Food-dependent exercise-induced anaphylaxis with a high level of plasma noradrenaline
Food-dependent exercise-induced anaphylaxis with a high level of plasma noradrenaline
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DOI：
10.1111/j.1346-8138.2006.00227.x
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发表时间：
2007-02-01
影响因子：
3.1
通讯作者：
Tsuboi, Ryoji
中科院分区：
文献类型：
--
作者：
Kato, Yukihiko;Nagai, Ayako;Tsuboi, Ryoji
摄入某些食物有时会在运动后引发过敏反应（食物依赖性运动诱导的过敏反应，FDEIA）。特定的食物引起的皮肤粘膜荨麻疹也可能进展为过敏反应（口腔过敏综合征，OAS）。对食物的阳性皮肤试验和/或放射性过敏吸附试验（RAST）提示免疫球蛋白（IG）E-过敏反应参与这两种疾病。在每种情况下，触发食物和最初的靶器官通常是不同的。在本研究中，一名32岁的男性报告呼吸困难伴风团，和低血压的症状，而步行后吃中国面条和甜甜圈。他还报告说，吃了甜瓜后，他的嘴和喉咙感到不舒服。进行运动激发试验。测试前和测试后测量血清组胺、血浆肾上腺素、去甲肾上腺素和多巴胺。运动或运动前摄入任何单一食物均未引起症状。然而，大量风团出现时，运动后的联合摄入的食物。同样，吃煎饼然后运动的顺序导致了许多风团和过敏反应。盐酸奥洛他定和富马酸酮替芬完全抑制这种过敏反应。皮肤点刺试验导致水果引起的红斑和风团。这些测试的结果与小麦，黄油和糖是阴性的，并没有引起症状的运动试验后，摄入西瓜，甜瓜或苹果。速发过敏样症状伴随血浆去甲肾上腺素显著升高。在这种情况下，不仅小麦，而且糖和黄油可能会诱发FDEA的发作。在本病例中，症状的强度与血清组胺水平之间无显著相关性。去甲肾上腺素可能参与FDEA的发作，因为去甲肾上腺素可能选择性抑制辅助性T细胞（Th）1功能，同时有利于Th 2反应。试验表明OAS和FDEIA的致病食物之间没有交叉反应性，表明它们之间的发病机制不同。
Ingesting certain foods sometimes triggers anaphylaxis when followed by exercise (food-dependent exercise-induced anaphylaxis, FDEIA). Specific food-induced mucocutaneous urticaria may also progress to anaphylaxis (oral allergy syndrome, OAS). A positive skin test and/or radioallergosorbent test (RAST) to the foods suggest involvement of immunoglobulin (Ig)E-anaphylaxis in both disorders. The triggering foods and initial target organs are usually different in each case. In the present study, a 32-year-old male reported dyspnea accompanied by wheals, and symptoms of low blood pressure while walking after eating Chinese noodles and donuts. He also reported uncomfortable sensations in his mouth and throat after ingesting melon. Exercise challenge tests were administered. Serum histamine, plasma adrenaline, noradrenaline and dopamine were measured pre- and post-test. No symptoms were induced by exercise or by the ingestion of any single food item before exercise. However, numerous wheals appeared when exercise followed the combined ingestion of foods. Likewise, the sequence of eating pancakes and then exercising resulted in numerous wheals and anaphylaxis. Olopatadine hydrochloride and ketotifen fumarate completely inhibited this anaphylaxis. The skin prick tests resulted in fruit-induced erythema and wheals. The results of these tests with wheat, butter and sugar were negative, and no symptoms were induced by the exercise test after ingestion of watermelon, melon or apple. The anaphylactoid symptoms were accompanied by a significant increase of plasma noradrenaline. In this case, not only wheat, but sugar and butter may induce the onset of FDEIA. There was no significant correlation between the intensity of the symptoms and the serum histamine levels in the present case. Noradrenaline may be involved in the onset of FDEIA, since noradrenaline may selectively inhibit T-helper (Th)1 functions while favoring Th2 responses. The tests showed no cross-reactivity between the causative foods of OAS and FDEIA, indicating that the mechanisms of onset are different between them.