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Correspondence to Dr Hirofumi Namiki, [email protected]
Background
Anaphylaxis is an acute and life-threatening condition that many physicians have experienced or might encounter on a daily basis. Exercise-induced anaphylaxis (EIAn) is characterised by anaphylaxis in the setting of physical exercise.1 Typical anaphylactic symptoms include sudden fatigue, warmth, flushing, generalised urticaria and pruritus. In the advanced stages, acute angioedema, upper airway obstruction and collapse are observed.1–3 These symptoms can occur at any time during exercise and occasionally occur just after physical exercise. Recognition of this disease is significant because increased awareness of this condition will enable physicians to make an accurate diagnosis, adequately educate patients and ultimately realise a better outcome for the patient and their quality of life.
Case presentation
A 75-year-old Japanese woman presented with acute flushing pruritus and a feeling of diffuse warmth followed by collapse while dancing at the studio contained within her home. That morning, she had arranged to go dancing with her friends. She performed the household chores and then ran to the dance studio, without eating breakfast. At the studio, 10 min after beginning to dance, she experienced sudden generalised pruritus that began in her neck, coincident with fatigue, diffuse warmth and abdominal discomfort. She did not experience facial oedema, chest pain, dyspnoea, nausea or diarrhoea. She did not have any relevant medical history except for a similar experience that occurred 2 years earlier while dancing on a sunny autumn day in another studio. She was not under medication and had no known food or drug allergies. She had no relevant family history. She had no illnesses and underwent yearly check-ups. She had last eaten a meal the previous evening at home.
Differential diagnosis
Cholinergic urticaria
Systemic mastocytosis
Hypertryptasemia
Cold-induced anaphylaxis
Exercise-associated reflux
Cardiovascular events
Exercise-induced bronchoconstriction
Hypoglycaemia
Neoplasmatic disorder
Postural orthostatic tachycardia syndrome (POTS)
Primary food allergy exacerbation by exercise
Treatment
After resting for 30 min following a rapid infusion of 500 mL of 0.9% sodium chloride at the emergency room, her symptoms improved and finally resolved.
Outcome and follow-up
The patient went home once her symptoms resolved. She was followed up for 7 days but did not experience any recurring symptoms. According to her history, the recent episode was the same as the patient’s previous experience, which was related...