DEAR DR. ROACH: Please write about food-dependent exercise-induced anaphylaxis. Many medical professionals still do not know about this rare and potentially deadly condition.
A: Anaphylaxis is the most serious of all the allergic reactions. It is rapid in onset, and initially causes symptoms such as warmth and flushing, diffuse hives and itching, and sudden fatigue. More serious symptoms include swelling of the lips, tongue and uvula (that thing that hangs down in the back of the throat). This can be so serious that it restricts a person's breathing. Gastrointestinal symptoms can occur, including nausea, cramping and diarrhea. Cardiovascular symptoms include low blood pressure, fainting and ultimately failure of the circulatory system. Anaphylaxis most often occurs after exposure to an allergen, especially drugs, but sometimes foods and insect stings as well.
Exercise-induced anaphylaxis is a rare form of anaphylaxis, more common in women. As its name states, the anaphylaxis is related to exercise and can begin at any stage of exercise. More intensive forms of exercise are more likely to cause symptoms. Stopping exercise immediately usually stops the symptoms; however, many people instinctively run for help, which can dramatically worsen the attack. That's the most important message about exercise-induced anaphylaxis.
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Food-dependent exercise-induced anaphylaxis is an even rarer subtype of exercise-induced anaphylaxis. In this condition, exercise-induced anaphylaxis occurs only if exercise begins within minutes or hours of eating a specific food, although rarely, symptoms can occur if a person eats the food immediately after exercising. The most commonly implicated foods are grains (especially wheat) and nuts, but many foods have been reported, including fruits, vegetables, legumes and seeds.