Anaphylaxis Induced by Exercise or Cold Stimulation with Hyperleukotrieneuria During a Challenge Testing Not Containing Food Ingestion

2020 ◽  
Author(s):  
Chikako Motomura ◽  
Koji Ide ◽  
Terufumi Shimoda ◽  
Hiroshi Odajima
Keyword(s):  
Cold Water ◽  
Challenge Test ◽  
Food Allergies ◽  
Food Ingestion ◽  
Post Challenge ◽  
Loading Test ◽  
Cold Stimulation ◽  
Plasma Adrenaline ◽  
Challenge Testing ◽  
Cold Drink

Abstract Background: Exercise-induced anaphylaxis (EIA) is rare and a potentially life-threatening disorder that can develop independently without food ingestion. Cold drinks can also trigger symptoms in some patients with cold-induced anaphylaxis. We present the case of a patient with exercise and cold-induced anaphylaxis that was diagnosed based on hyperleukotrieneuria in exercise loading and cold-drink challenge testing.Case presentation: A 12-year-old girl presented with acute flushing, cyanosis, swollen eyelids, and dyspnea after an endurance run in winter or swimming in a cold-water pool. She also developed dyspnea after having a cold drink. She had no history of food allergies or atopy. No association was noted between anaphylaxis and food intake in her history. On the 1st day, she ingested 200 mL cold water at a temperature of 5°C in 30 s, which did not trigger any symptomatic responses, but urinary LTE4 level increased (pre-challenge test 295 pg/mg.cr, post-challenge test 400 pg/mg.cr). On the 2nd day, she underwent the exercise loading test according to the Bruce protocol by increasing the power of exercise every 2 min using an ergometer. She had been fasting for >15 h and did not have breakfast. Just after the exercise loading test, the plasma adrenaline and noradrenaline increased. At 15min. after the exercise loading test, the plasma adrenaline and histamine (pre-challenge test 0.7 ng/mL, 15min.post-challenge test 81 ng/mL) rised sharply with anaphylaxis symptom accompaneid by increasing of urinary LTE4 (pre-challenge test 579 pg/mg.cr, post-challenge test 846 pg/mg.cr). After she was discharged, she was restricted from strenuous exercise especially in cold environments and prescribed an adrenaline autoinjector.Conclusion: To our knowledge, cold stimulation becomes a co-effector for EIA. Measurements of urinary LTE4 levels during challenge testing are useful to diagnose anaphylaxis induced by exercise or cold stimulation.

scholarly journals Exercise-induced anaphylaxis unrelated to food ingestion and with hyperleukotrieneuria during challenge testing

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Chikako Motomura ◽  
Koji Ide ◽  
Terufumi Shimoda ◽  
Hiroshi Odajima
Keyword(s):  
Cold Water ◽  
Challenge Test ◽  
Food Allergies ◽  
Strenuous Exercise ◽  
Food Ingestion ◽  
Post Challenge ◽  
Loading Test ◽  
Plasma Adrenaline ◽  
Challenge Testing ◽  
Exercise Induced

Abstract Background Exercise-induced anaphylaxis (EIA) is a rare and potentially life-threatening disorder that can develop independently without food ingestion. Cold drinks can also trigger symptoms in some patients with cold-induced anaphylaxis. We present a case of a patient with EIA that was diagnosed on the basis of positive exercise loading test with hyperleukotrieneuria. Case presentation A 12-year-old girl presented with acute flushing, cyanosis, swollen eyelids, and dyspnea after an endurance run in winter or swimming in a cold-water pool. She also developed dyspnea after having a cold drink. She had no history of food allergies, atopy, or asthma. No association was noted between anaphylaxis and food intake in her history. On the first day, she ingested 200 mL of 5 °C cold water in 30 s, which did not trigger symptomatic responses, but her urinary leukotriene E4 (LTE4) level increased (pre-challenge test: 295 pg/mg-creatinine (cr), post-challenge test: 400 pg/mg-cr). On the second day, she underwent the exercise loading test according to the Bruce protocol by using an ergometer to increase the power of exercise every 2 min. She had been fasting for > 15 h and did not have breakfast. Just after the exercise loading test, the plasma adrenaline and noradrenaline increased. At 15 min after the exercise loading test, her plasma adrenaline and histamine (pre-challenge test: 0.7 ng/mL, 15 min post-challenge test: 81 ng/mL) rose sharply with anaphylaxis symptoms accompanied by increasing urinary LTE4 (pre-challenge test: 579 pg/mg-cr, post-challenge test: 846 pg/mg-cr). After she was discharged, she was restricted from strenuous exercise especially in cold environments and prescribed an adrenaline autoinjector. Conclusion Cold stimulation can become a co-effector of EIA. Measurements of urinary LTE4 levels during challenge testing are useful for diagnosing EIA and capture the pre-anaphylaxis stage.

