Exercise-Induced Anaphylaxis

Abstract

Exercise-induced anaphylaxis (EIA) is a severe an allergic reaction occurring after physical exercise. A variant of EIA, food-dependent exercise-induced anaphylaxis (FDEIA), occurs when concomitant ingestion of food and exercise elicit symptoms of anaphylaxis. The pathophysiology is currently not well understood, but it is thought to be multifactorial. Certain medications have also been implicated in playing a role. The diagnosis of EIA and FDEIA is a clinical one that hinges on a thorough history that involves recognizing potential co-triggers. A controlled exercise provocation test can be pursued to further solidify the diagnosis but may not consistently elicit symptoms. The mainstay of management does not differ from other forms of anaphylaxis and encompasses immediate administration of epinephrine and antihistamines. Prevention includes carrying an epinephrine auto-injector at all times, avoiding identified co-triggers, exercising in a supervised setting, and, in the case of FDEIA, avoiding food at least 4–6 hours prior to exercising.