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The aetiology of anaphylaxis ranges from food, insect venom, drugs and various chemicals. Some individuals do not
develop anaphylaxis with the offending agent unless ingestion is related temporally to physical exertion, namely
food dependent exercise induced anaphylaxis (FDEIA).The foods implicated are wheat, soya, peanut, milk and sea
food. A retrospective study on patients with FDEIA from two Allergy clinics in Sri Lanka from 2011 to 2015 is repoited.
Patients were selected who fulfilled the following criteria: clinical diagnosis of anaphylaxis according to the World
Allergy Organization (WAO) criteria, where the onset of symptoms was during exertion, within 4 h of ingesting a food,
the ability to eat the implicated food independent of exercise, or exercise safely, if the food was not ingested in the
preceding 4 h and an in vitro (ImmunoCap serum IgE to the food) or in vivo (skin prick test) test indicating evidence
of sensitivity to the food. There were 19 patients (12 males: 7 females). The ages ranged from 9 to 45 (mean 22.9,
median 19 years). Eight patients (42.1%) were in the 9-16 age group.Those below 16 years had a male:female ratio
of 3:5, while for those above 16 years it was 9:2. Wheat was the only food implicated in FDEIA in all patients and was
confirmed by skin prick testing, or by ImmunoCap specific IgE to wheat or to - 5 gliadin. All patients had urticaria,
while 5/19 (26.3%) had angioedema of the lips. Fifteen patients (78.9%) had shortness of breath or wheezing, while 8
(42.1%) had lost consciousness. Nine patients (47.3%) had hypotension. Fourteen (73.6%) of our patients had severe
reactions, with loss of consciousness or hypotension, while 5 (26.3%) had symptoms related to the gastrointestinal
tract. One patient developed anaphylaxis on two occasions following inhalation of ganja, a local cannabis derivative
along with the ingestion of wheat and exertion. Wheat is the main food implicated in FDEIA in Sri Lanka. A local cannabis derivative, ganja has been implicated as a cofactor for the first time