A study of the state of implementation of oral challenge testing for food allergies

2014 ◽  
Vol 28 (3) ◽  
pp. 356-363
Author(s):  
Seigo Korematsu ◽  
Masafumi Zaitsu ◽  
Michiko Fujitaka ◽  
Kazuyo Kuzume ◽  
Mika Ogata ◽  
...  
Keyword(s):  
The State ◽  
Oral Challenge ◽  
Food Allergies ◽  
Challenge Testing

scholarly journals ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing

2018 ◽  
Vol 52 (5) ◽  
pp. 1801033 ◽  
Author(s):  
Teal S. Hallstrand ◽  
Joerg D. Leuppi ◽  
Guy Joos ◽  
Graham L. Hall ◽  
Kai-Håkon Carlsen ◽  
...  
Keyword(s):  
Airway Hyperresponsiveness ◽  
Task Force ◽  
Challenge Test ◽  
Technical Standard ◽  
Bronchial Challenge ◽  
Airway Narrowing ◽  
Airway Function ◽  
Challenge Testing ◽  
Challenge Tests ◽  
Indirect Tests

Recently, this international task force reported the general considerations for bronchial challenge testing and the performance of the methacholine challenge test, a “direct” airway challenge test. Here, the task force provides an updated description of the pathophysiology and the methods to conduct indirect challenge tests. Because indirect challenge tests trigger airway narrowing through the activation of endogenous pathways that are involved in asthma, indirect challenge tests tend to be specific for asthma and reveal much about the biology of asthma, but may be less sensitive than direct tests for the detection of airway hyperresponsiveness. We provide recommendations for the conduct and interpretation of hyperpnoea challenge tests such as dry air exercise challenge and eucapnic voluntary hyperpnoea that provide a single strong stimulus for airway narrowing. This technical standard expands the recommendations to additional indirect tests such as hypertonic saline, mannitol and adenosine challenge that are incremental tests, but still retain characteristics of other indirect challenges. Assessment of airway hyperresponsiveness, with direct and indirect tests, are valuable tools to understand and to monitor airway function and to characterise the underlying asthma phenotype to guide therapy. The tests should be interpreted within the context of the clinical features of asthma.

scholarly journals Hazardous Medications in Children with Egg, Red Meat, Gelatin, Fish, and Cow’s Milk Allergy

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 501 ◽  
Author(s):  
Caglayan-Sozmen ◽  
Santoro ◽  
Cipriani ◽  
Mastrorilli ◽  
Ricci ◽  
...  
Keyword(s):  
Public Health ◽  
Public Health Problem ◽  
Elimination Diet ◽  
Red Meat ◽  
Food Allergies ◽  
Allergic Reactions ◽  
Milk Allergy ◽  
Food Allergens ◽  
Food Ingestion ◽  
Severe Anaphylaxis

Childhood food allergies are a growing public health problem. Once the offending food allergens have been identified, a strict elimination diet is necessary in treatment or prevention of most of the allergic reactions. Accidental food ingestion can lead to severe anaphylaxis. Food- derived substances can be used in medications at various stages of the manufacturing process. In this review, the possible roles of medications which may contain egg, red meat, gelatin, and fish allergens on allergic reactions in children with food allergy were evaluated.

scholarly journals Safety Test of Agarwood Leaves Tea (Aquilaria malaccencis Lamk.) Through Skin Sensitization Test on Albino Rabbit

2019 ◽  
Vol 7 (22) ◽  
pp. 3896-3899
Author(s):  
Surjanto Surjanto ◽  
Ridwanti Batubara ◽  
Dedy Syahputera Rangkuti
Keyword(s):  
Challenge Test ◽  
Test Method ◽  
Control Group ◽  
Albino Rabbit ◽  
Skin Sensitization ◽  
Traditional Medicines ◽  
Safety Test ◽  
Aquilaria Malaccensis ◽  
Challenge Testing ◽  
Test Position

