Exercise induced urticaria pathophysiology

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action. Medically reviewed by Drugs. Last updated on Feb 3, Urticaria is also called hives. Hives can change size and shape, and appear anywhere on your skin. They can be mild or severe and last from a few minutes to a few days. Hives may be a sign of a severe allergic reaction called anaphylaxis that needs immediate treatment.

Urticaria that lasts longer than 6 weeks may be a chronic condition that needs long-term treatment. Your healthcare provider will examine you and ask about your symptoms. He may also ask about your family medical history, medicines you take, and foods you eat.

exercise induced urticaria pathophysiology

Tell your healthcare provider about any recent trauma, stress, or contact with allergens. You may need additional testing if you developed anaphylaxis after you were exposed to a trigger and then exercised. This is called exercise-induced anaphylaxis. You may need any of the following:. Hives often go away without treatment. Chronic urticaria may need to be treated with more than one medicine, or other medicines than listed below.

The following are common medicines used to treat urticaria:. You may also have itching, a rash, or feel like you are going to faint. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Skip to Content.Physical exercise may provoke the onset of clinical symptoms that are usually associated with an allergic reaction. Distinct forms of recognized physical allergies are exercise-induced anaphylaxis EIAfood-dependent EIA cholinergic urticaria, exercise-induced bronchospasm, and rhinitis. In a report,[ 2 ] the authors described a year-old male with 3-year history of exercise-induced rash accompanied by flushing, feeling unwell and warm, eyelid angioedema, pruritus, and headache.

His symptoms were relieved with discontinuation of exercise. No history of any specific food, drink, or medication intake before exercise was apparent, but the patient described nonspecific allergic rhinitis episodes to dust.

He subsequently underwent extensive investigation including skin prick tests to numerous food items including meat and vegetables as well as specific immunoglobulin E IgE for wheat, most of which proved to be negative. The only positive skin prick tests were for mites and grasses. His symptoms subsided with antihistamine and antileukotriene therapy with montelukast that enabled him to start exercising again without symptoms.

EIA is an unpredictable and potentially fatal syndrome affecting pediatric individuals also[ 3 ] with a prevalence of 0. This condition may occur independently or may require the ingestion of a food allergen either pre- or post-exercise. Atopic individuals are specifically prone to this condition. Therefore, this report raises several important questions concerning the etiology, pathophysiology, associations and treatment of EIA.

The authors have correctly speculated on mediators from degranulation of mast cells, lowering of degranulation threshold and increased sympathetic activity, but additional causes should be taken into consideration as has been emphasized in a recent position paper. The consumption of substances such as alcohol or aspirin that damage the gastric mucosa may significantly increase the risk of food allergic patients developing anaphylaxis.

On the other hand, the inhibitory effect of exercise on gastric acid secretion decreases the digestion of oral allergens and preserves the structural integrity that leads to continued systemic absorption of the allergens whether it be profilins, lipid transfer proteins, or other antigenic determinants.

Increased IgE cross-linking may be the result in tissue transglutaminase enzyme alterations causing peptide aggregation during exercise. During exercise, a fall in pH takes place creating an acidic state that may promote mast cell degranulation.

In vitro studies have shown that during exercise, plasma osmolarity is raised and this can increase basophil activation and histamine release. In the described patient, there was no history of any specific food or medication intake before exercise, but there are several kinds of commonly used foods drugs and environmental exposures [ Table 1 ] that should be always tested for.

exercise induced urticaria pathophysiology

For example, tomato salad is a commonly used food which can induce exercise anaphylaxis and should be always tested. Although tomatoes have become one of the most consumed vegetables worldwide, unfortunately, tomatoes are accompanied by an increasing risk of tomato allergy via five proteins with putative clinical relevance as tomato allergens.

Another effort-induced anaphylactic condition is the so-called cholinergic urticaria known as stress urticaria, allergy to effort and aquagenic urticaria. This kind of urticaria has been attributed to water in sweat aquagenicduring exercise, which reacts with sebum forming a compound acting as an allergen that induces the release of histamine.

This condition can be accompanied by systemic manifestations such as abdominal pain, nausea, vomiting and diarrhea. Recent reports have associated food-dependent EIA with acute coronary syndrome and especially with the Kounis hypersensitivity-associated coronary syndrome. It can manifest as allergic angina, allergic myocardial infarction or stent thrombosis with thrombus infiltrated by eosinophils and mast cells.Learn something new every day More Info Exercise urticariaalso known as exercise allergyis a condition in which patients develop urticaria, or hives, in response to physical activity.

This symptom is associated with two different diseases, cholinergic urticaria and exercise-induced anaphylaxis.

