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Exercise-Induced Anaphylaxis
Aka: Exercise-Induced Anaphylaxis, Exercise-Induced Urticaria, Exercise Anaphylaxis
- See also
- Exercise-Induced Asthma
- Anaphylaxis
- Urticaria
- Definition
- Allergic symptoms in response to Exercise
- Epidemiology
- On average, symptoms persist 10 years before diagnosis is made
- Types
- CholinergicUrticaria
- Micropapular hives
- Erythematous halo with central 2 to 5 mm Papule
- Exaggerated response to Body Temperature
- Associated with rise in plasma histamine
- Variant Exercise-Induced Anaphylaxis
- Lesions similar to CholinergicUrticaria
- May progress to Anaphylaxis
- Food-Dependent Exercise-Induced Anaphylaxis (FDEIA)
- Classic Exercise-Induced Anaphylaxis
- Precipitated by Exercise at any level
- Criteria
- Angioedema or Urticaria and
- Airway obstruction and
- Hypotension
- Associated symptoms
- Generalized Pruritus
- Choking sensation
- Gastrointestinal colic
- Nausea
- Headache
- Wheezing
- Course
- Duration: 30 minutes to 4 hours after Exercise
- Predisposing factors
- Family History
- Atopic history
- Specific food intakes prior to Exercise (in some cases any food before Exercise)
- Alcohol (common)
- Aspirin (common)
- NSAIDs (common)
- Seafood
- Celery
- Wheat
- Cheese
- Diagnosis: CholinergicUrticaria
- Passive Warming Test
- Increase core Body Temperature >0.5 C or >0.9 F
- Patient immerses in warm water or
- Raise Ambient Temperature
- Interpretation
- CholinergicUrticaria: Plasma histamine increases
- Exercise-Induced Anaphylaxis: No histamine increase
- Methacholine Skin Test
- Methacholine 100 units in saline injected intradermal
- Positive test induces micropapular hives
- Test Sensitivity: 33%
- High Test Specificity
- Diagnosis: Exercise-Induced Anaphylaxis
- Exercise challenge test with treadmill or Exercise bike
- Negative test does not rule out condition
- Emergency equipment must be available
- Epinephrine ready for Subcutaneous Injection
- Intubation equipment
- Oxygen Source
- Advanced Cardiac Life Support Cart
- Management: General Measures
- Activity modification
- Exercise with partner with BLS training (and who carries an Epinephrine Auto-Injector)
- Avoid exacerbating factors before Exercise
- Do not Exercise for 4-6 hours after eating
- Avoid Aspirin or NSAIDs prior to Exercise
- Avoid exercising during Menses
- Self-Management of acute episodes
- Subcutaneous Epinephrine (Epi-Pen) always available
- Stop Exercise with onset of symptoms (early stopping may prevent full Anaphylaxis)
- Administer Epi-pen for first signs of Anaphylaxis
- Flushing
- Pruritus
- Pursue immediate medical care for progressing signs
- Management: Medications
- Acute episode
- See Anaphylaxis
- See Urticaria
- Prevention
- Review if medication banned for competitive athlete
- Antihistamines
- Sedating Antihistamines: Hydroxyzine (Atarax)
- Non-Sedating Antihistamines: Allegra, Zyrtec
- Other potential agents
- Cromolyn Sodium (Intal)
- Leukotriene Antagonist (Singulair, Accolate, Zyflo)
- References
- Mason and Pensa in Herbert (2018) EM:Rap 18(10): 4-5
- Hosey (2001) Am Fam Physician 64(8):1367-74 [PubMed]
- Volcheck (1997) Mayo Clin Proc 72:140-7 [PubMed]