Téma: Review papers

Food-dependent, exercise-induced anaphylaxis

Miloš Jeseňák, Zuzana Rennerová, Jana Kryštofová, Peter Bánovčin

Anaphylaxis (anaphylactic reaction, AR) is severe, acute, life-treating generalized or systemic hypersensitivity reaction caused by rapid mediator deliberation from mastocytes and basophiles. The most severe form of anaphylaxis is anaphylactic shock. Food allergens, insect venom and pharmacological triggers belong to the most common causes of AR. In children more than 90 % of all AR is caused by these foods: nuts + peanuts + hen egg + cow milk + soybean + wheat flour + fish + sea food (AR can develop not only after food ingestion, but also after skin contact or inhalation of aerosol containing food particles). In certain cases, AR can develop only with help of several co-factors: acute or subacute infection, medicaments (α-blockers, β-blockers, ACE-inhibitors, non-steroidal anti-inflammatory drugs), spicy foods, high temperature or exercise/physical effort (especially among adolescents). These special cases of AR are called as „summary anaphylaxis“. Very interesting is especially one kind of summary AR, especially in adolescents, it is so-called food-dependent, exercise-induced anaphylaxis (FDEIA). It is some kind of „sport“ allergy, where exercise after some period of time after food ingestion, provokes AR. These patients during exercise feel heat, face flushing, generalized pruritus followed by the development of bronchoconstriction and hypotension, with potentially-fatal end in absence of adequate therapeutic intervention. Hormonal changes during menstruation and some medicaments (e.g. aspirin) belomg to the stimulating factors. FDEIA is typically IgE-mediated allergic reaction (so-called atopic allergic anaphylaxis in the context of revised nomenclature of allergic diseases), in which ingestion of special kind of food or of food in general followed by physical effort decreases the border activation of mastocytes with subsequently rapid anaphylactic mediators’ deliberation. FDEIA is clinically presented by this combination of symptoms: bronchospasm + upper airway obstruction + hypotension + urticaria + pruritus. It is typical for FDEAI that separated ingestion of special food without following exercise, or vice versa, exercise without previous food ingestion does not lead to the AR development, so exercise and food ingestion are tolerated separately. Therapy of FDEIA or AR in general is based on the rule of „3A + C“: Antigen elimination + Adrenalin (epinephrine) + Antihistamine + Corticosteroid. In acute phase also the administration of inhalant short-acting β2-agonists is necessary because of present bronchospasm. The treatment of diagnosed FDEIA is quite easy: strict avoidance of causal (in allergen-specific FDEAI) or any food (in food nonspecific FDEIA) at least 1-6 hours before planned exercise. Every patient with history of FDEIA should have „first-aid anti-allergic kit“ consisting from: Epi-Pen (self-applicable epinephrine) + peroral antihistamine + inhalant β2-agonist + corticosteroid. The education of patient, his family or other people (teachers) is very important for successful management of these patients.

Ročník 2009  Témy časopisu Paediatrics 1 / 2009

EDITOR IN CHIEF
prof. Peter Banovcin, MD., Ph.D.: Senior specialist of the Ministry of Health in the Slovak Republic for Pediatrics; Head of Department of Pediatrics, University Hospital Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava; Head of Center of Excellence for Experimental and Clinical Research in Respirology; Martin Slovakia

VICE EDITOR IN CHIEF
assoc. prof. Milos Jesenak, MD., MSc., Ph.D., MBA, Dott.Ric., MHA: Head of Center for diagnosis and treatment of primary immunodeficiencies, Department of Pediatrics, University Hospital Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava; Martin, Slovakia

