eMedicine Specialties > Pediatrics: General Medicine > Allergy & Immunology

Exercise-Induced Anaphylaxis: Differential Diagnoses & Workup

Author: William B Stratbucker, MD, MS,, Assistant Professor of Pediatrics, Michigan State University; Director of Research, Pediatrics Residency Program, Helen DeVos Children's Hospital
Coauthor(s): Paul H Sammut, MBBCh, FAAP, FCCP, Medical Director of the Pediatric Intensive Care Unit, Associate Professor, Department of Pediatrics, Section of Pulmonology, University of Nebraska Medical Center
Contributor Information and Disclosures

Updated: May 8, 2009

Differential Diagnoses

Asthma
Syncope

Other Problems to Be Considered

Cholinergic urticaria
Idiopathic anaphylaxis
Exercise-induced asthma
Vocal cord dysfunction
Mastocytosis

Workup

Laboratory Studies

  • Serum histamine levels are increased during anaphylactic episodes, including exercise-induced anaphylaxis (EIA). Increased serum tryptase levels have been reported in some patients.
  • In one study, laboratory tests included assessments of whole-complement activity (CH50), C3 and C4 complement proteins, immunoglobulin classes, and blood chemistries; results were within the reference range.

Imaging Studies

  • No imaging studies are routinely recommended.

Other Tests

  • Radioallergosorbent testing (RAST), allergy skin testing, food-challenge testing, exercise-challenge testing, exercise food–challenge testing, and methacholine-challenge testing all are potential ways to obtain valuable information about patients suspected of having EIA.

Procedures

  • No procedures are routinely recommended.

More on Exercise-Induced Anaphylaxis

Overview: Exercise-Induced Anaphylaxis
Differential Diagnoses & Workup: Exercise-Induced Anaphylaxis
Treatment & Medication: Exercise-Induced Anaphylaxis
Follow-up: Exercise-Induced Anaphylaxis
References
Further Reading

References

  1. Maulitz RM, Pratt DS, Schocket AL. Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol. Jun 1979;63(6):433-4. [Medline].

  2. Lee JY, Yoon S, Ye YM, Hur GY, Kim S, Park HS. Gliadin-specific IgE in wheat-dependent exercise-induced anaphylaxis. Allergy Asthma Proc. Nov-Dec 2008;29(6):614-21. [Medline].

  3. Gangemi S, Mistrello G, Roncarolo D, Amato S, Minciullo PL. Pomegranate-dependent exercise-induced anaphylaxis. J Investig Allergol Clin Immunol. 2008;18(6):491-2. [Medline].

  4. Orhan F, Karakas T. Food-dependent exercise-induced anaphylaxis to lentil and anaphylaxis to chickpea in a 17-year-old boy. J Investig Allergol Clin Immunol. 2008;18(6):465-8. [Medline].

  5. Adachi A, Horikawa T, Shimizu H, et al. Soybean beta-conglycinin as the main allergen in a patient with food-dependent exercise-induced anaphylaxis by tofu: food processing alters pepsin resistance. Clin Exp Allergy. Jan 2009;39(1):167-73. [Medline].

  6. Sheffer AL, Austen KF. Exercise-induced anaphylaxis. J Allergy Clin Immunol. Aug 1980;66(2):106-11. [Medline].

  7. Soyer OU, Sekerel BE. Food dependent exercise induced anaphylaxis or exercise induced anaphylaxis?. Allergol Immunopathol (Madr). Jul-Aug 2008;36(4):242-3. [Medline].

  8. Kjaer BN, Laursen LC. [Food-dependent exercise-induced anaphylaxis]. Ugeskr Laeger. Dec 1 2008;170(49):4058. [Medline].

  9. Gani F, Selvaggi L, Roagna D. [Exercise-induced anaphylaxis]. Recenti Prog Med. Jul-Aug 2008;99(7-8):395-400. [Medline].

  10. Castells MC, Horan RF, Sheffer AL. Exercise-induced anaphylaxis (EIA). Clin Rev Allergy Immunol. Winter 1999;17(4):413-24. [Medline].

  11. Castells MC, Horan RF, Sheffer AL. Exercise-induced Anaphylaxis. Curr Allergy Asthma Rep. Jan 2003;3(1):15-21. [Medline].

  12. Dice JP. Physical urticaria. Immunol Allergy Clin North Am. May 2004;24(2):225-46, vi. [Medline].

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  16. Joint Task Force on Practice Parameters. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. Mar 2005;115(3 Suppl 2):S483-523. [Medline].

