A critical case of anaphylaxis triggered by exercise in a pediatric asthma patient

A 13-year-old boy with well-controlled asthma presented with acute respiratory distress, generalized urticaria, and cyanosis after playing soccer, raising concerns for food-dependent exercise-induced anaphylaxis (FDEIA) or exercise-induced anaphylaxis (EIA). The patient initially underwent evaluation at a nearby clinic and was later admitted to the hospital where the initial management involved intubation and intensive resuscitation after a preliminary diagnosis of anaphylaxis. At the presentation in the hospital, the patient had severe neurological impairment with a Glasgow Coma Scale of 3/15. On physical examination, abnormalities included hypotension, tachycardia, fever, and severe hypoxemia, with a SpO2 of 99%. The neurological examination was positive for dilated pupils and absent deep tendon reflexes. Laboratory results showed significant metabolic derangements, elevated liver enzymes, and markedly elevated lactate levels. The patient received fluid resuscitation, neuroprotection, broad-spectrum antibiotics, and antiepileptic treatment. CT scan was positive for cerebral edema and diffuse hypoxia. Despite maximum medical therapy, including sedation and inotropic support, the patient eventually progressed to evidence of brain death three days after admission. The case illustrates the difficulty of managing severe anaphylactic reactions in an asthmatic patient after playing soccer, resulting in neurological sequelae. It emphasizes the necessity of further research on prevention measures and guidelines for managing such a case.