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Exercise Induced Anaphylaxis:  What To Know?

by Dr. Inderpal Randhawa, M.D.

Screenshot_2015-10-02-13-19-01 (2)Anaphylaxis from all causes impacts over 3 million Americans annually.  The most common cause of anaphylaxis involves the most common food triggers- milk, egg, wheat, soy, tree nuts, peanut, fish and shellfish.  Other triggers include medications, contrast dye, non-steroid anti-inflammatory drugs (NSAIDs), and other causes.  A very rare but interesting form of anaphylaxis is termed exercise induced anaphylaxis.

Exercise induced anaphylaxis has been described for decades.  It involves a patient eating foods like wheat or celery and typically one hour after ingestion with moderate exercise resulting in anaphylaxis symptoms.  The symptoms can be as mild as fatigue, red skin, lightheadedness, and throat tightening.  Symptoms can progress to life threatening anaphylaxis.  The causal relationship of the reaction is unclear.  The reaction is likely related to histamine release from mast cells and basophils primed by the food allergen exposure.

When should a parent be concerned about exercise induced anaphylaxis?  If a child, especially a teenager, notices a reduction in exercise tolerance after a new food exposure, it is worth a discussion with your primary care doctor.  It may be appropriate to perform food allergy testing and an exercise cardiopulmonary challenge to make the diagnosis.

An important note for OIT patients:  the reason most clinicians recommend a rest period after food dosing is due to the risk of a similar reaction described above.




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