SCIENTIFIC EDITORS
assoc. prof. Mario Barreto, MD., PhD: Department of Pediatrics, 2nd Faculty of Medicine, University La Sapienza, St. Andrew’s Hospital, Rome; Italy
assoc. prof. Vladimir Bzduch, MD., Ph.D.: Department of Pediatrics, Children Teaching Hospital in Bratislava, Faculty of Medicine of Comenius University Bratislava; Slovakia
dr. n. med. Joachim Buchvald, Ph.D.: Head of Department of Pediatric Pulmonology and Cystic Fibrosis; Rabka-Zdroj, Poland
assoc. prof. Miriam Ciljakova, MD., Ph.D.: Head of Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, University Hospital Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava; Martin, Slovakia
assoc. prof. Milan Dragula, MD., Ph.D.: Head of Department of Pediatric Surgery, Jessenius Faculty of Medicine of Comenius University in Bratislava, University Hospital Martin; Martin, Slovakia
ass. prof. Peter Durdik, MD., Ph.D.: Head of Division of Pediatric Pulmonology, Department Pediatrics, Jessenius Faculty of Medicine of Comenius University in Bratislava, University Hospital Martin; Martin, Slovakia
assoc. prof. Katarina Furkova, MD., Ph.D.: Head of the Department of Pediatrics, Vice-dean of Faculty of Medicine of Slovak Medical University; Bratislava, Slovakia
prof. dr. med. Janusz Haluszka, MD., Ph.D.: Head of Institute of Public Health, Medical College, Jagellonian University; Krakow, Poland
ass. prof. Zuzana Havlicekova, MD., Ph.D.: Head of Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics of Jessenius Faculty of Medicine of Comenius University in Bratislava; University Hospital Martin; Martin, Slovakia
Marian Hrebik, MD., Ph.D., MPH: Head of Pediatric Cardiology Center, Comenius University in Bratislava; Bratislava, Slovakia
prof. Hana Hrstkova, MD., Ph.D.: Department of Pediatrics, University Teaching Hospital in Brno, University of Masaryk in Brno; Brno, Czech republic
prof. Henrieta Hudeckova, MD., Ph.D.: Senior specialist of the Ministry of Health in the Slovak Republic for Epidemiology, Head of Department of Public Health, Jessenius Faculty of Medicine of Comenius University in Bratislava; Martin, Slovakia
assoc. prof. Lubica Jakusova, MD., Ph.D.: Department of Pediatrics, Jessenius Faculty of Medicine of Comenius University in Bratislava, University Hospital Martin; Martin, Slovakia
assoc. prof. Emilia Kaiserova, MD., Ph.D.: Head of Department of Pediatric Hematology and Oncology, Children Teaching Hospital in Bratislava, Faculty of Medicine of Comenius University Bratislava; Slovakia
assoc. prof. Ludmila Kostalova, MD., Ph.D.: Department of Pediatrics, Children Teaching Hospital in Bratislava, Faculty of Medicine of Comenius University Bratislava; Slovakia
prof. Karol Kralinsky, MD., Ph.D.: Head of Department of Pediatrics, Head of Department of Pediatric Intensive Care, Children Teaching Hospital in Banska Bystrica, Slovak Medical University; Banska Bystrica, Slovakia
prof. Zuzana Kristufkova, MD., Ph.D., MPH: Head of Department of Public Health, Vice-dean of Faculty of Medicine of Slovak Medical University; Bratislava, Slovakia
assoc. prof. Milan Kuchta, MD., Ph.D.: President of Slovak Pediatric Society, Department of Pediatrics, Children Teaching Hospital in Kosice, University of Pavol Jozef Safarik; Kosice, Slovakia
prof. Jozef Masura, MD., Ph.D., FSCAI: Head of Interventional and Diagnostic Pediatric Cardiology, National Institute for Heart and Vascular Diseases, Pediatric Cardiology Center, Comenius University in Bratislava; Bratislava, Slovakia
prof. Vladimír Mihal, MD., Ph.D.: Head of Department of Pediatrics, Faculty Teaching Hospital in Olomouc, University of Palacky; Olomouc, Czech Republic
assoc. prof. Slavomir Nosal, MD., Ph.D.: Head of Department of Pediatric Intensive Care Unit, University Hospital Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava; Martin, Slovakia
prof. MUDr. Petr Pohunek, CSc.: Head of Department of Pediatric Pulmonology, Department of Pediatrics, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
Elena Prokopova, MD.: Senior specialist of the Ministry of Health in the Slovak Republic for Pediatric Primary Care, Out-patient clinic for children and adolescent; Bratislava, Slovakia
prof. Roman Prymula, MD., Ph.D.: Department of Epidemiology, University of Defense; Hradec Kralove, Czech Republic
ass. prof. Zuzana Rennerova Bohmerova, MD., Ph.D.: Department of Pediatric Pulmonology, Children Teaching Hospital in Bratislava, Faculty of Medicine of Comenius University in Bratislava; Slovakia
prof. Tibor Sagat, MD., Ph.D.: Department of Pediatric Intensive Care Unit, Children Teaching Hospital in Bratislava, Faculty of Medicine of Comenius University in Bratislava; Bratislava, Slovakia
prof. Miroslav Sasinka, MD., DSc.: Department of Pediatrics, Faculty of Medicine of Slovak Medical University; Bratislava, Slovakia
Marta Spanikova, MD.: President of Slovak Society of Primary Pediatric Care, Out-patient clinic for children and adolescent; Bratislava, Slovakia
assoc. prof. Veronika Vargova, MD., Ph.D.: Department of Pediatrics, Children Teaching Hospital in Kosice, University of Pavol Jozef Safarik; Kosice, Slovakia
prof. Maria Pia Villa, MD., Ph.D.: Head of Department of Pediatrics, 2nd Faculty of Medicine, University La Sapienza, St. Andrew’s Hospital, Rome; Italy
prof. Mirko Zibolen, MD., Ph.D.: Senior specialist of the Ministry of Health in the Slovak Republic for Neonatology; Head of Department of Neonatology, Jessenius Faculty of Medicine of Comenius University in Bratislava, University Hospital Martin; Martin, Slovakia

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Pediatria (Bratislava)
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BRISCOE M.H., CLARK T.J., SIMONCELI G.H., DEVILD P.S. Preparing scientific illustrations? A guide to better posters, presentations and publications. 2nd Ed. New York: Springer-Verlag, 1996, 217 pp.
KOLLMANOVÁ S., BUBENÍKOVÁ L. Atlas medicínskych ilustrácii. 5. vyd. Martin: Osveta, 2001, 205 s.
Book chapter:
OSBORNE B.E. The electrocardiogram of the rat. In: BUDDEN R.,DETWEIERD K., ZBINDEN G. The rat electrocardiogram in pharmacology and toxicology. Oxford: Thorax, 53, 1981, p. 15-27.
Journal articles:
BURNARD, P. Writing for publication: a guide for those who must. Nurse Educ Today, 17, 1999, p. 208-212.
ČERVEŇOVÁ, O., POLÁK, V., VICIANOVÁ, K. Sríning a liečebné postupy anomálii uropoetického systému v novorodeneckom veku. Pediatria (Bratisl.), 48, 1993, s. 233-236.
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CARROLL, L. Exploring genes and genetic disorders [online]. Nov. 2004 [cit. 2005-02-10]. Available:[http://www.germany.eu.net/books/alice/html].

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