Among allergic diseases, the most serious life-threatening reaction is anaphylaxis. Exercise-induced anaphylaxis caused by exercise or related to food is a rare condition, but it is becoming more common.
What is Exercise-induced Anaphylaxis?
Anaphylaxis Anaphylaxis is defined as a potentially life-threatening systemic hypersensitivity reaction that affects many organs and systems, especially the skin, respiratory tract, gastrointestinal system and cardiovascular system.
Although anaphylaxis generally varies among societies, the percentage It varies between 0.09–5.1. Exercise-induced anaphylaxis is a rare subtype of anaphylaxis seen in the community. Some researchers report that anaphylaxis caused by exercise constitutes 1.5% of all anaphylaxis cases.
Exercise-induced anaphylaxis occurs after the start of exercise, followed by itching, rash, urticaria, angioedema, shortness of breath, wheezing, and low blood pressure. It manifests itself with dizziness and fainting. Although this clinical picture was first encountered in athletes and athletes, it was later found to occur in other people who exercise.
Especially if it occurs after the start of exercise and is not seen due to other physical causes of urticaria such as hot and cold sweating, it is considered as exercise-induced anaphylaxis. It is an important finding.
This clinical picture that develops due to exercise is divided into two groups:
Exercise-induced anaphylaxis, which develops only after exercise
Food-dependent exercise-induced anaphylaxis that occurs with exercise after ingestion of certain foods.
Exercise-induced anaphylaxis alone or food-dependent exercise-induced anaphylaxis can affect patients of all ages and ethnicities. Cases to date span a wide age range, including patients aged 4 to 74 years. It is reported that the incidence is increased in young adults. It appears that both men and women are affected equally, and affected individuals have concurrent allergic disease of an atopic nature.
Symptoms of exercise-induced anaphylaxis are generally common. It is triggered by moderate exercise. The activities most commonly thought to cause it include light walking, aerobic exercises, running, basketball, cycling, and dancing. There is no exercise that is completely safe for people with exercise-induced anaphylaxis. Symptoms may develop in athletes who exercise excessively, as well as in individuals who engage in light physical exertion, such as gardening.
Exercise-induced anaphylaxis is not predictable. Although it affects some patients, the intensity of exercise may sometimes not cause the same symptoms in the same patients. Additionally, in other patients, the same exercises may not cause symptoms. It is thought that some external factors may affect exercise-induced anaphylaxis. It is thought that hot environment, high humidity and cold environment may contribute to the formation of symptoms.
Food and physical exertion must be together to trigger anaphylaxis in patients with anaphylaxis caused by food-dependent exercise.
Food-dependent exercise must occur together. The foods most associated with anaphylaxis caused by wheat are wheat, especially the ω5-gliadin and shrimp in wheat, but other foods may differ depending on geographical distribution and cultural dietary habits.
In the Mediterranean region, anaphylaxis is more common with vegetables. . It is thought to be caused by sensitivity to lipid transfer protein (LTP), which is one of the allergens that causes a cross reaction between vegetables and pollen.
Tomatoes, grains and peanuts are the most common allergenic foods in Europe.
Wheat and shellfish are common in Asian populations.
In the Japanese population, wheat and especially omega-5 gliadin allergens are the most common. Other causative foods include seafood (especially shellfish), seeds, cow's milk, some vegetables and fruits (for example, oranges or grapes), foods that come into contact with aeroallergens such as house dust mites and Penicillium, and meat.
Since anaphylaxis attacks occur after swallowing specific foods to which the patient is sensitive, they are defined as anaphylaxis caused by specific food-dependent exercise. Anaphylaxis occurring after ingestion of any food is caused by nonspecific food-dependent exercise. It is defined as anaphylaxis.
Concomitant intake of foods, especially with different medications such as Nonsteroidal anti-inflammatory drugs (NSAIDs), the processing of foods and the amounts of food taken may have an impact on the occurrence and severity of anaphylaxis caused by food-dependent exercise.
What are the causes of exercise-induced anaphylaxis?
The causes of exercise-induced anaphylaxis and food-induced exercise-induced anaphylaxis are not fully understood. There is general agreement that increased histamine release is key. Increased plasma histamine levels have been documented in both exercise-induced anaphylaxis and food-induced exercise-induced anaphylaxis.
What is the exercise-specific factor or possibly factors responsible for poorly understood cell degranulation? Current hypotheses can be listed as follows.
Increased Gastrointestinal Permeability
Exercise increases absorption from the gastrointestinal tract. Although the significance of altered intestinal permeability is still controversial, increased permeability may also result in the absorption of only partially fully digested allergenic proteins. These allergic proteins can cause a reaction.
