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They were special dairy-free chocolate chips. They weren't supposed to trigger an allergic reaction in Stefania Paciocco's son Gabriele, who at 5 years old already had a laundry list of food allergies including milk, tree nuts, peanuts and eggs.
"I would make a [cookie] batter without eggs in it and I would add [the dairy-free] chocolate chips," said Paciocco, who lives in Plymouth, Mich. "Whenever he would eat anything with these chocolate chips in it, he would start to scratch his throat."
Paciocco suspected her son was allergic to chocolate, but the boy's doctor did not initially believe it.
"Even I was skeptical," said Dr. Harvey Leo, a pediatric allergist and immunologist at C.S. Mott Children's Hospital in Ann Arbor, Mich. "Chocolate allergies are really rare," he explained, adding that most reactions to chocolate either are not true allergic reactions or they come as a result of exposure to nuts or milk in the chocolate chunks.
However, after some persistence by Paciocco, a skin test and a food challenge showed Gabriele, indeed, had the allergy.
"I was shocked because I love chocolate," said Paciocco. "And I felt bad. He can't have a chocolate bar?"
In the end, both parent and doctor agreed persistence paid off in confirming an unusual and potentially dangerous allergy.
"I don't think patients should be afraid to challenge their doctor," said Leo.
"Dr. Leo and I have a really good relationship, so I feel really comfortable with him," added Paciocco. "You should always listen to that intuition."
It's the perfect excuse: I can't exercise because I'm allergic to it.
Sure, it sounds like a joke but a rare condition called exercise-induced anaphylaxis can result in an allergic reaction during exercise, and it can be severe enough to kill the exerciser.
"They have all of the manifestations one would have if you had an acute allergic reaction to peanuts," explained Dr. Thomas Casale, chief of allergy and immunology at Creighton University and executive vice president of the American Academy of Allergy, Asthma & Immunology.
Most often reported with running or jogging, the exercise-allergic person might get hives, swelling, trouble breathing, low blood pressure, itching, nausea, a headache or wheezing.
Because some of the symptoms occur commonly during normal exercise, some people with exercise-induced anaphylaxis might not realize they have the problem.
In addition, for some people, the reaction only comes when exercise is combined with a certain food. Casale noted several early reports of exercise-induced anaphylaxis from people who ate celery before they exercised.
"They could exercise, they were fine. They could eat celery, they were fine. They eat celery, then they exercise -- then they have an anaphylactic reaction," said Casale, who studied the phenomenon in the 1980s.
As is typical with most allergic reactions, the symptoms of exercise-induced anaphylaxis result from chemicals -- including histamines -- that are released by mast cells in the body. But Casale said researchers have yet to figure out why exercise, or the food/exercise combination, triggers the mast cells to act.
Still, doctors say there are ways for the afflicted to exercise and stay safe. You can exercise with a buddy, carrying adrenaline, and in the case of those with food triggers, avoid meals for two to four hours before and after exercise, Casale suggested.