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October 18, 2004

BehindTheMedspeak: Allergic to exercise?

Epipen1

People say it jokingly, and I certainly never heard of it back in medical school, but it turns out that exercise-induced anaphylaxis (EIA) is a real, potentially deadly syndrome.

The reason I never heard of it back in med school was because I went to med school in the dark ages, when we were still cupping and bleeding people.

The first case of EIA wasn't reported until 1979, and even that case was food-related, the individual having eaten shellfish prior to long-distance running and subsequent anaphylaxis.

The first report of exercise-only-induced anaphylaxis came in 1980, with 16 patients noted to have experienced anaphylaxis during exercise without a specific allergen exposure.

The condition appears to be increasing in incidence, for reasons - air pollution, chemicals in food and cosmetics, anything you can think of is posited as a factor - not at all clear.

This is serious stuff.

Anaphylaxis is most commonly seen as a result of an insect sting or drug, such as penicillin in an allergic patient, or food - peanut allergy comes first to mind.

When a person is exposed to the inciting allergen, a cascade of responses - flushing, itching, constriction of the throat, airway spasm, choking, hives, facial and tongue swelling, and a profound drop in blood pressure - can occur.

If not treated quickly with a shot of epinephrine (adrenaline), death can ensue.

Exercise alone can bring on this symptom complex.

Or, it can incite a reaction when coupled with ingestion of a particular food.

Anyone who's had even one-episode of exercise-induced anaphylaxis should wear a Medic-Alert

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bracelet at all times noting susceptibility to anaphylaxis.

Such individuals also should never be far from an epinephrine auto-injecting syringe (EpiPen).

Epipen

I am amazed that an EpiPen continues to be so exorbitantly expensive; the website just above had the best price I could find online, $45.

Epinephrine is a generic, almost free drug in the form we use it in the O.R.; I mean, a 1 cc glass ampoule, containing precisely the dosage of epinephrine in an Epipen, costs about 5 cents.

The company that invented the EpiPen is making a fortune off the allergic and anaphylactically-inclined populace.

October 18, 2004 at 12:01 PM | Permalink


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