Your good health: exercise-induced anaphylaxis is a rare form


Dear Dr Roach: Please write about exercise induced and diet dependent anaphylaxis. Many healthcare professionals are still unaware of this rare and potentially fatal disease. Thank you!


Anaphylaxis is the most serious of all allergic reactions. It is quick onset and initially causes symptoms such as hot and flushing, diffuse hives and itching, and sudden fatigue. More serious symptoms include swelling of the lips, tongue, and uvula (that thing that hangs down the back of the throat). It can be so bad that it restricts a person’s breathing. Gastrointestinal symptoms may occur, including nausea, cramps, and diarrhea. Cardiovascular symptoms include low blood pressure, fainting, and ultimately circulatory system failure. Anaphylaxis most often occurs after exposure to an allergen, especially drugs, but sometimes also food and insect bites.

Exercise-induced anaphylaxis is a rare form of anaphylaxis, more common in women. As the name suggests, anaphylaxis is linked to exercise and can begin at any stage of exercise. More intensive forms of exercise are more likely to cause symptoms. Stopping exercise immediately usually stops symptoms; However, many people instinctively ask for help, which can make the attack much worse. This is the most important message about exercise-induced anaphylaxis.

Diet-dependent exercise-induced anaphylaxis is an even rarer subtype of exercise-induced anaphylaxis. In this condition, exercise-induced anaphylaxis only occurs if exercise begins within minutes or hours of consuming a specific food, although rarely symptoms can occur if a person eats it. food immediately after exercise. The foods most commonly involved are grains (especially wheat) and nuts, but many foods have been reported including fruits, vegetables, legumes, and seeds.

The diagnosis should be suspected in anyone who develops severe allergic symptoms after exercise. You are absolutely correct that this is not a well-known condition and that a referral to an expert, such as an allergist, is appropriate when the diagnosis is suspected. The allergist may perform lab tests and skin tests for allergies to help confirm the diagnosis. A stress provocation test is done by some experts, only if they have the expertise and tools to deal with anaphylaxis if it occurs.

Dear Dr Roach: I had an “abnormal” result for atrial fibrillation from a commercial screening test. I currently do not have a primary care physician. Could you tell us how / where to start?


Screening tests are not very accurate at diagnosing atrial fibrillation, which is an abnormal heart rhythm that increases the risk of stroke. However, when a screening test is positive, it is certainly appropriate to obtain additional information.

Although there have been technical advancements in wearable devices, the best way to diagnose atrial fibrillation is still an ECG medically performed and interpreted by a doctor. A simple desktop ECG is accurate in diagnosing a person who is having atrial fibrillation at the time, but some people come in and out of atrial fibrillation. In this case, a medical device can be worn for a period of time, usually 48 hours or more, to identify atrial fibrillation. A primary care physician or cardiologist would usually order this test.

Hope you can contact a primary care doctor soon, as care should be better and cheaper than visiting an emergency room.

Dr Roach regrets not being able to respond to individual letters, but will fit them into the column whenever possible. Readers can email their questions to [email protected]

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