食物依赖运动诱发严重过敏3例并文献复习

Food Dependent Exercise-induced Anaphylaxis:3 Cases Report and Literature Review

目的:提高对食物依赖运动诱发严重过敏(FDEIA)的诊疗水平。方法:回顾分析3例食物依赖运动诱发过敏反应患者的临床特征及诊疗情况,并复习相关文献。结果:2例患者在进食小麦面食后,1例患者在进食海虾后由运动诱发全身荨麻疹、呼吸困难及意识障碍,发病时间均在进食食物后30min～2h,经肾上腺素、糖皮质激素及抗组胺药物治疗后缓解。3例患者致敏食物皮肤点刺试验和血清特异性IgE均为阳性。2例患者在禁食致敏食物1年,随访期间未发生过敏反应。结论:FDEIA临床罕见,患者可反复发生过敏性休克而导致死亡,临床进食某些食物过敏原和进食后运动2个因素同时存在时才会诱发FDEIA,治疗方法以抗组胺药物、肾上腺素和糖皮质激素等对症治疗为主,禁食致敏食物及进食致敏食物后4h内避免剧烈运动有可能避免本病的发生。

Objective：To improve the diagnosis and treatment of food-dependent exercise-induced anaphylaxis（FDEIA）.Methods：Clinical features,diagnosis and treatment of 3 patients with FDEIA were analyzed with literature review.Results：Three cases experienced exercise induced urticaria,breathing difficulties and impairment of consciousness in 30 minutes to 2 hours after taken allergic foods（2 cases for wheat and 1 case for shrimp）.Patients＇ symptoms were relieved after treated with anti-histamine,corticosteroids and adrenaline.The results of skin prick test and specific IgE to food were positive.Two cases had no anaphylaxis attack after avoiding causative food during 1 year＇s follow-up.Conclusions：FDEIA are rare in clinic.Patients may die from repeated anaphylactic shock.Only simultaneous existence of taking allergenic food and subsequent exercise can induce FDEIA.Avoidance of exercise for 4 hours after eating causative food might be helpful to prevent the occurrence of symptoms in many FDEIA cases.Dietary avoidance of causative food ingredients is a reliable method for prophylaxis of FDEIA.