アスピリンが誘因となった食物依存性運動誘発性アナフィラキシーの1例

A Case of Food-dependent Exercise-induced Anaphylaxis Provoked by Administration of Aspirin

要旨

　患者は58歳，男性．2001年9月に左冠動脈前下行枝の心筋梗塞に対するカテーテル治療が施行され，アスピリン投与が開始された．再検査の冠動脈造影では有意狭窄を認めなかったが，2002年6月，ゴルフ中に失神，2003年3月には農作業中に呼吸困難となった．その後も同様の発作を認めていたが，必ず蕁麻疹を合併しており，パン食後の労作中に発症することが判明した．皮内テストでは小麦とその主成分のグルテンで陽性であり，食物依存性運動誘発性アナフィラキシーと考えられた．本症はアスピリンが発作を増悪するので，アスピリン，グルテン摂取，トレッドミルを組み合わせて誘発試験が施行されたところ，アスピリン＋グルテンで症状の再現がみられた．アスピリン中止と小麦系食物の制限で症状は軽快した．虚血性心疾患の診療においてアスピリンは必須の薬剤であるので，循環器科医は本疾患についての認識をもつ必要があると思われる．

Summary

　A 58-year-old man was admitted to our hospital due to episodes of syncope and paroxysmal dyspnea in April 2003. In September 2001,he developed acute myocardial infarction and underwent stent deployment in the proximal left anterior descending coronary artery. He was administered aspirin thereafter,and no coronary restenosis was detected by follow-up coronary angiographies. However,he experienced syncope while playing golf in June,2002,and developed paroxysmal dyspnea during farm work in May 2003. After a series of similar bouts,it was eventually noticed that his symptoms were accompanied by urtication. Furthermore,a detailed patient history revealed that attacks had occurred during strenuous exercise within hours after eating bread. A skin prick test was positive for wheat and its main constituent gluten. Since aspirin was reported to enhance the reaction,provocation tests were attempted with combinations of aspirin,gluten and exercise. His symptoms were reproduced by a combination of aspirin and gluten,although gluten and exercise yielded negative result. With these findings in mind,a diagnosis of food-dependent exercise-induced anaphylaxis was confirmed,and aspirin was considered to be a main contributing factor. He was relieved of anaphylactic symptoms following discontinuation of aspirin and restriction of wheat intake. Because aspirin is a fundamental drug for ischemic cardiovascular disease,cardiologists must be aware of the possible untoward effect that aspirin may lead to food-dependent exercise-induced anaphylaxis.