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Dr El-Dieb suggests that the combination of inhaled antigen and exercise might suffice to induce anaphylaxis. Although acute allergic reactions have occurred after ingestion of pollen belonging to the Compositae family (which includes ragweed), to date inhalant-dependent, exercise-induced anaphylaxis has not been documented. Not all patients with food-dependent, exercise-induced anaphylaxis have had positive skin test results to food antigens; therefore, the negative skin test result to grape extract does not exclude the possibility that grapes were involved in our patient's reaction. To prove that the combination of grape ingestion and exercise could induce anaphylaxis, we would have had to subject our patient to a controlled challenge; we did not want to subject her to this additional stress.
Buchbinder EM, Bloch KJ. Food-Dependent, Exercise-Induced Anaphylaxis-Reply. JAMA. 1984;251(24):3224. doi:10.1001/jama.1984.03340480018015