D2.277 - First described case of bean-dependent exercise-induced anaphylaxis (AIEDA) associated with eosinophilic esophagitis (EE): presentation of investigation protocol

Justification: AIEDA is a severe, rare, underdiagnosed systemic hypersensitivity reaction associated with physical exercise and food, particularly wheat. Objective: To report a rare case in a man of AIEDA associated with EE, describing the investigation protocol. Case : 21-year-old man, with first episode of anaphylaxis at 16 years of age. Presented more than 6 episodes until guidance based on allergy tests. All episodes occurred during activity aerobics after an hour of lunch and an hour of starting physical activity. The last episode was more serious, requiring adrenaline. He underwent allergy tests and excluded milk, shrimp, wheat, peas, soy, beans, advised to avoid beans and all legumes, in addition to shrimp. However, after accidental exposure, when he consumed a hamburger with bean sauce, he developed a new episode of AIEDA. Abdominal pain began, and rice and milk were suspended, H pylori was treated and omeprazole was prescribed, without an esophageal biopsy. He repeated EDA with negative H pylori and eosinophils >20/GCA, when PPI increased with improvement in GER, and new EDA was normal. He was referred for our evaluation and new tests were carried out with IgE for beans of 89.3 KU/L and normal tryptase. Positive skin test for black beans, white beans, black-eyed peas, red beans, peas, positive except lentils and white beans. Skin reactivity in the prick test with black beans was 8x7mm and black-eyed peas 6x6 mm. I already consumed cow's milk and shrimp. with peas and white beans at rest and with exercise(PB) without reaction. Conclusion: We describe the first case of AIEDA triggered by black beans, which although it is usually part of the Brazilian diet, it has not yet been described as a trigger for AIEDA. It is necessary to follow a protocol when investigating AIEDA, with the aim of excluding other diagnoses