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.

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.^[36]

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.

Medication

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Author

Peter N Huynh, MD Chief of Allergy and Immunology, Kaiser Permanente, Panorama City Medical Center

Peter N Huynh, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Edward K Hu, MD Fellow, Division of Allergy and Immunology, LAC+USC Medical Center

Edward K Hu, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology

Disclosure: Nothing to disclose.

Salima A Thobani, MD Kaiser Permanente

Salima A Thobani, MD is a member of the following medical societies: American College of Physicians, American Medical Student Association/Foundation, American Medical Women's Association

Disclosure: Nothing to disclose.

Lyne Scott, MD Chief, Division of Allergy and Immunology, Director, Fellowship Training Program, Director, The Breathmobile Program, LAC+USC Healthcare Network; Assistant Professor, Department of Pediatrics, Keck School of Medicine of the University of Southern California

Lyne Scott, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD Faculty, Division of Allergy/Immunology and Infectious Diseases, Department of Pediatrics, Saint Peter's University Hospital

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 Pediatric Research, Society for Mucosal Immunology

Disclosure: Nothing to disclose.

Acknowledgements

C Lucy Park, MD Head, Division of Allergy, Immunology, and Pulmonology, Associate Professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine

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.

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

Disclosure: Nothing to disclose.

William B Stratbucker, MD, Assistant Professor of Pediatrics, Division of General Academic Pediatrics, Rush Medical College; Consulting Staff, Rush University Medical Center, Rush Children's Hospital

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Exercise-Induced Anaphylaxis Treatment & Management

Approach Considerations

Acute Anaphylaxis

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