Abstract
Background
Exercise-induced anaphylaxis (EIA) is an under-recognized condition that is a distinct
physical allergy. Triggers include varying amounts of exercise, alone or in combination
with certain foods or medications (food-dependent EIA, or FDEIA). Therapy is identical
to that of any immunoglobulin E-mediated allergic reaction.
Objectives
This case is reported to increase awareness among emergency physicians of EIA and
FDEIA.
Case Report
A 57-year-old man was found with a diffuse erythematous rash after eating a wheat
bagel and walking up five flights of stairs. Emergency medical services found him
hypotensive and combative. In the Emergency Department, the patient’s blood pressure
was 72/27 mm Hg, with an oxygen saturation of 97% on non-rebreather mask. The physical examination
was notable for bilateral inspiratory crackles in the lower one-third of the lungs.
He received intravenous (i.v.) diphenhydramine 25 mg, i.v. methylprednisolone 125 mg, and 1 L of normal saline, after which his blood pressure improved to 110/54 mm Hg. He was admitted to the hospital where his recovery was uneventful.
Conclusion
EIA and FDEIA are uncommon forms of physical allergy, but they represent important
entities for emergency physicians to consider. Recognition of the association with
exercise is key, as recurrences can be prevented by avoiding triggers.
Keywords
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Article info
Publication history
Published online: September 28, 2010
Accepted:
May 18,
2010
Received in revised form:
April 1,
2010
Received:
November 7,
2009
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
