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Query: UMLS:C0042109 (urticaria)
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At a time when the American public is committed to health through exercise, a variety of allergic conditions related to activity are being recognized with increasing frequency. Conditions such as cholinergic urticaria, bronchospasm, and even anaphylaxis have occurred as a consequence of exercise. Thus, a symposium has been developed to examine the role of exercise in association with such conditions. Several of the physical allergies are discussed in overview fashion. Exercise-induced anaphylaxis, the most serious form of allergic response to exercise itself, is considered in greater detail. The etiology, clinical features, and therapy for these physical allergies are addressed. Exercise-induced bronchospasm (EIB) has been well categorized in the literature. This is another exercise-related condition with an allergic component. The current concepts with respect to proposed etiology, epidemiology, and clinical features are discussed. EIB is an important condition to screen for, and techniques for identifying patients who should be screened are also addressed. Allergic rhinitis may also affect athletes. Accurate diagnosis and effective management of all these conditions may help greater numbers of people to enjoy the full benefits of exercise.
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PMID:Introduction: exercise and allergy. 140 65

Exercise-induced anaphylaxis (EIA) is a unique form of physical allergy that has been recognized with increasing frequency in recent years. The hallmarks of this syndrome are generalized pruritus with a flushing sensation, a feeling of warmth, and the development of urticaria in association with vigorous physical exertion. These symptoms tend to occur variably with exercise, but not with passive warming. Most patients report typical giant urticarial eruptions. Skin mast cells degranulate, and serum histamine increases during symptomatic attacks. Treatment is often problematic, but cessation of exercise with onset of symptoms and self-administration of epinephrine are recommended.
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PMID:Exercise-induced anaphylaxis. 140 67

Exercise-induced anaphylaxis (EIAn) is a rare condition characterized by giant urticaria, angioedema and acute gastrointestinal symptoms that develops on exertion. In the most severe forms it may be associated with acute cardiorespiratory symptoms (laringeal stridor, wheezing), profound hypotension or syncope. In some individuals, EIAn characteristically occurs after a meal suggesting that the anaphylactic reaction is provoked by both exercise and ingestion of a foodstuff to which the patient has become sensitized. Two representative cases of severe food-dependent EIAn are described, which emphasize the need of performing a careful allergological evaluation in sportsmen with unexplained cardiovascular and/or respiratory symptoms during effort, especially when associated with other allergic manifestations and/or occurring in the post-prandial period.
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PMID:Food-dependent exercise-induced anaphylaxis: report of two cases. 148 42

Allergic and asthmatic individuals may have exercise-induced respiratory problems and sports may induce, in some cases, allergic problems. Exercise-induced asthma (EIA) differs from common asthma only in its causative factor. It is a typical asthmatic attack following physical exercise, lasting 5-10 min, most often in cold and dry weather. The prevalence in asthmatic children is high, in adolescents not yet firmly established. Cold air and/or hypertonic bronchial challenges during exercise are discussed as pathophysiological mechanisms. Nonpharmacological and drug treatment of EIA must preferentially be preventive. Exercise-induced anaphylaxis (urticaria, pruritus, edema) occurs mainly in children, triggered by exercise alone or by the combination of sensitizing food and exercise. Antihistamines before exercise are recommended. The use of sport equipment can induce contact dermatitis in rare cases.
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PMID:Sports and allergy. 189 91

Exercise-induced anaphylaxis (EIA) is a unique and an increasingly recognized syndrome consisting of premonitory symptoms and signs of generalized body warmth, pruritus, and erythema, which progresses on continued exertion to confluent urticaria, laryngeal edema with stridor or hoarseness, and gastrointestinal colic and frequently culminates in vascular collapse. Previous studies of five individuals with this condition have demonstrated significant elevations of serum histamine concurrent with the early clinical manifestations after experimental exercise. To assess relevant morphologic alterations in the skin of these patients, cutaneous mast cells were examined by light and transmission electron microscopy before and during the initial erythema elicited by exertion. The marked alterations observed in mast cells immediately after exercise consisted of (1) loss of electron density and internal substructure of granules, (2) fusion of granule membranes with those of adjacent granules and with mast cell membranes creating conduits to the extracellular space, and (3) an apparent decrease in the number of intact granules per cell. Biopsy specimens obtained before exercise from patients with EIA and from two normal individuals who served as control subjects were identical, and the control subjects had normal mast cell morphology after exercise. Serum histamine levels were significantly elevated in patients with EIA after exercise at the time of biopsy, whereas control subjects had normal levels. These observations provide evidence that EIA is a distinct form of physical allergy associated with mast cell degranulation similar in morphology to that of human pulmonary mast cell IgE-Fc-dependent activation secretion. Characterization of this disorder is important because its prevalence may be underestimated, and its clinical consequences, which may include some morbidity, are not fully known.
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PMID:Exercise-induced anaphylaxis: a serious form of physical allergy associated with mast cell degranulation. 398 Aug 83

