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We present a case of a 27-years-old female who experienced several episodes of food-dependent exercise-induced anaphylaxis (FDEIA). Besides two typical episodes of FDEIA triggered by a postprandial physical exercise, she also experienced atypical episodes in which the sequence of the causative stimuli was clearly reversed-clinical symptoms which appeared after a prolonged exercise, followed by ingestion of the sensitizing food. This unusual clinical picture entitled us to extend the routine recommendations- avoidance of the coincidence of food allergens intake and exercise accordingly to her history.

Increased in vitro basophil activation in buffers of slightly elevated osmolarity in 2 cases of food-dependent exercise-induced anaphylaxis is presented. These data may suggest the importance of basophil activation degree in pathogenesis of this life threatening syndrome.

We present a case of anaphylactic shock induced by exercise following celery ingestion. The possible mechanism of food-dependent exercise-induced anaphylaxis (FDEIA) and the laboratory tests for its diagnosis are discussed. We evaluated spontaneous, celery-allergen-induced, and anti-FcepsilonRI-antibody-induced histamine release from basophils obtained from the patient, 2 celery-allergic controls, and 3 healthy controls. Buffers of increasing osmolarity were used to mimic conditions of vigorous physical exercise. Only the patient's basophils showed an increase in spontaneous, anti-FcepsilonRI antibody-induced and allergen-induced histamine release under physiological conditions and with slightly increased medium osmolarity. To our knowledge, this is the first report on the possible role of increased histamine releasability in the pathogenic mechanism of FDEIA. We suggest that FDEIA results from increased histamine releasability triggered by physical effort after exposure to a sensitizing food allergen.

Electron microscopic studies provided evidence that a patient with cow's milk allergy, manifested as bronchial asthma, has prominent eosinophil granule discharge, attributable to the release of cytotoxic major basic protein (MBP). This finding illustrates a critical role of eosinophil MBP in anaphylactic injury induced by food allergen. Patient white blood cells pretreated with Ketotifen revealed intact ultrastructure of eosinophils granules and cytoplasm. Inhibition of eosinophils degranulation by Ketotifen demonstrates a new pharmacologic mode of action of this anti-allergic, anti-anaphylactic agent.

In vitro challenge of peripheral white blood cells (WBC) from 15 food sensitive individuals and 16 asymptomatic controls was studied in allergic autocytotoxicity (ACT) assay using extracts of cow's milk, corn, and wheat. The observed disintegration of the WBC in the direct and antibody-dependent ACT was inhibited by ketotifen in a linear, dose-dependent manner. Therefore, our data demonstrate that the ACT response is associated with anaphylactic injury which is prevented by pretreatment with ketotifen, in vitro.