Exercise-induced anaphylaxis- (EIA) is a rare condition where the anaphylaxis transpires in connection with physical activity. Food-dependent exercise-induced anaphylaxis (FDEIA) on the other hand is a sub-category of EIA and occurs when the physical activity is within a relatively short time-frame of consuming a specific food pre- or post-exercise. In 90% of cases, symptoms occur within 30 minutes although it can occur a few hours later.
Even though the first reported case of this condition was way back in 1979, there is still a lot of confusion regarding both EIA and FDEIA. This is due to a combination of the rarity of the condition (About 5-15% of all anaphylactic patients and FDEIA is estimated to be 1/3- ½ of all EIA patients) and the lack of clarity with regards to anaphylaxis in general.
Additionally, confusion about FDEIA generates because neither the food item nor the exercise alone is sufficient enough to produce an anaphylaxis reaction in the patient. However, what is known about FDEIA is that the attack is triggered in the intestines. The state of exercise triggers a mast cell degranulation to an allergen which under normal situation does not cause a reaction. This is due to, Hyperosmolality enhances mast cell degranulation and thus increases gut permeability, resulting in an increased amount of food allergen(s) presented to the mast cells and basophils.
Both EIA and FDEIA are triggered by physical activity which includes, but is not limited to; jogging, running, biking and working out in the gym. In addition, under this large umbrella of triggers are activities ranging from lower-levels of exertion to more intense workouts. Even less understood it the reality that a specific level of exercise may trigger an attack in one occurrence but not another which results in an unpredictability factor.
Co-factors may increase risks of an attack include; aspirin and other nonsteroidal anti-inflammatory drugs, alcohol, phases of a woman’s menstrual cycle, extreme temperature and seasonal pollen exposure.
Patients may also experience nausea, abdominal cramping and diarrhea.
If the individual stops the physical activity after the symptoms first appear, there is usually an improvement in the symptoms within a few minutes, however continuing the physical activity causes the symptoms to worsen.
Prevention continues to be the best treatment plan for patients with EIA or FDEIA. A doctor can also provide direction and advice on how to effectively create a management plan so exercise can continue under the right circumstances which will be adapted to suit each patient’s situation and history of the condition.
Since people who are in better physical shape are less susceptible to both FDEIA and EIA than those who aren’t, doctors often recommend the patient including swimming into their weekly routine- which interestingly enough is the only exercise not reported to cause an allergic reaction.
A management plan might include:
The diagnosis of both FDEIA and EIA are made based on both clinical history and a physical examination. Great importance is placed on identifying which of the two conditions (EIA/FDEIA) the patient has- a fact which is crucial to the prevention of attacks in the future.
The good news is that prognosis for both FDEIA and EIA is generally favourable. Although no cure for this condition is currently known, most patients report experiencing fewer and less severe attacks over time and with appropriate lifestyle changes and keeping to a sufficient management plan can greatly shorten the episodes that do occur and possibly eliminate episodes of anaphylaxis altogether.
Additionally, a recent medical trial with the allergy department at Monash Health has had success with a medication called Omalizumab.
To read more about this condition click here for a list of medical journals and research information.
During our recent visit to Israel, we really struggled to find food for our son who has anaphylactic level allergies to egg and sesame. We approached both restaurants and hotels and were told they were unable or unwilling to take responsibility for preparing his food.
After learning about Dr. Eliana on-line, we contacted her in the hopes that she could provide a ‘normal’ restaurant experience for our family.
Both she and Shani were meticulous in their preparations with the restaurants to ensure that our son had a wonderful and safe experience.
We truly appreciate their efforts to take care of our son, and to provide us with a lovely vacation experience.
T.M., Chicago, USA
We want to thank you from the bottom of our hearts for the amazing gift you have given us over this Pesach- the gift of having you with us!!!!
We have NEVER felt more comfortable, calm, and at ease than we did these past 10 days. Your warmth, professionalism, kindness, and care shown through in all that you did.
My children are so grateful that they were able to be with you this Pesach. You made sure that they were so well looked after and they felt so at ease and comfortable with you! You were so amazing and approachable to them! And they LOVED all the food you so amazingly prepared (supervised allergy-free food preparation, managed menus) for them!
It’s very difficult for us to trust people when it comes to our kids and allergies. You magically were able to take away ALL of our anxieties, and nervousness (and we don’t give that away so easily!!)
We can never fully thank you enough. We truly feel that you instantly became part of our family and we look forward to G-d willing being able to be with you and plan amazing trips with you many many many more times!!!!
Thank you and may Hashem bless you for the work you do. My son Jacob said your allergy card has been very helpful. I am so grateful- beyond words.
L.R., NY, NY
Thank you for delivering our allergy free baked goods to our hotel. We just tasted the focaccia and it was delicious!
All the best,
S.C., New Jersey
We can't thank you enough for assembling this top-notch team of specialists to work with our daughter while she is in Israel.
T.G., Philadelphia, PA
"Food Allergy Concierge assisted us with a very helpful, detailed customized allergy card in Hebrew. The Allergy card was extremely helpful for multiple allergies and allowed us to eat safely in several eateries and hotels. Highly recommended.”
G.A. Illinois USA