Seven individuals with exercise-induced anaphylaxis under natural circumstances, characterized by the appearance of pruritic cutaneous erythema and urticaria and associated vascular collapse and/or upper respiratory tract symptoms and signs of angioedema, were subjected to a controlled period of exercise in a laboratory. Experimental challenge consisted of running in an occlusive suit on a treadmill of moving grade with maintenance or acceleration of speed for 5 to 17 min. Cutaneous pruritus and erythema without urticaria developed in four of the subjects and progressed to angioedema in two of them; the other three subjects were unaffected. Repeat challenge of three of the abnormal responders elicited a clinical response similar to that of the previous exercise challenge. In those subjects with a clinical response to exercise challenge, mean change from baseline levels of histamine to peak levels was 7.0 +/- 3.0 ng/ml (mean +/- SEM), whereas in the group without clinical symptoms the mean change from baseline was an increase of 0.6 +/- 1.6 ng/ml (mean +/- SEM). The abnormal elevations in serum histamine during the seven exercise-induced symptomatic episodes returned to normal in about 20 min while clinical signs were also subsiding. There were no changes in pulmonary function. Exercise-induced anaphylaxis is clinically separable from cholinergic urticaria and represents a distinct form of physical allergy.
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PMID:Exercise-induced anaphylaxis: a distinct form of physical allergy. 682 91

Although urticaria is generally an uncomfortable condition, it is usually considered to be relatively benign. Recent evidence indicates that numerous environmental stimuli can initiate cholinergic urticaria, and severe systemic manifestations may be associated with the onset of the urticaria. Exercise-induced anaphylaxis is a specific life-threatening reaction that has been documented to occur very unpredictably in susceptible individuals with cholinergic urticaria. The occurrence of severe hypotension, syncope, or laryngeal edema poses specific limitations to optimum performance should it occur in individuals employed in critical occupations. Although treatment with appropriate medications is generally effective in control of symptoms, these medications frequently have side effects not tolerable in high-risk situations. Four cases of U.S. Air Force aircrewmen referred to the USAF School of Aerospace Medicine for aeromedical evaluation illustrate the spectrum of problems that can be associated with cholinergic urticaria. Exercise history should always be carefully evaluated in all individuals who present with urticaria.
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PMID:Environmentally induced cholinergic urticaria and anaphylaxis. 688 17

There are several allergic responses that may occur in susceptible individuals as a result of exposure to physical stimuli. Most of these conditions are mediated by vasoactive substances and usually result in symptoms of urticaria and/or angioedema. There are 2 such conditions that may occur as a direct result from exercise. The first of these is cholinergic urticaria. Patients with cholinergic urticaria experience punctate (2 to 4mm) hives which occur reproducibly with exercise or with passive warming, such as might occur in a steam bath or hot pool. Life-threatening hypotension or angioedema usually do not occur with cholinergic urticaria. This condition usually responds well to oral hydroxyzine. Exercise-induced anaphylaxis (EIA) is a form of physical allergy that has been recognised with increasing frequency in recent years. This syndrome typically presents with generalised pruritus, a flushing sensation, a feeling of warmth and the development of conventional (10 to 15mm) urticaria in association with vigorous physical exertion only. Symptoms tend to occur variably with exposure to exercise and do not typically occur with passive warming. During symptomatic attacks, cutaneous mast cells degranulate and serum histamine levels increase. Treatment is problematic. Cessation of exercise with onset of symptoms and self-administration of epinephrine (adrenaline) are recommended. Other physical allergies that may affect exercising individuals include cold urticaria, localised heat urticaria, symptomatic dermatographism (dermographism), delayed pressure urticaria (angioedema), solar urticaria and aquagenic urticaria. Management of these conditions may include patient education, selective avoidance, antihistamines and, in some cases, induction of tolerance.
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PMID:Physical allergies and exercise. Clinical implications for those engaged in sports activities. 834 71

The clinical and laboratory study of 80 patients (75 males, 5 females) with cholinergic urticaria (CHU), treated from 1971 to 1996 is presented. The mean age at CHU occurrence was 22.3 years (10-50). The disease lasted at the time of examination from 3 months to 14 years, on an average 2 years and 11 months. Among 30 studied patients, the disease ceased after 1-3 in 5 patients, and it lasted from 3 to 24 years, on an average 9 years, in the remaining 25 patients. Exercise-induced anaphylaxis occurred in 8 patients and simultaneously cold urticaria occurred in 7 patients. The increase of histamine level in blood, following the exercise and/or heat test was found in 12 examined patients. The higher increase was noticed after the exercise, than after the heat test, which was well correlated with the severity of clinical features and the duration of skin manifestations. Repeated heat and/or cold test, performed at the same day, showed the weaker or no reaction at all. The role of the sweat, acetylcholine and histamine in CHU occurrence was discussed.
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PMID:[Clinical and laboratory studies of cholinergic urticaria]. 922 69

In a select group of persons, exercise can produce a spectrum of allergic symptoms ranging from an erythematous, irritating skin eruption to a life-threatening anaphylactic reaction. The differential diagnosis in persons with exercise-induced dermatologic and systemic symptoms should include exercise-induced anaphylaxis and cholinergic urticaria. Both are classified as physical allergies. Mast cell degranulation with the release of vasoactive substances appears to be an inciting factor for the production of symptoms in both cases. Exercise-induced anaphylaxis and cholinergic urticaria can be differentiated on the basis of urticarial morphology, reproducibility, progression to anaphylaxis and response to passive warming. Diagnosis is usually based on a thorough history and examination of the morphology of the lesions. Management of acute episodes of exercise-induced anaphylaxis includes cessation of exercise, administration of epinephrine and antihistamines, vascular support and airway maintenance. Long-term care may require modification of or abstinence from exercise, avoidance of co-precipitating factors and the prophylactic use of medications such as antihistamines and mast cell stabilizers.
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PMID:Exercise-induced anaphylaxis and urticaria. 1168 78


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