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History Taking
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Gabriel K Wong, Mamidipudi Thirumala Krishna
Although the mechanism is not clear, it is well known that co-factors such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), exercise, alcohol, stress and menstruation can potentially trigger or exacerbate symptoms of allergy. Patients with salicylate intolerance may develop upper respiratory symptoms and/or bronchospasm (asthma, salicylate intolerance and nasal polyps—Samter’s Triad) in response to NSAID/s and aspirin (Kowalski et al. 2011). These drugs may also lower the threshold of other allergic diseases without evidence of Samter’s triad. Exercise-induced allergy or food dependent exercise-induced anaphylaxis should be considered when a patient’s symptoms are clearly associated with the presence of co-factors (Wong et al. 2010). The connection between symptoms and physical factors such as pressure, change in temperature, solar exposure and even contact with water are well-described in specific disorders such as symptomatic dermographism, cholinergic urticaria, cold urticaria, solar urticaria and aquagenic urticaria respectively (Zuberbier et al. 2006). A detailed interrogation of these co-factors will allow the clinician to differentiate rarer diagnosis from chronic idiopathic diseases.
Recent Advances in Diagnosis and Management of Shellfish Allergy
Published in Andreas L. Lopata, Food Allergy, 2017
Sandip D. Kamath, Roni Nugraha, Andreas L. Lopata
Contact urticaria and eczematous contact dermatitis are two major allergy manifestations in skin. A recent study demonstrated that one third of a cohort of chefs and culinary trainees, developed allergy to molluscs. Most of these individuals, showed symptoms of dermatitis very early in their career as chefs (Dickel et al. 2014). Allergic reactions to shellfish occur within minutes of exposure. However, several cases have been reported for delayed type reactions frequently to mollusc species such as oyster, abalone and squid. In addition exercise-induced anaphylaxis has also been observed (Teo et al. 2009).
Recognition, Treatment, and Prevention of Anaphylaxis
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2014
Stephen F. Kemp, Richard D. deShazo
Anaphylaxis associated with exercise occurs as two syndromes of physical allergy: exercise-induced anaphylaxis (EIA) and cholinergic urticaria [70]. EIA occurs with prolonged strenuous exercise, frequently in conditioned athletes, such as marathon runners, and is usually accompanied by a short prodrome of cutaneous warmth and generalized pruritus. It may occur only after ingestion of certain foods, such as lettuce or celery, or a medication, such as aspirin, prior to exercise. Clinical manifestations may progress to generalized erythema and urticaria, nausea and diarrhea, upper or lower airway obstruction, hypotension, and possibly syncope as exercise continues [70]. Prophylaxis with antihistamines, a corticosteroid, or cromolyn sodium does not consistently prevent EIA, although some investigators suggest that prophylaxis might be more successful in food-dependent EIA [74]. Episodes occur sporadically, which distinguishes EIA from other forms of physical urticaria in which exercise provocation invariably produces symptoms [70]. Some individuals may demonstrate symptoms during a controlled exercise challenge, but the test is often negative, despite a classic clinical history [70]. Subjects with EIA should be taught to administer epinephrine and preferably should exercise with a partner educated about EIA and how to treat it.
Diagnosis and prevention of food-dependent exercise-induced anaphylaxis
Published in Expert Review of Clinical Immunology, 2019
Filipe Benito-Garcia, Ignacio Javier Ansotegui, Mário Morais-Almeida
Exercise-induced anaphylaxis is a type of anaphylaxis provoked primarily by exercise [1]. It is subdivided into two groups: anaphylaxis caused exclusively by exercise and anaphylaxis caused by exercise after eating a particular food [2]. The latter is called food-dependent, exercise-induced anaphylaxis (FDEIA) [3] and it can be further classified according to the triggering food. Episodes occurring after the ingestion of certain foods, to which the patient is sensitized, are described as specific FDEIA, while those occurring after the ingestion of any food are described as non-specific FDEIA [4].
Exercise-induced anaphylaxis: causes, consequences, and management recommendations
Published in Expert Review of Clinical Immunology, 2019
Morten J. Christensen, Esben Eller, Henrik F. Kjaer, Sigurd Broesby-Olsen, Charlotte G. Mortz, Carsten Bindslev-Jensen
Exercise-induced anaphylaxis is a rare but severe and potentially life-threatening condition that all allergists and practicing physicians should recognize. The best described entity within EIA is by far FDEIA, where recent publications have improved our understanding of this condition, however many questions so far remain unanswered.
Pediatric Anaphylaxis in the Prehospital Setting: Incidence, Characteristics, and Management
Published in Prehospital Emergency Care, 2018
Emily Andrew, Ziad Nehme, Stephen Bernard, Karen Smith
Suspected allergens are presented in Table 2. Common allergens included nuts (52%), dairy or baby milk formula (17%), and eggs (14%). Exercise-induced anaphylaxis was identified among 8% of patients aged 12–16 years.