Food-dependent exercise-induced wheals/angioedema, anaphylaxis, or both: A systematic review of phenotypes

Elsevier

Available online 29 March 2023

The Journal of Allergy and Clinical Immunology: In PracticeAuthor links open overlay panel, , , , , , , , AbstractBackground

Food-dependent exercise-induced allergic reactions can manifest with wheals, angioedema, and anaphylaxis, alone or in combination.

Objective

To systematically review the clinical manifestation, culprit foods and exercise, augmenting factors, comorbidities, and treatment options of each phenotype.

Methods

Using predefined search terms, we assessed and analyzed the relevant literature until June 2021. Preferred Reporting Items for Systematic Reviews and Meta-analysis recommendations were applied to this systematic review.

Results

A total of 231 studies with 722 patients were included. The most common phenotype was anaphylaxis with wheals, angioedema, or both, reported in 80% of patients. This was associated with a higher number of anaphylactic episodes, augmenting factors, and use of on-demand antihistamine compared to the least common phenotype, anaphylaxis without wheals or angioedema, reported in 4% of patients. Anaphylaxis with wheals/angioedema was also associated with distinct characteristics compared to stand-alone wheals, angioedema, or both, in 17% of patients: Patients with anaphylaxis were older at the time of disease onset, less often had history of atopy, showed more positive results in response to food and exercise provocation tests, had a more restricted spectrum of culprit foods, and more often used on-demand epinephrine.

Conclusions

The three phenotypes of allergic reactions to food and exercise differ in their clinical characteristics, triggers, and response to treatment. Knowledge of these differences may help with patient education and counseling, as well as disease management.

View full text

© 2023 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology

留言 (0)

沒有登入
gif