Exercise-induced anaphylaxis as a cause of syncope

J Emerg Med. 2012 Oct;43(4):651-4. doi: 10.1016/j.jemermed.2010.05.070. Epub 2010 Sep 23.

Abstract

Background: Exercise-induced anaphylaxis (EIA) is an under-recognized condition that is a distinct physical allergy. Triggers include varying amounts of exercise, alone or in combination with certain foods or medications (food-dependent EIA, or FDEIA). Therapy is identical to that of any immunoglobulin E-mediated allergic reaction.

Objectives: This case is reported to increase awareness among emergency physicians of EIA and FDEIA.

Case report: A 57-year-old man was found with a diffuse erythematous rash after eating a wheat bagel and walking up five flights of stairs. Emergency medical services found him hypotensive and combative. In the Emergency Department, the patient's blood pressure was 72/27 mm Hg, with an oxygen saturation of 97% on non-rebreather mask. The physical examination was notable for bilateral inspiratory crackles in the lower one-third of the lungs. He received intravenous (i.v.) diphenhydramine 25 mg, i.v. methylprednisolone 125 mg, and 1 L of normal saline, after which his blood pressure improved to 110/54 mm Hg. He was admitted to the hospital where his recovery was uneventful.

Conclusion: EIA and FDEIA are uncommon forms of physical allergy, but they represent important entities for emergency physicians to consider. Recognition of the association with exercise is key, as recurrences can be prevented by avoiding triggers.

Publication types

  • Case Reports

MeSH terms

  • Anaphylaxis / complications*
  • Anaphylaxis / drug therapy
  • Anaphylaxis / etiology
  • Exanthema / etiology
  • Humans
  • Male
  • Middle Aged
  • Motor Activity*
  • Syncope / etiology*
  • Wheat Hypersensitivity / complications*