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]
Researchers from Kanazawa University, Japan recently presented a case of FDEIA due to shrimp consumption in an 18-year-old. [snacksafely.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 patient presenting with FDEIA would typically present with anaphylaxis that was triggered during or briefly after exercise, only, if the culprit food was ingested a few hours prior to exercising. [symbiosisonlinepublishing.com]
Entire Body System
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Hypoxemia
On admission, he was found to be hypotensive with hypoxemia and was revived with the administration of intravenous fluids, hydrocortisone, oxygen, and anti-histamines. [ijpd.in]
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Rigor
She was instructed to avoid rigorous exercise in hot weather or in remote areas, or exercising without a partner and a cellphone. A tentative diagnosis of cholinergic urticaria, which may masquerade as exercise-induced anaphylaxis, was made. [consultqd.clevelandclinic.org]
Respiratoric
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Stridor
Indian J Paediatr Dermatol 2018;19:177-8 Sir, A 17-year-old boy presented to us with a history of developing itchy wheals all over the body during vigorous game activity which was followed within few minutes by stridor, breathlessness, and loss of consciousness [ijpd.in]
In fully established attacks, symptoms included choking, respiratory stridor, GI colic, nausea, and vomiting. Late sequelae included frontal headaches that persisted for 24-72 hours. (See Clinical Presentation.) [emedicine.medscape.com]
If the event progresses, fully developed EIA includes gastrointestinal symptoms with abdominal cramps, nausea, and vomiting, as well as symptoms of upper airway obstruction with dyspnea, stridor, and a feeling of choking. [ncbi.nlm.nih.gov]
Gastrointestinal
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Abdominal Pain
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]
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]
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]
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Colic
In fully established attacks, symptoms included choking, respiratory stridor, GI colic, nausea, and vomiting. Late sequelae included frontal headaches that persisted for 24-72 hours. (See Clinical Presentation.) [emedicine.medscape.com]
However, symptoms suggesting vascular compromise, headache (28%), gastrointestinal colic and nausea, upper respiratory obstruction, and even dysphagia, were also described. [7] EIA was often diagnosed on the basis of patient history. [jpharmacol.com]
(%) Symptom Wade et al. [5] Shadick et al. [6] Itching 92 92 Urticaria 83 86 Angioedema 78 72 Flushing 75 70 Shortness of breath 59 51 Dysphagia - 34 Chest tightness - 33 Loss of consciousness 32 32 Diaphoresis 43 32 Headache 30 28 Nausea/diarrhoea/ colic [en.wikipedia.org]
In 1980, Sheffer and Austen [ 9 ] presented a series of 16 patients in whom exertion elicited a variety of anaphylactic symptoms, including generalized urticaria, pruritus, angioedema, gastrointestinal colic, and hypotension. [ncbi.nlm.nih.gov]
Cardiovascular
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Chest Pain
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]
Finally, widespread symptoms can occur, including gastrointestinal issues like nausea and vomiting, cardiovascular and pulmonary issues that can make it hard to breathe or cause chest pain, and neurological issues, which can lead to loss of consciousness [premierallergyohio.com]
Skin
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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]
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Skin Lesion
Soon pruritic skin lesions developed, which started on his face and quickly increased in both number and size and became generalized, with development of urticaria. He started having a headache simultaneously. [jpharmacol.com]
Cold Urticaria Skin lesions are similar to those in EIA. They start in places exposed to cold, usually on the hands, face, and neck, and promptly take up the whole body. [ncbi.nlm.nih.gov]
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Chronic Urticaria
Discussion High-quality evidence supports administration of omalizumab for patients with antihistamine-resistant chronic urticaria/angioedema. [consultqd.clevelandclinic.org]
Neurologic
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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]
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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]
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Stroke
Cutaneous examination revealed no urticarial lesions, and there was no dermatographia evident with light stroking. Skin testing was performed, and revealed no remarkable wheal/flare reactions to wheat or soy. [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]
Prevention remains the best treatment for patients with exercise-induced anaphylaxis (see Treatment and Management). Reducing physical activity to a lower level may diminish the frequency of attacks. [aacos.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]
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]
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]
Pathophysiology, diagnosis and management of exercise-induced anaphylaxis. Curr Opin Allergy Clin Immunol 2010;10:312-7. 12. Cooper DM, Radom-Aizik S, Schwindt C, Zaldivar F Jr. [thoracicmedicine.org]
The pathophysiology of exercise-induced anaphylaxis is not fully understood. Symptoms are caused by histamine and tryptase, which are released on the activation and degranulation of mast cells. [dermnetnz.org]
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]
Physical exercise should be discontinued at the first sign of cutaneous erythema, pruritus, urticaria or malaise, to prevent worsening of the EIA. [jpharmacol.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]