Exercise-induced anaphylaxis (EIA) is a rare and potentially life-threatening disorder that can develop independently without food ingestion. Cold drinks can also trigger symptoms in some patients with cold-induced anaphylaxis. We present a case of a patient with EIA that was diagnosed on the basis of positive exercise loading test with hyperleukotrieneuria. A 12-year-old girl presented with acute flushing, cyanosis, swollen eyelids, and dyspnea after an endurance run in winter or swimming in a cold-water pool. She also developed dyspnea after having a cold drink. She had no history of food allergies, atopy, or asthma. No association was noted between anaphylaxis and food intake in her history. On the first day, she ingested 200 mL of 5 °C cold water in 30 s, which did not trigger symptomatic responses, but her urinary leukotriene E4 (LTE4) level increased (pre-challenge test: 295 pg/mg-creatinine (cr), post-challenge test: 400 pg/mg-cr). On the second day, she underwent the exercise loading test according to the Bruce protocol by using an ergometer to increase the power of exercise every 2 min. She had been fasting for > 15 h and did not have breakfast. Just after the exercise loading test, the plasma adrenaline and noradrenaline increased. At 15 min after the exercise loading test, her plasma adrenaline and histamine (pre-challenge test: 0.7 ng/mL, 15 min post-challenge test: 81 ng/mL) rose sharply with anaphylaxis symptoms accompanied by increasing urinary LTE4 (pre-challenge test: 579 pg/mg-cr, post-challenge test: 846 pg/mg-cr). After she was discharged, she was restricted from strenuous exercise especially in cold environments and prescribed an adrenaline autoinjector. Cold stimulation can become a co-effector of EIA. Measurements of urinary LTE4 levels during challenge testing are useful for diagnosing EIA and capture the pre-anaphylaxis stage.

中文翻译：

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运动诱发的过敏反应与食物摄入无关，并且在激发试验期间伴有高白细胞三神经症

运动诱发的过敏反应 (EIA) 是一种罕见且可能危及生命的疾病，可在不摄入食物的情况下独立发展。冷饮也会引发一些感冒引起的过敏反应患者的症状。我们介绍了一个 EIA 患者的病例，该患者根据运动负荷试验阳性并伴有高白细胞三神经症而被诊断出来。一名 12 岁女孩因冬季耐力跑或冷水池游泳后出现急性潮红、紫绀、眼睑肿胀和呼吸困难就诊。她在喝冷饮后也出现呼吸困难。她没有食物过敏、特应性或哮喘病史。在她的病史中没有发现过敏反应与食物摄入之间存在关联。第一天，她在 30 s 内摄入了 200 mL 5°C 的冷水，没有引发症状反应，但她的尿白三烯 E4 (LTE4) 水平升高（攻击前测试：295 pg/mg-肌酐（cr），攻击后测试：400 pg/mg-cr）。第二天，她按照布鲁斯协议进行了运动负荷测试，使用测力计每2分钟增加一次运动强度。她已经禁食 > 15 小时并且没有吃早餐。运动负荷试验刚结束，血浆肾上腺素和去甲肾上腺素升高。在运动负荷测试后 15 分钟，她的血浆肾上腺素和组胺（攻击前测试：0.7 ng/mL，攻击后测试 15 分钟：81 ng/mL）急剧上升，伴有过敏反应症状，并伴有尿 LTE4（前激发试验：579 pg/mg-cr，激发后试验：846 pg/mg-cr）。她出院后，她被限制剧烈运动，尤其是在寒冷的环境中，并给她开了肾上腺素自动注射器。冷刺激可以成为 EIA 的共同效应。挑战测试期间尿液 LTE4 水平的测量对于诊断 EIA 和捕捉过敏反应前阶段非常有用。