Presentation
Case report A 25-year-old woman presented to our allergy clinic for treatment for her repeated episodes of life-threatening acute allergic reactions. [ijaai.in]
Hiroshi Kimura, from Kanazawa University in Japan, and colleagues presented a case of FDEIA due to shrimp consumption in an 18-year-old woman with specific immunoglobulin (Ig)E antibodies against the new antigen 43 kDa. [medicalxpress.com]
She had been identified antenatally but unfortunately the on-call anaesthetic and obstetric teams were unaware of her at initial presentation. [academic.oup.com]
A thorough clinical history eliciting all exposures and symptoms in the hours prior to presentation is the most important component in diagnosis. [oatext.com]
Entire Body System
- Swelling
Despite being discharged on a course of oral steroids, she experienced recurrence of mouth swelling that evening, and then 48 hours later had swelling of her eyes, lips and tongue. [consultqd.clevelandclinic.org]
A factsheet from the Anaphylaxis Campaign in the UK says that mild symptoms of EIAn can include widespread flushing of the skin, hives, swelling of the skin anywhere on the body, swelling of the lips, abdominal pain, nausea, and vomiting. [foodallergycanada.ca]
If left untreated, it can lead to more serious gastrointestinal symptoms as well as swelling of the throat. landing page video title header: Exercise-Induced Anaphylaxis [epipen.ca]
A patient developed swelling, urticaria and bronchospasm after delivery in her first pregnancy which was presumed to be caused by ergometrine administration. [onlinelibrary.wiley.com]
Allergy has sent runner into anaphylactic shock, causing eyes, throat to swell. — -- Mary Johnson was on one of her regular runs last August when her eyes became itchy and her tongue started to swell. [abcnews.go.com]
- Fishing
She has since avoided any exercise for a minimum of 4 to 6 hours after consuming any fish or seafood. As the reactions occurred with both finned fish and shellfish, she was advised to avoid both possible triggers before exercise. [cfp.ca]
The patient was strictly advised to avoid wheat products, shell fish, and to avoid exercising or walking one hour after consuming food. [ijaai.in]
Indeed, during exercise the following can occur: FDEIA has been associated with several causes including disease conditions; environmental factors; foods such as fruits, fish, nuts and vegetables; and drugs. [njmonline.nl]
[…] exercise-related transient abdominal pain. 38 Castagna J...Pelletier F 31311236 2019 9 Idiopathic anaphylaxis. 38 Bilo MB...Krishna MT 31002196 2019 10 Food-dependent exercise-induced anaphylaxis. 38 Foong RX...du Toit G 30893086 2019 11 [A case of freshwater fish-dependent [malacards.org]
Skin-prick tests (SPTs) performed on the patient were positive for mites and grasses, but negative for egg, milk, wheat, peanut, soy, fish, seafood, seeds and nuts, such as, cashew; fruits, including chestnut, lemon, lime, and mango; corn and maize; garlic [jpharmacol.com]
Respiratoric
- Rhinitis
Medical history is significant for childhood atopic dermatitis, bronchial asthma, and allergic rhinitis. He has strong family history of atopy. His father as well as three of his siblings has asthma and seasonal allergic rhinitis. [thoracicmedicine.org]
These include EI-asthma, EI-bronchoconstriction, EI-rhinitis, EI-anaphylaxis and EI-urticaria. [scinapse.io]
The cases also suggest that atopic disorders commonly associated with the immune system, such as asthma, eczema, or rhinitis, are often found in those who suffer from exercise-induced anaphylaxis and that jogging is the most common exercise type to lead [premierallergyohio.com]
The patient experienced mild rhinitis symptoms in the spring/summer and fall months, for which she did not require regular medication. [consultqd.clevelandclinic.org]
His past medical history of nonspecific allergic rhinitis to dust was notable. [jpharmacol.com]
Gastrointestinal
- Abdominal Pain
This patient also developed anaphylactic shock during physical exercise, that was accompanied by urticaria on his chest and arms, abdominal pain, vomiting and diarrhea. [njmonline.nl]
A factsheet from the Anaphylaxis Campaign in the UK says that mild symptoms of EIAn can include widespread flushing of the skin, hives, swelling of the skin anywhere on the body, swelling of the lips, abdominal pain, nausea, and vomiting. [foodallergycanada.ca]
He denied any associated chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea or wheezing, with his episodes. His past medical history of nonspecific allergic rhinitis to dust was notable. [jpharmacol.com]
