Food-dependent exercise-induced anaphylaxis without IgE sensitivity – a rare challenging condition

Abstract

A 41 years-old healthy caucasian female, with a positive family history for atopy, refers that after eating crab and shrimp followed by aerobic exercises she develops severe generalized pruritus and diffuse urticaria, with large coalescent wheals. Emergency intravenous or oral antihistamines relieves her symptoms. She can eat shellfish without difficulties if not exercising afterwards. She also states that while exercising daily, there are no symptoms if she abstains from eating shellfish. Applying positive (histamine) and negative (diluent) controls, prick testing to shrimp, crab, oysters, scallops and clams were negative. She was advised to wait for 4 to 6 hours after having eaten shellfish to initiate aerobic exercises. An epinephrin autoinjector was supplied.