Exercise-induced anaphylaxis (EIA) is suspected when anaphylactic symptoms occur in association with exertion. Food-dependent, exercise-induced anaphylaxis is similar to EIA but is known for symptoms that are triggered by exercise that occurs within a few hours of eating specific foods. Both conditions present similarly with early signs and symptoms that include diffuse warmth and/or flushing, generalized pruritus, urticarial rash with a diameter of 10 to 15 mm, and sudden fatigue. Progression to more severe symptoms typically occurs if exercise continues, and those include angioedema, gastrointestinal symptoms, laryngeal edema, and hypotension. This condition can be one of the causes of a collapsed athlete. If suspicious symptoms occur, the athlete should be immediately withheld from further exertion.

Learning points:

  1. Exercise-induced anaphylaxis (EIA) is characterized by anaphylactic symptoms occurring in association with exercise.
  2. Food-dependent, exercise-induced anaphylaxis is triggered by exercise occurring within a few hours of eating specific foods.
  3. Both conditions present with early signs such as diffuse warmth, flushing, pruritus, urticarial rash, and sudden fatigue.
  4. Progression to more severe symptoms can occur if exercise continues, including angioedema, gastrointestinal symptoms, laryngeal edema, and hypotension.
  5. Athletes suspected of having EIA should be immediately withheld from further exertion.
  6. Gradual resumption of exercise over weeks to months is recommended once symptoms resolve, rather than immediate return to full activity.
  7. Counseling on avoidance of trigger foods before exercise is important.
  8. Cromolyn sodium may be used before food ingestion to help prevent attacks, while beta blockers and ACE inhibitors should be avoided.
  9. Access to an epinephrine autoinjector is essential for individuals with exercise-induced anaphylaxis.
  10. Athletes with EIA should consider avoiding sports where they are essential and should not compete through mild symptoms to prevent symptom progression.

Reference:

Feldweg A. Exercise-induced anaphylaxis: clinical manifestations, epidemiology, pathogenesis, and diagnosis. UpToDate. Accessed on July 5, 2021 at https://www.uptodate.com/contents/exercise-induced-anaphylaxis-clinical-manifestations-epidemiology-pathogenesis-and-diagnosis