pain. 38 Castagna J...Pelletier F 31311236 2019 9 Idiopathic anaphylaxis. 38 Bilo MB...Krishna MT 31002196 2019 10 Food-dependent exercise-induced anaphylaxis. 38 Foong RX...du Toit G 30893086 2019 11 [A case of freshwater fish-dependent exercise-induced [malacards.org]
Case Presentation The patient was jogging when he developed an urticarial rash of the trunk and bilateral upper and lower extremities, nausea, abdominal pain, angioedema of the tongue and face, and cardiovascular instability. [cureus.com]
Skin
- Eczema
The cases also suggest that atopic disorders commonly associated with the immune system, such as asthma, eczema, or rhinitis, are often found in those who suffer from exercise-induced anaphylaxis and that jogging is the most common exercise type to lead [premierallergyohio.com]
He does not have any known allergies to foods or medications, nor does he have any history of eczema or asthma. He is nonsmoker and nonalcoholic. [mjdrdypu.org]
- Insect Bite
Taking certain medications like aspirin can increase ones chances of exercise-induced anaphylaxis, as can exhaustion, menstruation, infections of the airway, insect bites, and exposure to allergens. [premierallergyohio.com]
Neurologic
- Headache
He started having a headache simultaneously. The patient immediately discontinued physical exercise at the first sign of pruritus and malaise, and therefore, the symptoms did not progress, but persisted till he was medicated [Figure 1]. [jpharmacol.com]
Late sequelae included frontal headaches that persisted for 24-72 hours. (See Clinical Presentation.) [emedicine.medscape.com]
Signs and symptoms typically include: • Diffuse redness and warmth of the skin • Widespread itchiness • Hives • Sudden fatigue • Headache • Gastrointestinal symptoms: nausea, vomiting, diarrhea and abdominal cramping • Difficulty in breathing with the [sportsmedtoday.com]
Less frequently, exercise-induced anaphylaxis may be accompanied by gastrointestinal symptoms such as nausea, vomiting, abdominal cramping and diarrhoea, as well as syncope, dysphagia, chest tightness, sweating, choking, throat constriction, headache [dermnetnz.org]
- Confusion
To confuse an already perplexing condition, there is a separate subtype of EIAn known as food-dependent EIAn, which only occurs if physical exertion occurs within several hours of consuming a specific food or combination of foods. [foodallergycanada.ca]
Signs of anaphylactic shock escalating include: pale, clammy skin weak, rapid pulse breathing problems confusion and loss of consciousness If the person has emergency medication like an epinephrine auto-injector, you may need to help administer it. [healthline.com]
[…] look out for include: skin swelling and rashes (such as hives, mosquito-bite-like rashes) itching and flushing asthma symptoms/trouble breathing choking gut symptoms (abdominal pain, nausea, vomiting) poor blood circulation (resulting in dizziness, confusion [acefitness.org]
- Tingling
Episode 3 (six days prior to evaluation): During high-intensity fitness training, she developed palmar/plantar tingling, throat tightness and tongue swelling. [consultqd.clevelandclinic.org]
Workup
With acute epinephrine treatment, allergy workup, and education regarding separation of shrimp and exercise, this patient was able to resume her normal diet and exercise regimen without further harm. [oatext.com]
The diagnostic workup is quite demanding, and (especially for FDEIAn) requires thorough investigation to identify the culprit food. [dovepress.com]
It has been suggested that the frequent involvement of exercise and NSAID in food-induced anaphylaxis highlights the importance of their recognition and inclusion into a diagnostic workup ( 101 ). [frontiersin.org]
Treatment
Treatment includes immediate intramuscular epinephrine injection and emergency department assessment. [cfp.ca]
The treatment of an acute attack of EIA begins with an understanding of how to treat anaphylactic shock. [sportsmedtoday.com]
Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. [rarediseases.info.nih.gov]
He was not following any medical treatment at all. [jpharmacol.com]
Following cessation of exercise, acute treatment is similar to that of most other IgE-mediated allergic reactions with the use of epinephrine (0.3 mL [0.3 mg] intramuscularly) as the mainstay of treatment. [oatext.com]
Prognosis
[…] test-evoked symptoms in wheat-dependent exercise-induced anaphylaxis. 38 Sugiyama A...Furue M 31176598 2019 14 Series of 12 cases of wheat-dependent exercise-induced allergy in Aragon, Spain. 38 Agullo-Garcia A...Colas Sanz C 30651196 2019 15 Favorable Prognosis [malacards.org]