Urticaria – an overview

Patients with cholinergic urticaria break into hives whenever their core body temperature rises. This is typically a mild condition that resolves on its own. In contrast, exercise-induced anaphylaxis can be life-threatening and is not triggered by alterations in body temperature. Most often, exercise urticaria is associated with a disease called cholinergic urticaria. Patients with this condition develop a reaction whenever their body temperature rises above normal, which can occur due to exercise, elevated external environmental temperatures, or fever.

The disease is most common in people in their 20s or 30s. The main symptom of cholinergic urticaria is a skin rash called urticaria, a condition commonly known as hives. With this rash, many small skin lesions appear, which are composed of raised areas of skin encircled by redness.

Often the rash comes on suddenly and is associated with itchiness, tingling, and pain. Occasionally patients can experience other symptoms such as dizzinessshortness of breath, nausea, and vomiting. Typically, the diagnosis of exercise urticaria in association with cholinergic urticaria is made on the basis of clinical history. Although some tests are available to help make the diagnosis, typically doctors rely on the patient's account of symptoms and inciting events.

The mainstay of treatment for this condition is to take medications in the antihistamine class. Patients should also avoid enduring conditions that are known to incite the urticaria, such as strenuous exercise.

In most cases, this condition resolves within ten years of diagnosis, and patients no longer have to take medications or avoid certain situations. Rarely, exercise urticaria can signal that a more severe condition called exercise anaphylaxis will develop. Patients with exercise anaphylaxis have much more severe symptoms than patients with cholinergic urticaria.

Both conditions cause the skin rash with its associated itchiness. Exercise anaphylaxis, however, causes additional symptoms including flushing, facial swelling, lightheadedness, and fatigue. Advanced cases can cause a severe sudden drop in blood pressure that can lead to fainting and collapse. Treatment of exercise urticaria associated with exercise anaphylaxis is mainly supportive.Exercise-induced urticaria is a condition that produces hives and other allergic symptoms.

They can occur on any part of the body. They often are redder around the edge than in the middle. Physical activity can cause some people to have allergic reactions. The exact cause of this condition is unknown.

If you notice hives and other symptoms, stop exercising right away. Contact your doctor if the hives do not go away 5 to 10 minutes after exercise. The doctor will look at your symptoms and review your health history. They may order a skin-prick test to check for allergies. Or they may do exercise tests to see if the reaction occurs again.

You cannot avoid exercise-induced urticaria. However, you can help prevent flare-ups. Avoid food, products, or types of exercise that trigger hives and other symptoms.

Work with your doctor to identify these. Medicines, such as antihistamines, can prevent and treat some symptoms. In severe cases, symptoms may be life threatening, but this is rare. This is more commonly known as an EpiPen. You inject this medicine as soon as symptoms start. It stops the symptoms before they become life threatening. People who have severe cases may need to avoid exercise all together. Other people may be able to exercise if they avoid triggers.

exercise induced urticaria pathophysiology

These can include certain types of exercise or foods. Keep track of what you eat before you exercise. If you notice a pattern to your symptoms, stop eating that food. If hives and symptoms also stop, tell your doctor. They probably will tell you to avoid the food.Exercise-induced anaphylaxis EIA and food-dependent, exercise-induced anaphylaxis FDEIA are rare but potentially life-threatening clinical syndromes in which association with exercise is crucial. The range of triggering physical activities is broad, including as mild an effort as a stroll.

EIA is not fully repeatable ie, the same exercise may not always result in anaphylaxis in a given patient. In FDEIA, the combined ingestion of sensitizing food and exercise is necessary to precipitate symptoms.

Clinical features and management do not differ significantly from other types of anaphylaxis. Different hypotheses concerning the possible influence of exercise on the development of anaphylactic symptoms are taken into consideration.

These include increased gastrointestinal permeability, blood flow redistribution, and most likely increased osmolality. This article also describes current diagnostic and therapeutic possibilities, including changes in lifestyle and preventive properties of antiallergic drugs as well as acute treatment of these dangerous syndromes.

Anaphylaxis is defined as a potentially life-threatening generalized or systemic hypersensitivity reaction involving several organs and systems, particularly the skin, respiratory tract, gastrointestinal tract, and cardiovascular system [ 1 ]. There is no unified method of obtaining data about anaphylaxis; thus, its incidence is very difficult to evaluate clearly. Epidemiologic studies have reported a range of 8 to 50 perperson-years, with a lifetime prevalence of 0.

A recent study from the United Kingdom reported the prevalence of anaphylaxis to be 32 in[ 5 ]. General opinion suggests that the prevalence of anaphylaxis is underestimated and has increased in recent years. Since the earlys, interest has grown in patients with anaphylaxis triggered by exercise. The first case report came from Maulitz et al. Both strenuous exercise and causative food alone were well-tolerated.

Kidd and coworkers [ 8 ] presented four such patients and designated the phenomenon of food-dependent, exercise-induced anaphylaxis FDEIA. InSheffer and Austen [ 9 ] presented a series of 16 patients in whom exertion elicited a variety of anaphylactic symptoms, including generalized urticaria, pruritus, angioedema, gastrointestinal colic, and hypotension.

