A case of NSAIDs intolerance initially susupected to be Food-dependent exercise-induced anaphylaxis*
NSAIDs intolerance is conceptualized well as hypersensitivity to nonsteroidal anti-inflammatory drugs（NSAIDs）including aspirin and similar substances which have anti-cyclooxygenase（anti-COX）activity. The clinical symptoms, similar to type-I allergy, are common, including asthma attacks, conjunctival irritation, and generalized flushing. Involvement of the skin is manifested in the form of urticaria with or without angioedema and is rarely complicated with asthma. In severe cases, life-threatening anaphylactic shock may develop. The pathogenesis of NSAIDs intolerance is not fully understood, but it has been hypothesized that it results directly from a non-allergic, non-IgE-dependent mechanism because the clinical symptoms frequently depend on the dosage of NSAIDs and the sensitivity of each individual. Food-dependent exercise-induced anaphylaxis（FDEIA）is a distinct form of food allergy induced by physical exercise. Among various food items, wheat is reported to be the allergen with the highest frequency in Japan. We report on a patient who was initially suspected as having FDEIA because urticaria and dyspnea developed after ingestion of food. The diagnosis was confirmed to be NSAIDs intolerance, type III, after a challenge test consisting of ingestion of the assumed food. This case illustrates that NSAIDs intolerance should be kept in mind and an accurate diagnosis should be made in cases with symptoms such as urticaria, angioedema, and dyspnea of unknown cause. (Accepted on April ７，2008)
