Barzilai University Medical Center

107 Research Day 2020 Barzilai University Medical Center 76 A CASE OF FOOD-DEPENDENT EXERCISE-INDUCED ANGIOEDEMA Magen E 1 , Chikovani T 2 . 1 Allergy and Clinical Immunology Unit, Medicine C Department, Barzilai University Medical Center and Faculty of health Sciences, Ben Gurion University of Negev, Ashkelon, Israel. 2 Department of Immunology, Tbilisi State Medical University, Tbilisi, Georgia. Background: We presume that among the patients with idiopathic histaminergic angioedema might be some cases of food-dependent exercise-induced angioedema that may possibly be revealed by thorough anamnestic evaluation. Case A 26-year-old woman was referred to our allergy clinic complaining of eyelid, face, lips, and extremities edema. A thorough history-taking revealed that angioedema episodes occurred when the patient exercised (running) 1 to 4 hours after eating or after ingesting milk and resolved within 2 to 4 days. The patient had experienced similar episodes 7 times while running and 4 times within 2 hours after jogging in the past 16 months. She experienced no urticarial rash, pruritus, nausea, vomiting, and/or diarrhea during angioedema episodes. Results The patient's history, the positive SPT responses with cow's milk, the negative treadmill exercise challenge test results in the fasting state and 1 hour after a meal not containing cow's milk, the appearance of angioedema without urticaria after food-dependent exercise challenge after consumption of cow's milk, and the negative open oral challenge test result with cow's milk indicate that the patient had IgE-mediated food-dependent exercise-induced angioedema to cow's milk. Conclusions The exact mechanisms of food-dependent exercise-induced angioedema are unknown, although an IgE-mediated mechanism may be suggested in light of the SPTs and specific IgE results for cow's milk. The following mechanisms have been proposed: IgE cross-links with a specific food allergen and, when linked with exercise, it lowers the threshold for mast cell and basophil degranulation with release of histamine and vasoactive mediators to cause histaminergic angioedema. Moreover, after consumption of milk products, increased gut permeability during exercise and possible abnormalities of the autonomic nervous system could potentially trigger histaminergic angioedema.