Exercise-Induced Anaphylaxis Treatment & Management

Updated: Aug 24, 2017
  • Author: Peter N Huynh, MD; Chief Editor: Harumi Jyonouchi, MD  more...
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Treatment

Approach Considerations

In an attack of acute exercise-induced anaphylaxis or food-dependent exercise-induced anaphylaxis, as with anaphylaxis in general, the focus should be on acute resuscitation and the emergency ABCs (airway, breathing, circulation). Maintenance of a patent airway and monitoring for circulatory collapse are critical.

Admit patients with exercise-induced anaphylaxis (EIA) to the intensive care unit (ICU) if mechanical ventilation and/or cardiac monitoring is required. Admit to the inpatient ward for monitoring if the patient recovers from the episode. Arrange for injectable epinephrine teaching while the patient is in the hospital.

If symptoms progress to anaphylaxis, intramuscular epinephrine is the drug of choice. Airway maintenance, oxygen therapy, fluid resuscitation, and cardiopulmonary support should be used if necessary. Surgical intervention is indicated only for patients who need emergent tracheostomy or central line access.

Long-term management of exercise-induced anaphylaxis and food-dependent exercise-induced anaphylaxis must be individualized to each patient, because the severity, frequency, intensity of exercise needed to trigger anaphylaxis and the possible association with other co-triggers all vary. Other medications, such as oral steroids, leukotriene-modifying agents, and omalizumab, are either unstudied or reported only in isolated cases.

Patients should be educated to recognize the prodromal manifestations of exercise-induced anaphylaxis so that physical activity can be discontinued at the earliest warning signs and the progression to vascular collapse can be prevented.

To see complete information on Pediatric Anaphylaxis, please go to the main article by clicking here.

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Acute Anaphylaxis

Intramuscular epinephrine is the drug of choice for acute attacks of exercise-induced anaphylaxis (EIA) or food-dependent exercise-induced anaphylaxis (FDEIA). Early administration of intramuscular epinephrine is associated with decreased mortality in patients with anaphylaxis. [34]

Other medications play an ancillary role in the treatment of anaphylaxis. H1-antihistamines relieve itch and hives, but they do not relieve airway obstruction or shock. Beta2-adrenergic agonists relieve bronchospasm, but they do not relieve upper airway obstruction or shock. Glucocorticoids might prevent protracted or biphasic symptoms, but they do not provide rapid relief of upper or lower airway obstruction, shock, or other symptoms of anaphylaxis.

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