Bac-HA Serum Transfer

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도영 궁
5 years ago
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1 Physical allergies with physical exercise Yi Sub Kwak Dong Eui University College of Physical Education

2 Do You Know FDEIA??

3 CONTENTS What is FDEIA? When is happen FDEIA? Why is happen FDEIA? How prevention about FDEIA? SUMMARY

4 WHAT IS FDEIA?

5 보낸날짜 오후 2:43:19, 받는사람 ysk2003@deu.ac.kr 서울용산에살고있습니다. 최근경험했던생사를넘나든사건 (?) 으로인터넷웹서핑을하다가우연히교수님의논문과관련된개략적인내용을접하고메일을쓰게되었습니다. 운동에따른면역학을주로연구하신분으로알고있으며저명한분이시더군요^^ 아무튼제경험을간략하게말씀드리겠습니다. 저는약 16년여전부터수영을줄기차게해왔고최근 (3년전 ) 에는철인3종에입문하여열심히운동을하고있는평범한 40대 ( 정확히 44 세 ) 가장입니다. 연습은주로동네수영장에서이곳저곳돌아다니며자유수영을하고틈나는대로마라톤과로드사이클도타고있는데요... 최근 ( 그러니까 밤 10시경 ) 에개인적으로생사를넘나든사건이일어났습니다. 그건다름아닌다음과같은내용입니다. (He was 44 yrs old, He has swam for 16 years, and he has also played triathlon for 3 years. One day, he got a big trouble during swimming) 평상시처럼수영장에가서 ( 입수 : 저녁 9시 ) 수영을 30여분정도했는데계속온몸이가려운것같은증세가있고따끔따끔해서오늘따라락스를물에너무많이탔나하는생각에수영장관계자에게따져볼까도생각하면서샤워장으로나왔습니다. 샤워장에들어올때까지만해도그다지몸에많은두드러기가있지는않았는데이때부터정말끔찍스런현상이온몸에나타나기시작합니다. 저녁 9시 40분경샤워실에들어가샤워하면서비누를칠하는데계속해서굵직굵직한두드러기같은게얼굴을제외한온몸으로퍼져나가는겁니다. (He felt big urticaria during exercise and spread it to a whole body ) 순간당혹스럽기도하고무섭기도하고그랬는데한 7~8년전에수산시장에서어패류 ( 소라, 고동등 ) 잘못먹고두드러기가나고설사해고복통을일으키는등큰일을치른경험이있어오늘저녁에식사때먹었던꼬막이문제가되지않았나싶기도했는데그증세가너무심했습니다. (Actually, he has an experience of food allergy after eating conch (a triton). At that day, He also ate conches for supper before swimming) 너무심한두드러기때문에주위눈치슬슬보면서 ( 아마도피부병이라오인할수도있을것같았음 ) 빨리옷을갈아입고나와서차를몰고집까지 10여분정도걸리는거리를달려왔습니다. 이때부터가기억하고싶지않은악몽이시작됩니다. (At that time, Many people mistake this for a skin disease)

6 차를파킹하고나서문을잠그고나와서바로제가정신을잃었습니다. 어느정도시간을정신을잃었는지도모르는데제가잠깐깨어났을때주위에살고있는외국인이저를계속깨우고있더군요... 그리고난뒤다시실신을합니다... 그때까지도계속그외국인이저를돌보고있었다는것을나중에야알았고요,,, 그다음엔제가살고있는집이어디인지묻더군요. (He parked car and he experienced black out and was awakened by a foreigner but he fainted again and again) 우여곡절 ( 집까지가는동안서너차례정도의식을잃었다고함 ) 끝에집에들어가게됩니다. 집에들어와서도거실에서두번정도정신을잃은뒤 119 응급차로인근병원에응급실로실려가심전도검사 / 시티검사 / 혈액검사등등받은뒤알러지처방으로주사맞고세시간정도후인새벽 1시경에퇴원을했습니다. (He finally went to hospital by 119 and He was diagnosed as food allergy after several ECG, CT, and blood test in the hospital). 의식을잃었을때는호흡이어땠는지알수는없었지만폐와목부분이계속숨쉬기에어려움이있다고느낄만큼의기침을하고있음을알았으며그때의여파로이틀이지난지금까지도편도가부어있음을느낍니다. (He also felt hard to breathe and experienced a swollen tonsils) 정말아찔한경험을했고... 순간저는개인적으로아 ~ 이렇게정신이나간뒤에돌아오지못하면죽겠구나하는생각이들었습니다. 죽음이멀리있지않다는생각도했고요 ~~ (He also felt the fear of death) 내용이너무나장황했나요? 제가경험한내용을적다보니이렇게되었습니다. 교수님께문의드리고싶은내용은이렇습니다. 이젠수영을하지말아야하는가? 라는생각을해보았고요... 12월4일에는또국민생활체육진흥공단에서주최하는마라톤대회에나가서경기참여를하게되어있는데이마저도하지말아야하는건지도묻고싶습니다. 아참, 지금제상태를먼저말씀드리겠습니다. (He ask me if he can participate in the marathon event?)