BACKGROUND: Agarwood tree (Aquilaria malaccensis Lamk) is a tree from the Thymeleaceae tribe that has a high selling value. The part that is often used is the sapwood of the agarwood tree, used as a base for perfumes and traditional medicines. Agarwood farmers in Langkat have used their leaves as tea drinks, brewing aloes leaves. Before being widely produced by the community, it is necessary to test the safety of agarwood leaf tea products through skin sensitization test. AIM: To find out whether steeping aloes leaves irritate the skin or not. METHODS: The test method using test animals namely albino rabbits as many as 15 tails, consisting of 4 test groups 1 group there were 3 test animals and 1 control group, induced with Freund's Complete Adjuvant (FCA) by intradermal and topical injection with a test position of 1.3%, 2.6%, 3.9% and 5.2% to form an immune response, then a Challenge test. The level and degree of skin reaction were assessed based on the Magnusson and Kligman scales. RESULTS: From the observation for 72 hours there was no change in the skin of the test animals after exposure to the test doses, indicating that the agarwood leaf tea is safe to consume if the tea is on the skin, the skin will not experience irritation. CONCLUSION: Testing on albino rabbits with four different doses did not show an irritating effect on the skin. Observation also shows that there is not a single bit that can affect intradermal to challenge testing so it was safe for consumption.

Temperature effect on the human dive response in relation to cold water near-drowning

1984 ◽  
Vol 56 (1) ◽  
pp. 202-206 ◽  
Author(s):  
J. S. Hayward ◽  
C. Hay ◽  
B. R. Matthews ◽  
C. H. Overweel ◽  
D. D. Radford
Keyword(s):  
Heart Rate ◽  
Water Temperature ◽  
Cold Water ◽  
Breath Holding ◽  
Breath Hold ◽  
Cold Stimulation ◽  
Near Drowning ◽  
Voluntary Hyperventilation ◽  
Dive Response ◽  
Breath Hold Duration

To facilitate analysis of mechanisms involved in cold water near-drowning, maximum breath-hold duration (BHD) and diving bradycardia were measured in 160 humans who were submerged in water temperatures from 0 to 35 degrees C at 5 degrees C intervals. For sudden submersion BHD was dependent on water temperature (Tw) according to the equation BHD = 15.01 + 0.92Tw. In cold water (0–15 degrees C), BHD was greatly reduced, being 25–50% of the presubmersion duration. BHD after brief habituation to water temperature and mild, voluntary hyperventilation was more than double that of sudden submersion and was also dependent on water temperature according to the equation BHD = 38.90 + 1.70Tw. Minimum heart rate during both types of submersions (diving bradycardia) was independent of water temperature. The results are pertinent to accidental submersion in cold water and show that decreased breath-holding capacity caused by peripheral cold stimulation reduces the effectiveness of the dive response and facilitates drowning. These findings do not support the postulate that the dive response has an important role in the enhanced resuscitatibility associated with cold water near-drowning, thereby shifting emphasis to hypothermia as the mechanism for this phenomenon.

scholarly journals Effects of Cold Stimulation Induced Pain on Cardiopulmonary Parameters: A Gender Based Study

2020 ◽  
Vol 18 (1) ◽  
pp. 15-18
Author(s):  
R.K. Jha ◽  
S. Amatya
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Acute Pain ◽  
Cold Water ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Cold Stimulation ◽  
Cross Sectional ◽  
Pressor Test

Background Cold pressor induced pain elicits sympathetic responses which can be monitored by measuring blood pressure, heart rate and respiratory rate after exposure to the cold stress. Objective This study was done to evaluate gender difference in acute pain induced by cold pressor test on blood pressure, heart rate and respiratory rate of healthy individuals. Method Our study was cross sectional study with the sample size of 40 including 20 male and 20 female undergraduates. Acute pain was induced by immersion of hand in cold water at 4°C. Changes in blood pressure, heart rate and respiratory rate were recorded by the digital sphygmomanometer and AD Instruments (Model: ML856, Serial: T26-4025) and analysis was done by Lab Chart 7 Pro v 7.3.3 respectively. Acute pain parameter like pain threshold was also recorded. Statistical analysis was done by using Paired “t” test and non-parametric test. Result The present study enrolled 40 participants, aged between 18 – 24 years, and body mass index from 15.78 – 36.06 kg/m2. The respiratory rate was increased in both males (17.30±3.19 to 19.0±3.21, P=0.01) and females (18.60±1.98 to 19.90±2.82, P= 0.01) however significant increase in heart rate was only found in females (77.80±8.07 to 80.70±7.80, P=0.03) after cold pressor test. The systolic as well as diastolic blood pressure did not increase significantly after cold pressor test. The pain thresholds ranged from 25.2 to 105.8 seconds (61.60±23.26, male Vs. 52.69±18.49, female, p = 0.188). Conclusion Our findings point towards autonomic adjustments suggesting more of sympathetic over activity immediately after cold pressor test.

