Exercise–induced Anaphylaxis: the Role of Cofactors

Introduction: Anaphylaxis is a dramatic clinical emergency. It is a very severe, life-threatening generalized or systemic hypersensitivity reaction. Based on immunologic mechanism the anaphylaxis is divided in IgE, IgG, complement, or immune complexes-mediated vs non allergic anaphylaxis. Th e re are a lot of etiologic factors of anaphylaxis, but the three principal immunologic triggers are drugs, insect stings, and foods. Regarding the clinical severity there are several proposed grading systems. Th e diagnosis of anaphylaxis is mainly clinical. Discussion: Th e anaphylaxis markers measured in clinical laboratories are total tryptase and histamine. Th e re are some conditions that modulate the onset of anaphylaxis, acting as co- or augmentation factors, which signifi c antly lower the allergen dose necessary for triggering anaphylaxis. Th e well-documented cofactors of anaphylaxis are physical exercise, alcohol consumption, some foods, co-administration of nonsteroidal anti-infl a mmatory drugs (NSAID), and concomitant infectious diseases. Development of anaphylaxis depends on the sensitization pattern, the proportion of the involved immunoglobulin classes, characteristics of the allergen, the proportion of the involved immunoglobulin classes, the avidity and affi n ity of immunoglobulins to bind an allergen, the route of allergen application, and, last but not least, the presence of cofactors of anaphylaxis. Conclusion: Anaphylaxis remains a continuous challenge for the diagnosis and treatment. Th e adequate management of anaphylaxis requires rapid diagnosis, implementation of primary and secondary prevention measures, and immediate administration of subcutaneous epinephrine.