Can you be allergic to work? In this episode, we’ll discuss the concept of Exercise Induced Anaphylaxis (EIA) and Food Dependent Exercise Induced Anaphylaxis (FDEIA).
During a 5K race standby, you arrive to find a 24 YOF lying on the side of the track against a concrete barrier. She is conscious, but a little bit lethargic. She is complaining of a sudden onset difficulty breathing during the run that worsened. Now she feels like her throat is closing off and she feels like she can’t breathe. Only medical history is an amalgam based dental filling 2 months ago. Only medications include oral birth control pills and an NSAID last night and this morning due to some soreness from some pre-race workout and training.
On physical exam, you note her skin is flush some itching. You hear expiratory wheezing on auscultation.
Heart Rate – 137
Blood Pressure – 80/50
SpO2 – 90%
She denies any allergies. Denies any new foods or medication. Last oral intake was corn on the cob at the pre-race BBQ along with chili (that’s chili WITH beans, for you Texans). No possibility of pregnancy — LMP is now. No new known exposures. No new clothing. No new laundry detergent. No insect bites or stings. In short, she’s had NO allergen exposure.
What’s going on?
- Barg, W., Medrala, W., & Wolanczyk-Medrala, A. (2010). Exercise-Induced Anaphylaxis: An Update on Diagnosis and Treatment. Current Allergy and Asthma Reports, 11(1), 45-51. doi:10.1007/s11882-010-0150-y
- Pravettoni, V., & Incorvaia, C. (2016). Diagnosis of exercise-induced anaphylaxis: current insights. Journal of Asthma and Allergy, Volume 9, 191-198. doi:10.2147/jaa.s109105
- Ansley, L., Bonini, M., Delgado, L., Giacco, S. D., Toit, G. D., Khaitov, M., . . . Robson-Ansley, P. J. (2015). Pathophysiological mechanisms of exercise-induced anaphylaxis: an EAACI position statement. Allergy, 70(10), 1212-1221. doi:10.1111/all.12677