sensitization profiles to eight recombinant Phleum pratense molecules. Allergy. 2018;73:673-682.
3. Asaumi T, Yanagida N, Sato S, Shukuya A, Nishino M, Ebisawa M. Provocation tests for the diagnosis of food-dependent exercise-induced anaphylaxis. Pediatr Allergy Immunol. 2016;27(1):44-9.
4. Jo EJ, Yang MS, Kim YJ, Kim HS, Kim MY, Kim SH, Cho SH, Min KU, Chang YS. Food-dependent exercise-induced anaphylaxis occurred only in a warm but not in a cold environment. Asia Pac Allergy. 2012;2(2):161-4.
5. Christensen MJ, Eller E, Kjaer HF, Broesby-Olsen S, Mortz CG, Bindslev-Jensen C. Exercise-induced anaphylaxis: causes, consequences, and management recommendations. Expert Rev Clin Immunol. 2019;15(3):265-273.
6. Feldweg AM. Food-Dependent, Exercise-Induced Anaphylaxis: Diagnosis and Management in the Outpatient Setting. J Allergy Clin Immunol Pract. 2017;5(2):283-288.
7. Brockow K, Kneissl D, Valentini L, Zelger O, Grosber M, Kugler C, Werich M, Darsow U, Matsuo H, Morita E, Ring J. Using a gluten oral food challenge protocol to improve diagnosis of wheat-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol. 2015;135(4):977-84.e4.
8. Niggemann B, Beyer K. Factors augmenting allergic reactions. Allergy. 2014;69(12):1582-7.
9. Wong GK, Krishna MT. Food-dependent exercise-induced anaphylaxis: is wheat unique? Curr Allergy Asthma Rep. 2013;13(6):639-44.
10. Matsukura S, Aihara M, Sugawara M, Kunimi Y, Matsuki M, Inoue Y, Kambara T, Ikezawa Z. Two cases of wheat-dependent anaphylaxis induced by aspirin administration but not by exercise. Clin Exp Dermatol. 2010;35(3):233-7.
11. Foong RX, Giovannini M, du Toit G. Food-dependent exercise-induced anaphylaxis. Curr Opin Allergy Clin Immunol. 2019;19(3):224-228.
12. Christensen MJ, Eller E, Mortz CG, Brockow K, Bindslev-Jensen C. Wheat-Dependent Cofactor-Augmented Anaphylaxis: A Prospective Study of Exercise, Aspirin, and Alcohol Efficacy as Cofactors. J Allergy Clin Immunol Pract. 2019;7(1):114-121