Introduction
Cow’s milk (CM) and wheat are the second and third most common causes of childhood food allergies in Japan, respectively.1Although most children with these allergies acquire tolerance spontaneously with age, some do not.2–5 While oral immunotherapy (OIT) for CM or wheat in patients who do not acquire tolerance has been shown to be effective in achieving desensitization,6–9 exercise after ingestion of the causative antigen can cause immediate allergic symptoms in those children.10–14 Manabe et al. suggested two types of exercise-induced allergic symptoms: food-dependent exercise-induced anaphylaxis (FDEIA or FEIAn)15 and desensitization status and exercise-induced anaphylaxis.10,16
We have previously reported on 14 cases of exercise-induced allergic reactions among 20 patients who were desensitized to 5,200 mg wheat protein after rush OIT (ROIT).11 We designated this status as “exercise-induced allergic reaction on desensitization” (EIARD). There are also several case reports of EIARD after both slow OIT and ROIT.11,12–14 However, there are no case series or case control studies of EIARD after the implementation of slow OIT. Therefore, this study aimed to analyze the results of exercise provocation tests (EPTs) for the diagnosis of EIARD after slow OIT and identify the factors associated with EIARD.