Taking aspirin and NSAIDs
NSAIDs, and aspirin, have been shown to cause symptoms of food-induced exercise-induced anaphylaxis. Two mechanisms must be considered. First, aspirin has been proven to increase gastrointestinal permeability and antigen uptake. Second, aspirin can increase immune cell degranulation.
Increased Tissue Enzyme Activity
Tissue transglutaminase in the intestinal mucosa can be activated by exercise and aspirin. Omega-5 gliadin, a major allergen to wheat leading to food-induced exercise-induced anaphylaxis, is cross-linked by tissue transglutaminase, resulting in the formation of large peptide aggregates and, in turn, facilitating cross-linking of IgEs. It is thought that wheat may cause allergic reactions in this way in patients with anaphylaxis caused by food-dependent exercise.
Blood Flow Redistribution
Even with mild exercise, allergens in the blood in the intestines with the redistribution of blood flow. It is thought that it spreads rapidly to the skin and skeletal muscle in the circulation, causing symptoms.
Increased Osmolality
The first step in anaphylaxis caused by food-dependent exercise is most likely mast cell activation in the intestines due to the increased osmolality of the microenvironment. can be shown.
Increased Endogenous Endorphin Release
Endogenous endorphins are known to increase mast cell degranulation, but a significant increase in serum endorphins has been observed with long-term and strenuous exercise.
Plasma pH Although moderate-intensity exercise did not significantly change blood pH, unlike long-term and strenuous exercise, only two cases reported that food-induced exercise-induced anaphylaxis symptoms were inhibited by the administration of sodium bicarbonate. It is thought that these changes in plasma pH may lead to the formation of anaphylaxis.
What are the Symptoms of Exercise-induced Anaphylaxis?
The symptoms of exercise-induced anaphylaxis may begin at any stage or after the exercise. , but in 90% of patients, they begin within 30 minutes of initiating exercise.
Symptoms of food-induced exercise-induced anaphylaxis most commonly develop within 30 minutes of the beginning of physical activity, but can occur at any stage of exercise and occasionally It may start afterwards. Culprit foods are usually consumed within 4 hours before exercise. However, some researchers show that it can also occur if food is swallowed shortly after completion of exercise.
The most distinctive feature of exercise-induced anaphylaxis is that symptoms begin to appear in a short time during exercise, with the onset of exercise.
Symptoms that occur with exercise
Shortness of breath (dyspnea),
Cough,
Rush in the body, generalized itching,
Includes abdominal pain and rhinorrhea (runny nose)
Cease of exercise usually results in improvement in symptoms.
If exercise continues
Common urticaria,
Angioedema,
Bronchospasm and hypotensive syncope may occur.
The clinical picture may lead to an anaphylactic reaction. is similar. A typical attack begins with a generalized feeling of warmth and flushing, usually while the patient is exercising, followed by itching and urticaria, and in most cases angioedema (typically the face and hands). If exercise continues, other symptoms may occur, such as gastrointestinal (abdominal pain, nausea, vomiting, diarrhea), respiratory distress symptoms, bronchospasm, laryngeal edema, followed by dizziness, tachycardia, hypotension and vascular collapse. If activity is stopped immediately after the first symptoms, improvement or decrease is often seen within minutes.
Exercise levels have been reported to be variable in the occurrence of exercise-induced anaphylaxis. Intense activity such as running is most common. Symptoms have also been reported with light activity. The onset of symptoms varies significantly between patients and may even vary within the same patient.
Exercise is considered the most common triggering factor for the emergence of food allergy. However, some other triggers can affect immunological mechanisms, leading to the onset of an anaphylactic reaction.
Pain medications containing nonsteroidal anti-inflammatory drugs (NSAIDs)
Alcoholic beverages
Premenstrual or ovulation phases of the menstrual cycle
Extreme temperatures (high heat and humidity or exposure to cold)
It should not be forgotten that seasonal pollen exposure and infections may trigger the formation of anaphylaxis in patients sensitive to pollen.
How is the diagnosis of exercise-induced anaphylaxis made?
The diagnosis of exercise-induced anaphylaxis is made based on clinical history and physical examination.
Urticaria occurs in patients after they start exercising. Exercise-induced anaphylaxis can be diagnosed if angioedema and/or angioedema occur, if there are signs of cardiovascular collapse such as low blood pressure, if there are gastrointestinal disorders such as diarrhea and abdominal pain, and if other anaphylactic symptoms such as upper or lower respiratory tract obstruction occur.
Diagnostic criteria for exercise-induced anaphylaxis
1. Signs and symptoms consistent with anaphylaxis occurring during (or within one hour of) exercise.
2. Make the patient's symptoms worse
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