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Exercise-induced anaphylaxis (EIA)

  • Allergic Emergencies
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Summary

EIA is a unique physical allergy with increasing incidence as the exercising population increases. Clinical features are indistinguishable from IgE-mediated anaphylaxis in which the offending allergens are known (food or insect stings). Recognition of the association with exercise is crucial. A wide variety of exercises can induce the symptoms, including brisk walking. Symptoms may not be always reproduced by the same amount and type of exercise in a given patient suggesting that associated factors are also needed. Food is an associated factor recognized with increasing frequency, and in the last 5 yr, wheat has been the most frequently associated. Avoidance of the known associated factors, such as food of nonsteroidals, induces a long-lasting remission of EIA. Treatment does not differ from that of anaphylaxis of any other cause. General recommendations for patients with EIA include avoidance of exercise 4–6 h after eating, avoidance of aspirin and nonsteroidals before exercise, and avoidance of all associated conditions known to trigger attacks in each particular patient. Discontinuation of exercise at the earliest warning symptom is critical.

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References

  1. Matthews, K. P. and Pan, P. M. (1970),Ann. Intern. Med. 72, 241–249.

    Google Scholar 

  2. Sheffer, A. L. and Austen, K. F. (1980),J. Allergy Clin. Immunol. 66, 106–111.

    Article  PubMed  CAS  Google Scholar 

  3. Hirschmann, J. V., Lawlor, F., English, J. S., Louback, J. B., Winkelmann, R. K., and Greaves, M. W. (1987),Arch Dematol. 123, 462–467.

    Article  CAS  Google Scholar 

  4. Sheffer, A. L. and Austen, K. F. (1984),J. Allergy Clin. Immunol. 73, 699.

    Article  PubMed  CAS  Google Scholar 

  5. Bochner, B. S. and Lichtenstein, L. M. (1993),N. Engl. J. Med. 324, 1786–1790.

    Google Scholar 

  6. Kidd, J. M., Cohen, S. H., Sosman, A., and Fink, J. N. (1983),J. Allergy Clin. Immunol. 71, 311–316.

    Article  Google Scholar 

  7. Wade, J. P., Liang, M. H., and Sheffer, A. L. (1989),Prog. Clin. Biol. Res. 297, 175.

    PubMed  CAS  Google Scholar 

  8. Maulitz, R. M., Pratt, D. S., and Schocket, A. L. (1979),J. Allergy Clin. Immunol. 63, 433–434.

    Article  PubMed  CAS  Google Scholar 

  9. Buchbinder, E. M., Bloch, K. J., Moss, J., et al. (1983),JAMA 250, 2973.

    Article  PubMed  CAS  Google Scholar 

  10. Dohi, M., Suko, M., Sugiyama, H., et al. (1991),J. Allergy Clin. Immunol. 87, 34.

    Article  PubMed  CAS  Google Scholar 

  11. Armentia, A., Martin-Santos, J. M., Blanco, M., et al. (1990),Ann. Allergy 65, 149.

    PubMed  CAS  Google Scholar 

  12. Guinnepain, M. T., Elort, C., Raffard, M., et al. (1996),Ann. Allergy Asthma Immunol. 77, 491–619.

    Article  PubMed  CAS  Google Scholar 

  13. Romano, A., DiFonis, M., et al. (1995),Allergy 50, 817–824.

    Article  PubMed  CAS  Google Scholar 

  14. Fiocchi, A., Mirri, G. P., Santini, I., et al. (1997),J. Allergy Clin. Immunol. 100, 424, 425.

    Article  PubMed  CAS  Google Scholar 

  15. Anibarro, B., Dominguez, C., Diaz, J. M., Martin, M. F., Garcia-Ara, M. C., Boyano, M. T., et al. (1994),Allergy 49, 481–482.

    Article  PubMed  CAS  Google Scholar 

  16. Martin Munoz, F., Lopez Cazana, J. M., Villas, F., Contreras, J. F., Diaz, J. M., and Ojeda, J. A. (1994),Allergy 49, 314–316.

