A 16-Year-Old Girl With Full-Body Rash, Dyspnea, and Swelling

Peter Huynh, MD

Disclosures

January 19, 2022

Intramuscular epinephrine is the drug of choice for acute attacks of EIA or FDEIA. Early administration of intramuscular epinephrine is associated with decreased mortality in patients with anaphylaxis.[16]

Other medications play an ancillary role in the treatment of anaphylaxis. H1-antihistamines relieve itch and hives, but they do not relieve airway obstruction or shock. Beta-2–adrenergic agonists relieve bronchospasm, but they do not relieve upper-airway obstruction or shock. Glucocorticoids might prevent protracted or biphasic symptoms, but they do not provide rapid relief of upper or lower-airway obstruction, shock, or other symptoms of anaphylaxis.

Long-term management of EIA and FDEIA must be individualized to each patient because the severity, frequency, and intensity of exercise needed to trigger anaphylaxis and the possible association with other cotriggers all vary. Other medications, such as oral steroids, leukotriene-modifying agents, and omalizumab, are either unstudied or reported only in isolated cases.

Patients must understand the emergent nature of EIA and the proper use of emergency injectable epinephrine. Instruct patients with EIA to recognize the early warning signs and symptoms and stop physical activity to prevent progression of the syndrome. This includes limiting exercise and being cautious in temperature extremes.

Patients with FDEIA or medicine-dependent EIA need to be aware of the offending food or medication (if specific ones can be identified) and know how long to refrain from exercise after eating. Educate patients with EIA about the need to exercise with a partner who is aware of EIA and the emergent nature of an episode.

The prognosis of patients with EIA is generally favorable. Most patients experience fewer and less severe attacks over time. Although rare, several fatalities have been attributed to EIA or FDEIA.[17,18,19] No cure for these disorders is known. With appropriate lifestyle changes, however, patients may be able to reduce or eliminate episodes of anaphylaxis, and prompt intervention can abort episodes that do occur.

The patient in this case was counseled and given appropriate instructions on necessary preparations and interventions, as described above.

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