Exercise-Induced Anaphylaxis and Food-Dependent Exercise-Induced Anaphylaxis

Abstract

Exercise-induced anaphylaxis (EIAn) is characterized by symptoms of anaphylaxis in the setting of significant physical exertion. A food-dependent form of exercise-induced ­anaphylaxis also exists, in which symptoms develop only if the patient has eaten in the hours immediately preceding exercise. In most patients with the food-dependent form, only a specific food(s) will elicit symptoms when combined with exercise, and patients usually have demonstrable IgE to this food. Attacks of exercise-induced anaphylaxis are unpredictable. Management of these disorders involves teaching the patient to stop exercise immediately at the first sign of symptoms and preparing them to self-administer intramuscular epinephrine if needed. Depending on the role of food, patients may need to avoid the culprit food for 4–6 h before exercise, remove the food from their diet altogether, or avoid ingesting any food for several hours before exercise. Pharmacotherapy to prevent attacks has been generally disappointing, although some patients with the food-dependent form may be helped by oral cromolyn, taken before meals. Most patients report fewer attacks over time.