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Exercise-induced anaphylaxis

Exercise-induced anaphylaxis (EIAn) is a rare, unpredictable, potentially fatal, syndrome characterised by anaphylaxis associated with exercise; about 5-15% of anaphylactic episodes have been associated with exercise. The majority of EIAn episodes have been reported to occur during mild exercise such as sweeping leaves, jogging and following ingestion of food, which suggests this may be associated with food allergies.  However the exact mechanisms that may explain EIAn have not been determined and there are several theories for why this may occur.  Many of the current theories are based on the physiological effects of high intensity exercise undertaken by highly trained athletes which is not appropriate for the majority of situations when EIAn occurs (mild exercise); this fact alone eliminates the majority of the proposed mechanisms for EIAn. The symptoms of EIAn may vary in severity but reassuringly, fatalities are rare.  EIA occurs in all ages, in both sexes, and is more common in individuals prone to allergies. There are now more than one hundred reviews on the topic of EIAn upon which much of our current knowledge of the condition is based. A recent publication has reviewed some of the current working hypothesis for EIAn and indicated that many of the hypotheses are inappropriate for the physiological changes that occur during exercise.  The EIAn task force is examining these proposed theories in the context of exercise physiology and immunology and will develop a Position Statement on the current understanding of the condition, future research directions and indications for management of the condition.