Food-dependent exercise-induced anaphylaxis (FDEIA)

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at NSU

Food-dependent exercise-induced anaphylaxis (FDEIA) is a special form of food allergy where a food-intake alone does not induce any symptoms. Anaphylaxis occurs only when triggering factors such as exercise or aspirin-intake are added after ingestion of the causative food.

Clinical features of FDEIA

In FDEIA, patients develop anaphylaxis after eating and exercising. They have no symptoms are rest.

Sequence of events: eating --> exercise --> anaphylaxis

There are two types of patients with food-dependent EIA ("generalists" and "specialists"):

- Patients who develop anaphylaxis when exercising in temporal proximity to ingestion of any
type of food ("generalists")

- Patients who develop anaphylaxis with exercise only with ingestion of a specific food ("specialists")

Foods associated with FDEIA

Wheat is the most common food associated with food-dependent exercise-induced anaphylaxis (FDEIA). Both exercise and aspirin-intake facilitate allergen absorption from the gastrointestinal tract.

80% of the patients with wheat-induced FDEIA have IgE reacting to omega-5 gliadin and the remaining of the patients to high molecular weight glutenin (HMW-glutenin).

Foods associated with FDEIA

- Wheat. Prevalence of wheat allergy in Japan is 0.2% - the assessment was based on questionnaire-based exam, skin prick test, and omega-5 gliadin sIgE (
- Buckwheat
- Crustaceans
- Cephalopods
- Celery
- Chicken
- Grapes
- Tomato
- Dairy products
- Mushrooms

Management of FDEIA

Management of food-dependent EIA includes:

- avoiding exercising in proximity to food consumption (4-6 hours)
- carrying self-injectable epinephrine (EpiPen)
- exercising with a partner
- wearing a medical alert bracelet which lists the condition FDEIA and treatment (EpiPen)

Which of the following foods is often associated with food-dependent exercise-induced anaphylaxis (FDEIA)?

(A) peanut
(B) fish
(C) wheat
(D) soy
(E) egg
(F) milk

Answer: C.

Please note that FDEIA is different from exercise-induced bronchospasm (EIB) (click to enlarge the image):


Food-Dependent Exercise-Induced Anaphylaxis-Importance of Omega-5 Gliadin and HMW-Glutenin as Causative Antigens for Wheat-Dependent Exercise-Induced Anaphylaxis. Morita E, Matsuo H, Chinuki Y, Takahashi H, Dahlström J, Tanaka A. Allergol Int. 2009 Oct 25;58(4).
LTP and PG2A are tomato allergens

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