History and clinical findings: A 72-year-old woman developed generalized urticaria. Quincke oedema, shortness of breath and hypotension two hours after eating a meal containing pork and after mild physical activity (ironing) in-between. She was treated by an emergency physician and then admitted to hospital for one day of monitoring her condition. During the past several years such episodes of generalized urticaria had recurred twice to four times a year.
Investigations: Pin-prick tests gave an immediate-type reaction to beef but not to pork. Specific serum IgE antibodies were demonstrated to pork and beef, cat's epithelia, milk albumin and casein. Oral provocation tests were negative for pork and beef. But when pork and beef were eaten mild physical activity (bicycle ergometry at 20 W), generalized urticaria occurred after eating pork and beef, but not after drinking milk.
Treatment and course: Exercise-induced anaphylaxis to pork and beef was diagnosed. No allergic reaction has occurred in more than 12 months of avoiding eating these meats.
Conclusion: The picture of exercise-induced anaphylaxis caused by food allergy can be precipitated by even mild activity. This must be taken into account in the diagnosis of systemic rapid-reaction response and in the performance of provocation tests.