Exercise-Induced Anaphylaxis in an Air Force Aviator Taking a HMG-CoA Reductase Inhibitor: A Case Report and Review of the Presentation, Diagnoses, and Treatment

Military Medicine
Chad Gregory Kahl, Crystal Deas

Abstract

A 46-year-old healthy male Air Force pilot presented to the emergency department (ED) experiencing symptoms of exercise-induced anaphylaxis (EIAn), during a vigorous outdoor run. The patient recovered in the ED and was seen, subsequently, by a civilian allergist; eventually a diagnosis consistent with EIAn was made. EIAn is a rare but potentially life-threatening syndrome believed to involve IgE mediated release of histamine and other immunoactive compounds, during or after exercise. The diagnosis is determined by a strong clinical suspicion along with careful exclusion of other potential diagnoses. Interestingly, this particular patient was also found to have a possible correlation between the introduction of 3-hydroxy-3-methylglutaryl-coenzyme A, for hyperlipidemia, shortly before his first episode of EIAn, and remission of the condition since discontinuing the statin medication. A detailed review of the clinical notes, ED presentation, and all subspecialty consultation notes were include in the compilation of this case report, in conjunction with a careful review of all current literature pertaining to drug exacerbated, exercise-induced EIAn. The review of literature was also conducted to review potential mechanisms of this ...Continue Reading

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