  17. Kutting B, Brehler R. Exercise-induced anaphylaxis. Allergy. Jun 2000;55(6):585-6. [Medline].

  18. Lashley M, Klein N. Exercise-induced anaphylaxis in a 4-year-old boy. Ann Allergy. Apr 1990;64(4):381-2. [Medline].

  19. Longo G, Barbi E, Puppin F. Exercise-induced anaphylaxis to snails. Allergy. May 2000;55(5):513-4. [Medline].

  20. Matsuo H, Morimoto K, Akaki T, et al. Exercise and aspirin increase levels of circulating gliadin peptides in patients with wheat-dependent exercise-induced anaphylaxis. Clin Exp Allergy. Apr 2005;35(4):461-6. [Medline].

  21. Morimoto K, Hara T, Hide M. Food-dependent exercise-induced anaphylaxis due to ingestion of apple. J Dermatol. Jan 2005;32(1):62-3. [Medline].

  22. Morimoto K, Tanaka T, Sugita Y, Hide M. Food-dependent exercise-induced anaphylaxis due to ingestion of orange. Acta Derm Venereol. 2004;84(2):152-3. [Medline].

  23. Novembre E, Cianferoni A, Bernardini R, et al. Anaphylaxis in children: clinical and allergologic features. Pediatrics. Apr 1998;101(4):E8. [Medline][Full Text].

  24. Perez-Calderon R, Gonzalo-Garijo MA, Fernandez de Soria R. Exercise-induced anaphylaxis to onion. Allergy. Aug 2002;57(8):752-3. [Medline].

  25. Perkins DN, Keith PK. Food- and exercise-induced anaphylaxis: importance of history in diagnosis. Ann Allergy Asthma Immunol. Jul 2002;89(1):15-23. [Medline].

  26. Senna G, Mistrello G, Roncarolo D, et al. Exercise-induced anaphylaxis to grape. Allergy. Dec 2001;56(12):1235-6. [Medline].

  27. Shadick NA, Liang MH, Partridge AJ, et al. The natural history of exercise-induced anaphylaxis: survey results from a 10-year follow-up study. J Allergy Clin Immunol. Jul 1999;104(1):123-7. [Medline].

  28. Tilles S, Schocket A, Milgrom H. Exercise-induced anaphylaxis related to specific foods. J Pediatr. Oct 1995;127(4):587-9. [Medline].

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Keywords

exercise-induced anaphylaxis, EIA, food-dependent exercise-induced anaphylaxis, drug-dependent exercise-induced anaphylaxis, medicine-dependent exercise-induced anaphylaxis, physical urticaria, pruritus, NSAIDs, shock, hypotension, anaphylaxis syndrome, nausea, cramping, diarrhea, vomiting, tinnitus, vertigo, pruritus, difficulty breathing, chest tightness, treatment, diagnosis

Contributor Information and Disclosures

Author

William B Stratbucker, MD, MS,, Assistant Professor of Pediatrics, Michigan State University; Director of Research, Pediatrics Residency Program, Helen DeVos Children's Hospital
William B Stratbucker, MD, MS, is a member of the following medical societies: American Academy of Pediatrics and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Paul H Sammut, MBBCh, FAAP, FCCP, Medical Director of the Pediatric Intensive Care Unit, Associate Professor, Department of Pediatrics, Section of Pulmonology, University of Nebraska Medical Center
Paul H Sammut, MBBCh, FAAP, FCCP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Lung Association, American Thoracic Society, and International Society for Heart and Lung Transplantation
Disclosure: Nothing to disclose.

Medical Editor

C Lucy Park, MD, Head, Division of Allergy, Immunology, and Pulmonology, Associate Professor, Department of Pediatrics, University of Illinois at Chicago
C Lucy Park, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Medical Association, Chicago Medical Society, Clinical Immunology Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

John Wilson Georgitis, MD, Consulting Staff, Lafayette Allergy Services
John Wilson Georgitis, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association for the Advancement of Science, American College of Chest Physicians, American Lung Association, American Medical Writers Association, and American Thoracic Society
Disclosure: Nothing to disclose.

CME Editor

David Pallares, MD, Clinical Assistant Professor, Department of Pediatrics, Division of Allergy and Immunology, University of Louisville
David Pallares, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology
Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD, Associate Professor, Division of Pulmonary Allergy/Immunology and Infectious Diseases, Department of Pediatrics, UMDNJ-New Jersey Medical School
Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Mucosal Immunology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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