The following is a summary of “Food-Dependent Exercise-Induced Wheals/Angioedema, Anaphylaxis, or Both: A Systematic Review of Phenotypes,” published in the June 2023 issue of Allergy and Clinical Immunology by Kulthanan et al.
Food-dependent, exercise-induced allergic reactions can manifest as wheals, angioedema, and anaphylaxis, individually or in combination. The purpose is to systematically examine each phenotype’s clinical manifestation, perpetrator foods and exercise, augmenting factors, comorbidities, and treatment options. Researchers evaluated and analyzed the pertinent literature through June 2021 using predefined search terms. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations were applied in this systematic review. Included were a total of 231 studies involving 722 patients.
About 80% of patients reported anaphylaxis with wheals, angioedema, or both as their predominant phenotype. It was associated with more anaphylactic episodes, augmenting factors, and use of on-demand antihistamines compared to the phenotype reported in 4% of patients, anaphylaxis without wheals or angioedema. In 17% of patients, anaphylaxis with wheals/angioedema was also associated with distinct characteristics compared to wheals, angioedema, or both alone.
At the time of disease onset, patients with anaphylaxis were older, had less atopy history, responded more positively to food and exercise provocation tests, had a narrower spectrum of offending foods, and utilized epinephrine on demand more frequently. Clinical characteristics, triggers, and treatment responses vary among the three phenotypes of allergic reactions to food and exercise. These distinctions may aid in patient education, counseling, and disease management.