Use of NSAIDs shown to trigger exercise-induced anaphylaxis

The combination of NSAID use and exercise can elicit anaphylaxis in certain individuals, according to a medically challenging case report presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

Researchers presented the case of a woman who developed exercise-induced anaphylaxis after taking prophylactic naproxen during her marathon training.

“We saw a 40-year-old avid runner in our clinic who had no history of food or medication allergies,” Sebastian Sylvestre, MD, of Penn State Health, said in the release. “She had previously tolerated NSAIDs, and she took naproxen before her marathon training run. By mile four she had developed itching and swelling around her eyes. By mile six she had hives, lightheadedness, difficulty breathing and vomiting. Her husband brought her to the emergency room for treatment.”

In the ED the patient received anaphylaxis support without epinephrine and was discharged home. Later tests showed she subsequently tolerated all foods she ate prior to the run. She now avoids NSAIDs, carries an epinephrine autoinjector and has not had a recurrence of these symptoms during exercise.

NSAIDs can elicit IgE-mediated allergic responses and promote mast cell degranulation of histamine, according to the researchers. Exercise also results in many physiologic changes, some of which can promote basophil histamine release. Thus, the researchers concluded that the combination of NSAIDs and exercise may predispose some individuals to anaphylaxis.

“It is important that those who engage in strenuous exercise be mindful of the phenomenon and they know the risks, as well as how to manage any anaphylactic symptoms that might arise in the future during exercise,” Taha Al-Shaikhly, MBChB, allergist and immunologist at Penn State Health, said in the release.

Reference:

• Medically challenging case shows NSAIDs can prompt exercise-induced anaphylaxis. https://annualmeeting.acaai.org/2021/nsaids-anaphylaxis.cfm. Published Nov. 5, 2021. Accessed Nov. 5, 2021.