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What

Exercise-induced anaphylaxis (EIA) is a severe allergic reaction that occurs only after physical activity. Anaphylaxis is a serious condition characterized by rash, respiratory difficulty, diarrhea and low blood pressure that requires emergency treatment. EIA may be food-related, meaning that it occurs after intake of a specific food (or in some cases any food) followed by exercise, but not with only the food or only the exercise. Alternatively, EIA can be medication-related and occur after intake of medication and then exercise, but not after only one or the other. Jogging is the most common form of physical activity that triggers EIA.

Who

EIA affects equal numbers of boys and girls. It can affect children of any age, most commonly those age 4 or older, and children of any race/ethnicity.

Signs and Symptoms

A person with EIA will suffer recurrent attacks of anaphylaxis, lasting minutes to hours, and associated with exercise and food. The following list summarizes the progression of symptoms typically experienced during an episode of EIA, but not everyone will experience all of these symptoms each time. Fatigue Feeling warm Itchiness (also called pruritus) Large hives (urticaria) may or may not be present Swelling of the lips, eyelids and occasionally other body parts (angioedema) Cramps Nausea Vomiting Diarrhea Difficulty breathing (e.g. choking sensation) Low blood pressure (hypotension), which can lead to fainting These attacks always occur in association with exercise, but in some people, only happen when they eat a certain food. In a few cases, the anaphylaxis can happen with exercise and the ingestion of any food. The symptoms are related to release of abnormally high amounts of a substance called histamine by the immune system during an episode of EIA. To obtain more information, refer to the sites listed under “Website Links” below.

Possible Causes

The exact cause of EIA is unknown and is currently being researched. It is known that there are certain risk factors, such as family history of EIA and exposure to the food or medicine causing the allergy that can predispose an individual to developing EIA or trigger its onset. The allergy-causing food or medicine makes the body overly sensitive to developing anaphylaxis during exercise. Exercising during very hot or cold weather can also trigger an episode of EIA. Girls are also more susceptible to developing episodes of EIA during menstruation.

Diagnosis

The child may be diagnosed with EIA during an acute episode (for example, while receiving emergency treatment). A blood test may be done at that time to check the level of tryptase, a protein in the blood that indicates recent anaphylaxis. After the episode, the child will be tested for food allergies and allergies to any medications. An exercise-challenge test, in which the child exercises under careful supervision of a physician, may be done to observe resulting symptoms.

Treatment

Immediate treatment includes stopping the exercise and seeking any necessary emergency treatment such as epinephrine administration, oxygen therapy, and cardiac support. Antihistamines in oral preparations may be given to reduce the amount of histamine present and thus help relieve the symptoms of EIA. Several of these antihistamine medications are available without prescription and should be readily available at home, school or wherever the child is actively exercising. EIA can often be managed by avoiding ingestion of the allergy-causing food(s) or medication(s) a good 12 hours prior to any physical activity. If food in general triggers EIA, no food should be eaten 6-8 hours before exercise. Like any person who has experienced anaphylaxis, someone with EIA must have, and know how to use, an epinephrine auto-injector (Epi-pen).

Prognosis

Children with EIA usually do not have to give up the physical activities they enjoy. They should be careful to avoid the food(s) or medicine(s) that trigger the allergy for at least an hour prior to doing their activity, but in most cases do not have to give up that food or exercise altogether. The prognosis is generally very good for children with EIA with proper treatment/management. Death from EIA is very rare.

Connect with other parents

In the spirit of community and support, Madisons Foundation offers the unique service of connecting parents of children with rare diseases. If you would like to be connected to other parents of children with this disease, please fill out this brief form.

Weblinks

http://www.aaaai.org/patients/publicedmat/tips/whatisanaphylaxis.stm
This website contains general information about anaphylaxis and contact information for the American Academy of Allergy, Asthma, and Immunology.

http://www.gosafe.ca/content/whatis/anaphylaxis_is.asp
This website contains general information about anaphylaxis and includes a link to Safe4Kids, a website designed specifically for children of different ages who have had episodes of anaphylaxis.

http://www.calgaryallergy.ca/aaia/AAIAarticles/3as.htm
This website of the Allergy/Asthma Information Association in Canada contains information about awareness and tips for prevention of anaphylaxis.

http://www.emedicine.com/ped/topic724.htm
For more details and technical information about EIA, including a description of different types of EIA and causes of symptoms, you can visit this website.

Google Search for Exercise-Induced Anaphylaxis (EIA)

References and Sources

www.emedicine.com/ped/topic724.htm www.aafp.org/afp/20011015/1367.html www.dermatology.about.com/library/blexana.htm