eMedicine Specialties > Pediatrics: General Medicine > Allergy & Immunology

Exercise-Induced Anaphylaxis: Follow-up

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

Follow-up

Further Inpatient Care

  • Admit patients with exercise-induced anaphylaxis (EIA) to the pediatric intensive care unit (PICU) if a need for mechanical ventilation and/or cardiac monitoring is present.
  • Admit to the pediatric floor for monitoring if the patient recovers from the episode.
  • Arrange for injectable epinephrine teaching while the patient is in the hospital.

Further Outpatient Care

  • Arrange for a food and over-the-counter medication diary; remind the patient of prevention techniques; and perform exercise-challenge testing, food-challenge testing, skin prick testing, and radioallergosorbent testing (RAST) testing.

Inpatient & Outpatient Medications

  • Inpatient medications include subcutaneous epinephrine, fluid resuscitation as needed, cardiovascular support as needed, and an antihistamine for urticaria and pruritus.
  • Outpatient medications include prophylactic antihistamines and EpiPen injection.

Transfer

  • Patients in whom the episode has progressed to the point of needing cardiovascular and pulmonary support, including mechanical ventilation, require transfer to an appropriate facility capable of that level of care.

Deterrence/Prevention

  • Prevention remains the best treatment for patients who have exercise-induced anaphylaxis. Avoiding offending food 12 hours prior to exercise is essential, and, if no offending food is known, then the patient should avoid eating any food 6-8 hours prior to exercise. If aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) are suspected as the trigger, these medications should be avoided prior to future exercise.
  • Instruct patients on the proper use of emergency injectable epinephrine, or EpiPen, and have at least one available and with them when exercising. Patients should wear a medical alert bracelet with instructions on the use of epinephrine.
  • Patients should always exercise with a partner knowledgeable about the syndrome and its emergent nature as well as the proper treatment. This partner needs to be instructed on the proper use of an EpiPen.

Complications

  • Hypotension, shock, loss of consciousness, airway compromise, and death are possible complications.

Prognosis

  • The prognosis of exercise-induced anaphylaxis depends on the preventative techniques employed by the patient.
    • Patients can usually avoid the progression of an exercise-induced anaphylaxis attack by ceasing exercise at any indication of pruritus or urticaria.
    • Some patients with exercise-induced anaphylaxis are instructed to avoid any exercise for 6-8 hours after eating any food, to avoid exercise for 12 hours after eating the offending food (if known), to abstain from use of aspirin or other NSAID prior to exercise, and to modify their exercise in extremes of temperature.

Patient Education

  • Patients must understand the emergent nature of exercise-induced anaphylaxis and the proper use of emergency injectable epinephrine.
    • Instruct patients with exercise-induced anaphylaxis on the ways to abate a full attack by recognizing the early warning signs and symptoms and taking the steps to prevent the progression of the syndrome.
    • Teach patients with exercise-induced anaphylaxis to limit exercise and be cautious in temperature extremes.
    • In the food- or medicine-dependent variants, the patient needs to have knowledge of the offending food or medication (if known) and know how long to refrain from exercise after eating.
    • Educate patients with exercise-induced anaphylaxis about the need to exercise with a partner who is aware of exercise-induced anaphylaxis and the emergent nature of an episode.
 


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
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References

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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

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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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