BACKGROUND The practice of Indian Ayurvedic medicine is spreading in Western countries and Shilajit is one of the most used drugs, for its antioxidant activities and immunomodulatory effects. Albeit Shilajit has showe...BACKGROUND The practice of Indian Ayurvedic medicine is spreading in Western countries and Shilajit is one of the most used drugs, for its antioxidant activities and immunomodulatory effects. Albeit Shilajit has showed a high degree of safety, it can act as cofactor of anaphylaxis, especially in condition at high risk, such as mast cell activation syndrome(MCAS). We reported this case to sensitize practitioners to investigate to the use of complementary and alternative medicine,in case of exercise-induced anaphylaxis(EIAn).CASE SUMMARY A 43-year-old woman, working as a dance teacher, developed urticaria after ingestion of rice, tuna and Shilajit, which did not respond to intramuscular corticosteroids. Subsequently, she developed dyspnoea and hypotension with loss of consciousness that arose 1 h after sexual activity. The patient did not refer personal history of atopy. Specific IgE for main food allergens resulted negative,with total IgE levels of 14 IU/L. Oral provocation test with Shilajit was not perfomed because the patient refused, but we performed prick-by-prick and patch test that resulted negative. Serum tryptase at the time of anaphylaxis was 20.6 μg/L that fell down to of 10.6 μg/L after therapy, but has remained at the high value after two days and during the follow-up. We performed an analysis of the c-KIT gene in peripheral blood, which was negative. We felt the diagnosis consistent with EIAn in a patient with a possible MCAS.CONCLUSION In Western countries the use of drugs from Ayurvedic medicine is more common than in the past. These substances can be cofactors of anaphylaxis in patients with risk factors.展开更多
Exercise induced anaphylaxis is an uncommon condition first reported by Sheffer and Austen in 1980. In this condition there is an exercise-induced lowering of the mast cell degranulation threshold, causing release of ...Exercise induced anaphylaxis is an uncommon condition first reported by Sheffer and Austen in 1980. In this condition there is an exercise-induced lowering of the mast cell degranulation threshold, causing release of histamine and other mediators leading to the progression of symptoms of anaphylaxis. These can range from mild cutaneous pruritis and urticaria to severe systemic manifestations such as hypotension, cardiovascular collapse, syncope and even death. In Pregnancy and Labour, this can result in a number of complications and challenges. We will describe a case we were involved with.展开更多
Background： Wheat-dependent, exercise-induced anaphylaxis （WDEIA） is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise chall...Background： Wheat-dependent, exercise-induced anaphylaxis （WDEIA） is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge： however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria tbr Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria t＇or Chinese WDE1A patients. Methods： We prospectively included 283 clinically diagnosed WDEIA patients from January 1,2010 to June 30, 2014, and in tile meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by lbod other than wheat. 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic （ROC） curves were plotted, areas under curve （AUC） tbr specific immunoglobin E （slgE） were compared to evaluate the diagnostic value of lgE specific to wheat, gluten, and 0）-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis. Results： We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 （73.3%） reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% （425/567） occurred during exercise. The highest AUC （0.910） was observed for sIgE for gluten, followed by omega-5 gliadin （AUC 0.879）. Combined gluten- and co-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents. Conclusions： In this study, we proposed diagnostic criteria and management of WDEIA patients in China, Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive slgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without perforating a food exercise challenge.展开更多
Background Wheat-dependent exercise-induced anaphylaxis （WDEIA） is a complex disease resulting from interaction of environmental and genetic factors. The aim of this study was to investigate the association of three...Background Wheat-dependent exercise-induced anaphylaxis （WDEIA） is a complex disease resulting from interaction of environmental and genetic factors. The aim of this study was to investigate the association of three single nucleotide polymorphisms （SNPs） （IL-4-C590T, IL-4RA A1727G and IL-10-A627C） with WDEIA. Methods SNP genotyping was conducted among the case subset composing 51 patients with WDEIA and four control subsets by sequencing DNA yielded from polymerase chain reaction （PCR）. Statistical analysis of genotype/allele＇s frequencies between cases and controls were carried out through Fisher＇s exact test with the software of SPSS16.0. Results For IL-4-C590T, there were statistically significant differences of genotype frequencies in case-control 1 （P=0.03） and case-control 4 （P=0.001） and statistically significant differences of allele frequencies in three case-control models （case-control 1：OR=4.27 （95% CI=1.40-13.07）, P=0.009; case-control 3：OR=1.99 （95% CI=1.13-3.50）, P=0.02; case-control 4：OR=2.39 （95% CI=1.49-3.84）, P=0.001）. All other association studies showed no statistically significant （P 〉0.05）. Conclusions IL-4-C590T may be related to the susceptibility of WDEIA, and the minor allele C might be a potential risk factor accounting for WDEIA. IL-4RA A1727G and IL-10-A627C might not be involved in the occurrence of WDEIA.展开更多
