Exercise-induced anaphylaxis: Management and prognosis
- Anna M Feldweg, MD
Anna M Feldweg, MD
- Deputy Editor — Allergy and Immunology
- Instructor in Medicine
- Harvard Medical School
Exercise-induced anaphylaxis (EIAn) is a disorder in which anaphylaxis occurs in response to physical exertion. Food-dependent, exercise-induced anaphylaxis (FDEIAn) is a disorder in which patients only develop symptoms if exercise takes place within a few hours of eating, and in most cases, only if a specific food is eaten during the pre-exercise period.
There are no randomized trials of therapy for EIAn or FDEIAn. Thus, there are only low quality evidence and clinical experience on which to base recommendations. The authors' approach is described here. The management of EIAn and FDEIAn must be individualized for each patient, to some extent, depending upon the severity and frequency of symptoms, the importance of food or other co-triggers, and the patient's desire to continue participating in the particular sports or types of exercise that trigger symptoms.
The management of FDEIAn is relatively straightforward and is centered on avoidance of the culprit food prior to exercise. In contrast, the management of EIAn is more challenging, as attacks tend to be unpredictable.
In all but the most severe cases, patients typically have a strong desire to continue some form of exercise, and we make every attempt to construct a personalized management plan that allows them to do so, because of the many health benefits of regular exercise. However, modifications in the patient's choice of activities may be required. (See 'Resumption of exercise' below.)
The management and prognosis of patients with EIAn and FDEIAn are discussed in this topic review. The clinical manifestations, epidemiology, pathogenesis, and diagnosis are presented elsewhere. (See "Exercise-induced anaphylaxis: Clinical manifestations, epidemiology, pathogenesis, and diagnosis".)
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- CO-FACTOR AVOIDANCE
- Patients with EIAn
- Food avoidance in patients with FDEIAn
- PROPHYLACTIC PHARMACOTHERAPY
- Cromoglycates in FDEIAn
- H1 antihistamines
- Other agents
- RESUMPTION OF EXERCISE
- Stopping at the first sign of symptoms
- Access to epinephrine
- Other precautions
- PATIENT EDUCATION
- SUMMARY AND RECOMMENDATIONS