Long-term Prognosis: Anaphylaxis is life-threatening, but it is typically avoidable and treatable with quick action. The first step is to identify and avoid known allergy triggers. [atlantaallergydoctor.com]
[…] anti-inflammatory drugs (NSAIDs), alcohol, certain phases of the menstrual cycle, temperature extremes, and seasonal pollen exposure. [2] As a result, patients may be advised to minimize their exposure to these risk factors. [1] Last updated: 10/12/2016 The prognosis [rarediseases.info.nih.gov]
[…] d'aliments avec sensibilisation alimentaire IgE-dependante (syndrome de Maulitz et Kidd), 1II) l'anaphylaxie ...more Background The allergist usually sees patients with anaphylaxis after the event for the purposes of identifying the cause, establishing a prognosis [scinapse.io]
Etiology
Co-factors such as foods, alcohol, temperature, drugs (eg, aspirin and other nonsteroidal anti-inflammatory drugs), humidity, seasonal changes, and hormonal changes are important in the precipitation of attacks. [1] (See Etiology.) [emedicine.medscape.com]
The specific etiology is unclear; however, a lowering of the degranulation threshold of the mast-cell is detected in skin biopsies. It is often diagnosed on the basis of patient history and examination, but an exercise-challenge is confirmatory. [jpharmacol.com]
Epidemiology
Epidemiology of anaphylaxis. Tang ML, Osborne N, Allen K. Current opinion in allergy and clinical immunology, 2010, Jan.;9(4):1473-6322. [greatist.com]
There is a 2:1 ratio of females versus males described in two epidemiological studies [ 8, 11 ]; some authors identify the menstrual cycle as a triggering factor [ 12, 13 ]. It is more common in atopic individuals. [breathe.ersjournals.com]
"Exercise-induced anaphylaxis: epidemiologic observations". Progress in Clinical and Biological Research. 297 : 175–182. ISSN 0361-7742. PMID 2587584. ^ a b c d e f g h Shadick, N. A.; Liang, M. H.; Partridge, A. J.; Bingham III, C. [en.wikipedia.org]
Exercise-induced anaphylaxis: epidemiologic observations. Prog Clin Biol Res. 1989; 297 :175–182. [ PubMed ] [ Google Scholar ] 13. Shadick NA, Liang MH, Partridge AJ, et al. [ncbi.nlm.nih.gov]
The term “anaphylaxis” defines an acute, life-threatening, generalized reaction with various clinical presentations that concern the skin, respiratory, gastrointestinal, and cardiovascular systems. 1, 2 Recent epidemiological surveys have found a prevalence [dovepress.com]
Pathophysiology
The sporadic and unpredictable nature of its reactions has puzzled clinicians and scientists for decades, but recent studies on WDEIA have enlightened us about the pathophysiology of this condition. [wrap.warwick.ac.uk]
These include the consumption of alcohol, exposure to pollen, extreme temperatures, the taking of non-steroidal anti-inflammatory drugs ( NSAIDs ), and even certain phases of the menstrual cycle. [15] Pathophysiology [ edit ] The pathophysiology surrounding [en.wikipedia.org]
Pathophysiology, diagnosis and management of exercise-induced anaphylaxis. Curr Opin Allergy Clin Immunol 2010;10:312-7. 12. Wölbing F, Fischer J, Köberle M, Kaesler S, Biedermann T. [mjdrdypu.org]
This case raises important issues concerning the pathophysiology of exercise, food consumption, allergy, anaphylactic shock, cholinergic, stress-induced, allergy to effort, aquagenic urticaria and the Kounis hypersensitivityassociated acute coronary syndrome [njmonline.nl]
Table 1 Exercise induced anaphylaxis: differential diagnoses Pathophysiology Pathophysiological mechanisms of EIAn and FDEIAn are still unclear, and many hypotheses have been proposed. [breathe.ersjournals.com]
Prevention
Identification of the triggers is important so that steps can be taken to prevent recurrence. [cureus.com]
Preventive measures for FDEIAn include food avoidance up to 6 hours before exercising and 1 hour after. Preventive measures and good management plans allow a return to exercise for most of the patients. [breathe.ersjournals.com]
Injury Prevention Modification of activities and behavior is very important to the prevention of EIA. [sportsmedtoday.com]
Wheat-dependent, Exercise-induced Anaphylaxis: A Successful Case of Prevention with Ketotifen. Ann Dermatol 2009;212:203-5. 2. Harada S, Horikawa T, Icihashi M. [ijaai.in]
Physical exercise should be discontinued at the first sign of cutaneous erythema, pruritus, urticaria or malaise, to prevent worsening of the EIA. [jpharmacol.com]