7 외관상으로, 저를보시지못하고이렇게온라인으로만장황하게말씀드리는점양해부탁드리며어쩌다보니제가하고있 는운동과면역에관한연구를하셨고전공이시기에저와딱맞는케이스가여기에있었구나하는생각에메일을보내드립 니다. 논문요약집에보니까 " 수영훈련이림프구의수를증가시켜면역력을높이지만알레르기에감작된그룹은비정상적으로세포수가증가한다. 규칙적인수영운동이면역력을증가시켜주지만부작용으로천식및알레르기반응을증가시키고과격한운동은알레르기쇼크사를유발한다 " 는내용을보았는데... 이내용이아마도제경우와유사하지않나하는염려로의견을여쭙습니다. (He also ask about exercise and allergy connection after reading my books and papers trough on and off line) 연구활동으로바쁘시겠지만혹조언해주시면감사하겠습니다. 혹, 추후에제케이스가교수님의연구활동에도움이될수있고연락을주고받게된다면저에관한더자세한내용을알려드리겠습니다. 감사합니다 ^^

8 Anaphylaxis is defined as a very serious systemic hypersensitive allergic reaction involving the skin, respiratory tract, gastrointestinal (GI) tract, and cardiovascular system. This spontaneous and severe reaction is often accompanied by various signs and symptoms such as dyspnea, angioedema, and hypotension. It has been reported that FDEIAn symptoms include urticaria, respiratory disturbances (dyspnea, coughing and wheezing) angioedema, GI symptoms and even hypotension. It is results from the release of bioactive mediators from mast cell and basophils.

9 FDEIA Of Symptoms Asthma Allergy(Urticaria) Anaphylaxis Death

10 Diagnosis of exercise-induced anaphylaxis: current insights. Pravettoni V, Incorvaia C. J Asthma Allergy Oct 27;9: Review. PMID: Free PMC Article Combined effects of food and exercise on anaphylaxis. Kim CW, Figueroa A, Park CH, Kwak YS, Kim KB, Seo DY, Lee HR. Nutr Res Pract Oct;7(5): doi: /nrp Review. PMID: Free PMC Article Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Romano A, Di Fonso M, Giuffreda F, Papa G, Artesani MC, Viola M, Venuti A, Palmieri V, Zeppilli P. Int Arch Allergy Immunol Jul;125(3): PMID: Diagnosis and management of food allergy. Abrams EM, Sicherer SH. CMAJ Oct 18;188(15): Review. No abstract available. PMID: Swim training increases ovalbumin induced active systemic anaphylaxis in mice. Kim CH, Kwak YS. Immunol Invest. 2004;33(4):

11 When is happen FDEIA?

12 FDEIAn arises from a combination of allergenic food and physical exercise, especially highintensity regimens. In other words, an individual who has FDEIAn will present signs and symptoms during exercise a few hours after ingesting allergenic food. The difference between anaphylaxis and FDEIAn is the inclusion of physical activity as a causal factor.

13 Anaphylaxis can occur when patients consume a particular food and participate in exercise within a few hours of eating. Anaphylaxis

14 Severity of an allergy reaction can be determined based on the amount of allergenic food that has been consumed. The most common trigger food for FDEIAn are eggs, milk, wheat products, cheese, tomatoes, peaches and shellfish.

