What is the definition of Exercise-Induced Anaphylaxis?

Exercise-induced anaphylaxis (EIAn) is a rare disorder in which anaphylaxis occurs in association with physical activity. Food-dependent exercise-induced anaphylaxis is a subset of this disorder in which symptoms develop if exertion takes place within a few hours of eating a specific food. In the case of food-dependent exercise-induced anaphylaxis, neither the food nor the exercise alone is enough to cause anaphylaxis. Vigorous forms of physical activity, such as jogging, are more commonly associated with exercise-induced anaphylaxis, although lower levels of exertion (eg, walking and yard work) are also capable of triggering attacks. However, the condition can be unpredictable; a given level of exercise may cause an episode on one occasion but not another. Symptoms of exercise-induced anaphylaxis may include itching, hives (urticaria), flushing, extreme fatigue, and wheezing. Affected individuals may also experience nausea, abdominal cramping, and diarrhea. Continuing the physical activity causes the symptoms to become worse. However, if the individual stops the activity when the symptoms first appear, there is usually improvement within minutes. In most cases, these conditions are sporadic , though familial cases have been reported.

What are the current treatments for Exercise-Induced Anaphylaxis?

Prevention remains the best treatment for patients with exercise-induced anaphylaxis. Management should include education about safe conditions for exercise, identification and avoidance of offending foods, the importance of stopping exercise immediately if symptoms develop, the appropriate use of epinephrine, and the importance of having epinephrine available at all times. Patients may also be advised to wear a medical alert bracelet with instructions on the use of epinephrine. The following factors may increase the risk of an exercise-induced attack and are often considered co-factors: nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, certain phases of the menstrual cycle, temperature extremes, and seasonal pollen exposure. As a result, patients may be advised to minimize their exposure to these risk factors. 

What is the outlook (prognosis) for Exercise-Induced Anaphylaxis?

The prognosis for patients with exercise-induced anaphylaxis is generally favorable. Most patients experience fewer and less severe attacks over time. Although rare, fatalities have been reported, though many of these cases had extenuating circumstances. No cure for this disorder exists. With appropriate lifestyle changes, however, patients may be able to reduce or eliminate episodes of anaphylaxis, and prompt intervention can shorten those episodes that do occur.

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