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Initial outpatient evaluation was followed by hospital admission, where intubation and intensive resuscitation were required. Case presentation: Severe neurological impairment (Glasgow Coma Scale 3/15), hypotension, tachycardia, fever, and hypoxemia with abnormal pupillary and reflex findings were documented, alongside metabolic derangements, elevated liver enzymes, and markedly high lactate. Despite maximal therapy including sedation and inotropic support, cerebral edema and diffuse hypoxia progressed to brain death three days after admission.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-critical-case-of-anaphylaxis-triggered-by-exercise-in-a-pediatric-asthma-patient/442483/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-critical-case-of-anaphylaxis-triggered-by-exercise-in-a-pediatric-asthma-patient/442483.png","ImageObject",300,407,{"name":92,"@type":93},"Alexandar","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What symptoms appeared after the child played soccer?","Question",{"text":112,"@type":113},"He developed acute respiratory distress, generalized urticaria, and cyanosis, raising concern for FDEIA or EIA.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What were the key hospital findings during presentation?",{"text":117,"@type":113},"He had severe neurological impairment (GCS 3/15) with hypotension, tachycardia, fever, and severe hypoxemia, plus abnormal pupillary findings and absent deep tendon reflexes.",{"name":119,"@type":110,"acceptedAnswer":120},"How did the case evolve despite treatment?",{"text":121,"@type":113},"Despite fluid resuscitation, neuroprotection, antibiotics, antiepileptic treatment, and maximal supportive care, cerebral edema and diffuse hypoxia progressed to brain death three days after admission.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},442483,1790774725,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090768658,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Moshfegh etal. BMC Pediatrics (2026) 26:10 [https://doi.org/10.1186/s12887-025-06256-6](https://doi.org/10.1186/s12887-025-06256-6)  \nBMC Pediatrics  \nCASE REPORT Open Access  \nA critical case of anaphylaxis triggered by exercise in a pediatric asthma patient  \nFereshteh Moshfegh 1, Zahra Hosseinzade 1*, Mohammad Javanbakht2, Maryam Sakhaei3 and Ali Manafi Anari3  \nAbstract  \nBackground 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) .  \nThe 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.  \nCase presentation 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.  \nConclusion 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.  \nKeywords Asthma, Anaphylaxis, Neurological, CT  \n*Correspondence:  \nZahra Hosseinzade  \n[hosseinzadeh.za@iums.ac.ir](hosseinzadeh.za@iums.ac.ir)  \n1Fellowship Assistant of Pediatric Intensive Care Unit, Department of Pediatrics, Ali Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran  \n2Nephrology and Urology Research Center, Clinical Science Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran  \n3Pediatric Intensive Care Unit, Department of Pediatrics, Ali Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran  \nBackground  \nAnaphylaxis is a rapid, life-threatening allergic reaction requiring immediate treatment, accounting for up to 0.26% of hospital admissions [1, 2]. In recent years, the global prevalence of anaphylaxis and related hospitalizations has increased, driven largely by rising food allergy rates, especially in children, as well as greater awareness and improved diagnosis of the condition. Children and the young are more vulnerable to emergency department visitation and hospitalization [3, 4].  \nAnaphylaxis is also a significant risk in pediatric populations due to foods (i.e., peanuts and tree nuts), drugs,  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended u","cbCaibKZ8Noks9MH","https://ap.wps.com/l/cbCaibKZ8Noks9MH","pdf",699795,"English","# Abstract\n## Background\n## Case presentation\n## Conclusion\n# Background\n## Epidemiology and risk factors\n## Common triggers in children\n# Exercise-induced anaphylaxis (EIA)","[{\"question\":\"What symptoms appeared after the child played soccer?\",\"answer\":\"He developed acute respiratory distress, generalized urticaria, and cyanosis, raising concern for FDEIA or EIA.\"},{\"question\":\"What were the key hospital findings during presentation?\",\"answer\":\"He had severe neurological impairment (GCS 3/15) with hypotension, tachycardia, fever, and severe hypoxemia, plus abnormal pupillary findings and absent deep tendon reflexes.\"},{\"question\":\"How did the case evolve despite treatment?\",\"answer\":\"Despite fluid resuscitation, neuroprotection, antibiotics, antiepileptic treatment, and maximal supportive care, cerebral edema and diffuse hypoxia progressed to brain death three days after admission.\"}]","A critical case of anaphylaxis triggered by exercise in a pediatric asthma patient | PDF",1790700478,15]