食物依赖运动诱发性过敏反应一例并文献复习

Food-dependent exercise-induced anaphylaxis： ease report and review of literature

目的提高临床医师对食物依赖运动诱发性过敏反应（FDEIA）的认识。方法2007年12月至2009年10月通过对1例FDEIA患者的诊断、治疗经过以及随访结果的分析，结合文献复习，详细阐述该病的病因、临床表现、诊断方法、治疗及预防方法。结果患者男，18岁，反复出现荨麻疹、呼吸困难及意识障碍8个月，每次发作均是在进食小麦面食后由运动诱发，经抗组胺、肾上腺素药物和（或）地塞米松治疗后快速缓解。血清食物特异性IgE检测，发现虾、蟹特异性IgE阳性，但临床上无相关过敏症状。小麦-运动激发试验结果阳性，诊断为FDEIA。此后患者禁食小麦面食1年多，期间未发生过敏反应，恢复进食小麦面食后，运动再次诱发FDEIA。结论FDEIA发病率低，小麦是常见的致敏食物。进食过敏食物后4h内避免剧烈运动有可能避免本病的发生，禁食致敏食物是预防FDEIA的可靠方法。

Objective Food-dependent exercise-induced anaphylaxis （FDEIA） is a kind of food allergic disorder induced by physical exercise. Some FDEIA patients presented severe symptoms which were threat to life. The aim of the article was to improve the recognition of FDEIA among physicians. Methods The clinical data of a patient with FDEIA in our hospital was collected and analyzed, and current related literatures were reviewed. Results An eighteen year-old male was admitted to our hospital because of repeated episodes of urticaria, dyspnea and loss of consciousness for eight months. Each episode was induced by exercise after ingestion of wheat-made food. Symptoms were relieved rapidly by treatment with adrenaline, antihistamines, and/or dexamethasone. Assay of food-specific lgE in serum of the patient showed positive result for shrimp and crab. However, no anaphylaxis was related to the suspected food. Wheat-exercise challenge test showed positive result in the patient, which confirmed the diagnosis of FDEIA. Since then, the patient had avoided wheat food for more than one year, during which period no episode of anaphylaxis was observed, until one day the patient exercised after a diet of wheat food. Conclusions The incidence of FDEIA was rare. Wheat is the common causative food. Food-exercise challenge test is a reliable method for diagnosis of FDEIA. Avoidance of exercise for 4h after eating causative food might be helpful to prevent the occurrence of symptoms in many FDEIA cases. Dietary elimination of causative food ingredients was a reliable method for prophylaxis of FDEIA.