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.