15 Why is happen FDEIA?

chemokines, heparine); 5 - granules; 6 - mast cell; 7 - newly

16 Degranulation processes: 1 - antigen; 2 - IgE antibody; 3 - FcεRI receptor; 4 - preformed mediators (histamine, proteases, chemokines, heparine); 5 - granules; 6 - mast cell; 7 - newly formed mediators (prostaglandins, leukotrienes, thromboxanes, PAF)

17 Exercise helps increase the absorption of food allergens in the GI tract and the degranulation of mast cells. It is also been reported that IgE production is increased in patients with allergies because isotype switching from type I to type II cytokines occurs during physical exercise.

18 The importance of FDEIAn should not be overlooked because this is life- threatening disorder. Furthermore, it is difficult to diagnose FDEIAn because many factors are involved.

19 EIA(exercise induced asthma) symptoms can be observed at any moment during or after physical activity. However approximately, 90% of patients develop symptoms within 30 min after exercise cessation. Signs and symptoms generally last at least 30 min and up to 4h after exercising.

20 Food-dependent exercise-induced anaphylaxis (FDEIAs) is induced by different types and various intensities of physical activity, and is distinct from food allergies. Intake of allergenic food or medication before exercise is a major predisposing factor for FDEIAn. A number of foods have been reported to be involved in the onset of FDEIAn including wheat, eggs, chicken, shrimp, shellfish, nuts, fruits, and vegetables.

21 How prevention about FDEIA?

22 To diagnose FDEIAn, the medical history of the patient is first reviewed to find a specific cause of the symptoms and signs. This is followed by allergy tests including skin prick tests or immunoglobulin E assay. Physical allergies are a group of reactions caused by physical stimuli such as low temperature, heat, exercise, sunlight, and mechanical pressure.

23 It has also been reported that alcohol consumption can provoke a variety of hyperseinsitive reactions. Furthermore, alcohol intake may increase total serum IgE levels.

24 If a patient is suspected to suffer from FDEIAn, a diagnostic physical stress test can be performed. This can be accomplished on a treadmill in a manner similar to graded exercise testing(gxt).

25 Exercise also induces the release of mediators from mast IgE dependent cell. It was found that exercise lowers the mast cell degranulation threshold. More intense and prolonged episodes of exercise provoke a more severe allergic reaction.

disrupts the digestion and absorption of allergenic

26 Other research indicated that prolonged and intense physical exercise (sometimes, alcohol consumption) disrupts the digestion and absorption of allergenic food, leading to a rise in allergenic proteins in the blood.

27 Histamine and leukotriene stimulates smooth muscle constriction, causing difficulties in breathing and GI symptoms. Histamine also induces vasodilation, and leads to urticaria and angiodedma, decreased blood pressure, and syncope.

28 Once FDEIAn develops, patients need to cause physical activity. This is the most crucial factor for avoiding further progression of the disease. The best treatment for FEDIAn is to prevent the intake of causative foods and reduce exercise intensity. Lower intensity

29 Patients who participate in exercise are also encouraged to have an individualized emergency kit that includes epinephrine, antihistamines, and corticosteroids. Prophylactic use of antihistamine, corticosteroid, β-stimulant, and theophylline has been documented. The use of cromolyn, a mast cell stabilizer and antihistamine, has been shown to be effective for the prophylactic treatment of FDEIAn.

30 Individuals with FDEIAn should avoid causative allergenic foods and do not exercise until 3 to 5 h after eating. If patients have any signs or symptoms while exercising, they should stop their exercise and seek medical aids.

31 SUMMARY Several exercises predispose individuals to FDEIAn. These include running, tennis, basketball, soccer, swimming, and even brisk walking. Numerous foods have been identified as allergens associated with FDEIAn. To prevent the occurrence of FDEIAn, patients should not eat any causative food within 4h before exercising and should avoid vigorous physical activities. Further research on the specific mechanisms underlying FDEIAn along with the development of effective treatment and diagnostic techniques are urgently needed.

32 Thank You

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ÀÇÇÐ°�ÁÂc00Ì»óÀÏ˘ Common Allergic Diseases in Children Sang - Il Lee, M.D. Department of pediatrics Sungkyunkwan University School of Medicine, Samsung Medical Center E - mail : silee@smc.samsung.co.kr Abstract Allergy