文摘BACKGROUND The practice of Indian Ayurvedic medicine is spreading in Western countries and Shilajit is one of the most used drugs, for its antioxidant activities and immunomodulatory effects. Albeit Shilajit has showed a high degree of safety, it can act as cofactor of anaphylaxis, especially in condition at high risk, such as mast cell activation syndrome(MCAS). We reported this case to sensitize practitioners to investigate to the use of complementary and alternative medicine,in case of exercise-induced anaphylaxis(EIAn).CASE SUMMARY A 43-year-old woman, working as a dance teacher, developed urticaria after ingestion of rice, tuna and Shilajit, which did not respond to intramuscular corticosteroids. Subsequently, she developed dyspnoea and hypotension with loss of consciousness that arose 1 h after sexual activity. The patient did not refer personal history of atopy. Specific IgE for main food allergens resulted negative,with total IgE levels of 14 IU/L. Oral provocation test with Shilajit was not perfomed because the patient refused, but we performed prick-by-prick and patch test that resulted negative. Serum tryptase at the time of anaphylaxis was 20.6 μg/L that fell down to of 10.6 μg/L after therapy, but has remained at the high value after two days and during the follow-up. We performed an analysis of the c-KIT gene in peripheral blood, which was negative. We felt the diagnosis consistent with EIAn in a patient with a possible MCAS.CONCLUSION In Western countries the use of drugs from Ayurvedic medicine is more common than in the past. These substances can be cofactors of anaphylaxis in patients with risk factors.
文摘Exercise induced anaphylaxis is an uncommon condition first reported by Sheffer and Austen in 1980. In this condition there is an exercise-induced lowering of the mast cell degranulation threshold, causing release of histamine and other mediators leading to the progression of symptoms of anaphylaxis. These can range from mild cutaneous pruritis and urticaria to severe systemic manifestations such as hypotension, cardiovascular collapse, syncope and even death. In Pregnancy and Labour, this can result in a number of complications and challenges. We will describe a case we were involved with.
基金This study was supported by grants from the CAMS Innovation Fund for Medical Sciences （No. 2016-12M-1-003） and the Natural Science Foundation of China （No. 81273277）.
文摘Background： Wheat-dependent, exercise-induced anaphylaxis （WDEIA） is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge： however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria tbr Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria t＇or Chinese WDE1A patients. Methods： We prospectively included 283 clinically diagnosed WDEIA patients from January 1,2010 to June 30, 2014, and in tile meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by lbod other than wheat. 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic （ROC） curves were plotted, areas under curve （AUC） tbr specific immunoglobin E （slgE） were compared to evaluate the diagnostic value of lgE specific to wheat, gluten, and 0）-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis. Results： We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 （73.3%） reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% （425/567） occurred during exercise. The highest AUC （0.910） was observed for sIgE for gluten, followed by omega-5 gliadin （AUC 0.879）. Combined gluten- and co-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents. Conclusions： In this study, we proposed diagnostic criteria and management of WDEIA patients in China, Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive slgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without perforating a food exercise challenge.
文摘Background Wheat-dependent exercise-induced anaphylaxis （WDEIA） is a complex disease resulting from interaction of environmental and genetic factors. The aim of this study was to investigate the association of three single nucleotide polymorphisms （SNPs） （IL-4-C590T, IL-4RA A1727G and IL-10-A627C） with WDEIA. Methods SNP genotyping was conducted among the case subset composing 51 patients with WDEIA and four control subsets by sequencing DNA yielded from polymerase chain reaction （PCR）. Statistical analysis of genotype/allele＇s frequencies between cases and controls were carried out through Fisher＇s exact test with the software of SPSS16.0. Results For IL-4-C590T, there were statistically significant differences of genotype frequencies in case-control 1 （P=0.03） and case-control 4 （P=0.001） and statistically significant differences of allele frequencies in three case-control models （case-control 1：OR=4.27 （95% CI=1.40-13.07）, P=0.009; case-control 3：OR=1.99 （95% CI=1.13-3.50）, P=0.02; case-control 4：OR=2.39 （95% CI=1.49-3.84）, P=0.001）. All other association studies showed no statistically significant （P 〉0.05）. Conclusions IL-4-C590T may be related to the susceptibility of WDEIA, and the minor allele C might be a potential risk factor accounting for WDEIA. IL-4RA A1727G and IL-10-A627C might not be involved in the occurrence of WDEIA.