    Article  PubMed  CAS  Google Scholar 

  17. Vasjonen, E., Vainio, E., and Kalimo, K. (1997),Clin. Exp. Allergy 27, 162–166.

    Article  Google Scholar 

  18. Dohi, M., Suko, M., Sugiyama, H., et al. (1990),Arerugi 39, 1598.

    PubMed  CAS  Google Scholar 

  19. Sheffer, A. L., Tong, A. K., Murphy, G. F., Lewis, R. A., McFadden, E. R., Jr., and Austen, K. F. (1985),J. Allergy Clin. Immunol. 75, 479–484.

    Article  PubMed  CAS  Google Scholar 

  20. Schwartz, H. J. (1995),J. Allergy Clin. Immunol. 95, 917–919.

    Article  PubMed  CAS  Google Scholar 

  21. Holgate, S. T., Benyon, R. C., Lowman, M. A., et al. (1989),Prog. Clin. Res. 297, 103.

    CAS  Google Scholar 

  22. Craig, S. C. and Schwartz, L. B. (1989),Immunol. Res. 8, 130–148.

    Article  PubMed  CAS  Google Scholar 

  23. Moore-Robinson, M. and Warin, R. P. (1968),Br. J. Dermatol. 80, 794–799.

    Article  PubMed  CAS  Google Scholar 

  24. Soter, N. A., Wasserman, S. I., Austen, K. F., and McFadden, E. R., Jr., (1980),N. Engl. J. Med. 302, 604–608.

    Article  PubMed  CAS  Google Scholar 

  25. Volcheck, G. W., Beck, K. C., Mottram, C. D., and Hunt, L. W. (1996),Ann. Allergy Asthma Immunol. 76, 76.

    Google Scholar 

  26. Volcheck, G. W. and Li, J. T. C. (1997),Mayo Clin. Proc. 72, 140–147.

    Article  PubMed  CAS  Google Scholar 

  27. Schwartz, L. B. (1994),J. Clin. Immunol. 11361, 25,956–25,957.

    Google Scholar 

  28. Grant, J. A., Farnam, J., Lord, R. A., Thueson, D. O., Lett-Brown, M. A., Wallfisch, H., et al. (1985),Ann. Allergy 54, 35–38.

    PubMed  CAS  Google Scholar 

  29. Longley, S. and Panush, R. S. (1987),Ann. Allergy 58, 257–259.

    PubMed  CAS  Google Scholar 

  30. McFadden, Er, Jr. and Gilbert, I. A. (1996),New Engl. J. Med. 330, 1362.

    Article  Google Scholar 

  31. Wiggins, C. A., Dykewicz, M. S., and Patterson, R. (1988),J. Allergy Clin Immunol. 82, 839–855.

    Article  Google Scholar 

  32. Austen, K. F. (1992),New Engl. J. Med. 326, 639–640.

    Article  PubMed  CAS  Google Scholar 

  33. Horan, R. F. and Sheffer, A. L. (1992),Immunol. Allergy Clin. North Am. 12, 559.

    Google Scholar 

  34. Juji, F. and Suko, M. (1994),Ann. Allergy 72, 452–454.

    PubMed  CAS  Google Scholar 

  35. Katsunuma, T., Iikura, Y., Akasawa, A., Iwasaki, A., Hashimoto, K., and Akimoto, K. (1992),Ann. Allergy 68, 184–188.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 02115, Boston, MA

    Mariana C. Castells, Richard F. Horan & Albert L. Sheffer

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  1. Mariana C. Castells
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  2. Richard F. Horan
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  3. Albert L. Sheffer
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Castells, M.C., Horan, R.F. & Sheffer, A.L. Exercise-induced anaphylaxis (EIA). Clinic Rev Allerg Immunol 17, 413–424 (1999). https://doi.org/10.1007/BF02737646

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