scholarly journals Atopy Patch Test in the Diagnosis of Food Allergens in Infants with Allergic Proctocolitis Compared with Elimination/Introduction Challenge

2021 ◽  
Author(s):  
Saba Arshi ◽  
Majid Khoshmirsafa ◽  
Maryam Khalife ◽  
Mohammad Nabavi ◽  
Mohammad Hasan Bemanian ◽  
...  
Keyword(s):  
Patch Test ◽  
Challenge Test ◽  
Disease Onset ◽  
Egg White ◽  
Food Allergies ◽  
A Cell ◽  
Food Elimination ◽  
The Mean ◽  
Allergic Proctocolitis ◽  
Fresh Foods

Allergic proctocolitis is a cell-dependent food allergy that is present in both breast and formula-fed infants. The presence of blood with different amounts in the stool is the main manifestation of the disease. Different results have been published on the accuracy and specificity of the atopic patch test (APT). The purpose of this study was to evaluate the results of the APT and compare them with those obtained in the food elimination/introduction (E/I) challenge, as the gold standard of confirming the allergy. Twenty-eight patients (18 boys, 10 girls, <1 year) with allergic proctocolitis were recruited in this study. The mean age of the disease onset and enrolling the study were 2.23±1.7 and 5.25±2.19 months, respectively. After performing APT with fresh foods, an E/I challenge was done in a patient with positive tests, and results were analyzed. APT was positive in 14/28 (50%) individuals. The most common foods detected by APT in all of the individuals were: milk (10/28), rice (5/28), soy (4/28), and egg white (4/28), while in E/I challenge in the APT-positive individuals were: milk (8/10), rice (3/5), egg white (1/4), and soy (0/4). APT was positive in half of the infants<1 year with allergic proctocolitis and there was no significant correlation between the APT results and the E/I challenge test for all foods. Comparing the results of APT and E/I challenge methods showed a convergence between the milk and rice sensitivity, thus we suppose APT to be a useful tool in identifying these two allergens in cell-mediated food allergies like allergic proctocolitis.

scholarly journals Study of the population dynamics of Listeria monocytogenes and Pseudomonas fluorescens in buffalo-milk mozzarella cheese by means of challenge testing

2016 ◽  
Vol 5 (3) ◽  
Author(s):  
Donatella Nava ◽  
Salvatore Capo ◽  
Vincenzo Caligiuri ◽  
Valerio Giaccone ◽  
Loredana Biondi ◽  
...  
Keyword(s):  
At Risk ◽  
Population Dynamics ◽  
Listeria Monocytogenes ◽  
Pseudomonas Fluorescens ◽  
Bacterial Load ◽  
Challenge Test ◽  
Buffalo Milk ◽  
Mozzarella Cheese ◽  
Challenge Testing

Campania buffalo mozzarella is a greatly appreciated cheese in Italy and worldwide. From a microbiological standpoint, it is a highly perishable food and potentially at risk of contamination by pathogens such as <em>Listeria monocytogenes</em> (<em>L. monocytogenes</em>). The present paper reports the results of a challenge test carried out with the aim to assess the population dynamics of <em>L. monocytogenes</em>, alone and in the presence of <em>Pseudomonas fluorescens</em> (<em>Ps. fluorescens</em>), in buffalo mozzarella. For this purpose buffalo mozzarella samples were contaminated with <em>L. monocytogenes</em> alone or combined with <em>Ps. fluorescens</em>. In samples wherein <em>L. monocytogenes</em> was inoculated alone, the bacterial load remained unchanged. By contrast, in samples contaminated with <em>L. monocytogenes</em> and <em>Ps. fluorescens</em>, the growth of <em>L. monocytogenes</em> was increased.

Sign in / Sign up

Export Citation Format

Share Document