As this set of symptoms was very similar to anaphylactic syndrome resulting from contact with foreign antigen, they termed it exercise-induced anaphylaxis EIA. In a population of more than 76, Japanese junior high school students, Aihara et al. There is no known racial predilection for EIA.Exercise-induced anaphylaxis EIAEIAn, EIAs is a rare condition in which anaphylaxisa serious or life-threatening allergic response, is brought on by physical activity.

The exact proportion of the population with EIA is unknown, but a study of 76, Japanese junior high students showed that the frequency of EIA was 0. Exercise-induced anaphylaxis is not a widely known or understood condition, with the first research on the disorder only having been conducted in the past 40 years. A case report in on EIA was the first research of its kind, where a patient was described to experience anaphylactic shock related to exercise 5—24 hours following the consumption of shellfish.

The condition is thought to be more prevalent in women, with two studies of EIA patients reporting a ratio of for females:males with the disorder. Survey results from EIA patients have shown that the average number of attacks per year is The anaphylaxis campaign splits symptoms of EIA into two categories: mild and severe. Mild symptoms may include "widespread flushing of the skin", hives or urticariaswelling of the body angioedemaswelling of the lips, and nausea or vomiting. A paper by Sheffer and Austen splits an EIA event into four distinct stages: prodromal, early, fully developed, and late.

In the early stage, generalised urticaria develops. If the reaction does not diminish, it may become fully developed EIA, in which gastrointestinal symptoms and constriction of the airway may occur.

The late phase, which follows recovery from the reaction, includes frontal headaches and a feeling of fatigue; these symptoms may manifest themselves up to 72 hours following onset of the reaction. Food-dependent exercise-induced anaphylaxis FDEIA is a subcategory of the disorder where exercise only invokes a reaction when followed by the ingestion of a food allergen.

Ingestion of the trigger food most often precedes exercise by minutes or hours in cases of an attack; there are, however, reported incidents of attacks occurring when ingestion transpires shortly following activity.

Exercise-induced anaphylaxis is most commonly brought on by aerobic exercise.

Exercise-induced anaphylaxis

It is most often caused by higher levels of exertion, such as jogging, but can be brought on by milder activities, such as a gentle walk.

There are several factors outside of food and exercise that have been suggested to increase the risk of an EIA attack. These include the consumption of alcohol, exposure to pollen, extreme temperatures, the taking of non-steroidal anti-inflammatory drugs NSAIDsand even certain phases of the menstrual cycle.

Research shows that histaminea chemical involved in the allergic response, plays a key role in EIA. Theories for the pathophysiology of EIA include increased gastrointestinal permeability, increased tissue enzyme activity, and blood flow redistribution. Exercise is known to increase absorption from the gastrointestinal tract.

Urticaria - not always an ALLERGY

Another theory is that exercise and aspirin could activate tissue transglutaminase in intestinal mucus.DermNet provides Google Translate, a free machine translation service. Note that this may not provide an exact translation in all languages. Updated January There are several types of urticaria. The name urticaria is derived from the common European stinging nettle Urtica dioica.

A weal or wheal is a superficial skin-coloured or pale skin swelling, usually surrounded by erythema redness that lasts anything from a few minutes to 24 hours.

Usually very itchy, it may have a burning sensation. Angioedema is deeper swelling within the skin or mucous membranes and can be skin-coloured or red. It resolves within 72 hours. Angioedema may be itchy or painful but is often asymptomatic.

Chronic urticaria may be spontaneous or inducible. Both types may co-exist. One in five children or adults has an episode of acute urticaria during their lifetime. It is more common in atopics. It affects all races and both sexes.

exercise induced urticaria pathophysiology

Chronic spontaneous urticaria affects 0. Inducible urticaria is more common. There are genetic and autoimmune associations.

Urticarial weals can be a few millimetres or several centimetres in diameter, coloured white or red, with or without a red flare. Each weal may last a few minutes or several hours and may change shape. Weals may be round, or form rings, a map-like pattern or giant patches.

Angioedema is more often localised. It commonly affects the face especially eyelids and perioral siteshands, feet and genitalia. It may involve tongue, uvula, soft palate, or larynx. Serum sickness due to blood transfusion and serum sickness-like reactions due to certain drugs cause acute urticaria leaving bruises, feverswollen lymph glands, joint pain and swelling.

In chronic inducible urticaria, weals appear about 5 minutes after the stimulus and last a few minutes or up to one hour. Characteristically, weals are:. The weals are more persistent in chronic spontaneous urticaria, but each has gone or has altered in shape within 24 hours. They may occur at certain times of the day. Visual analogue scales can be used to record and compare the degree of itch.

The activity of chronic spontaneous urticaria can be assessed using the UAS7 scoring system. The emotional impact of urticaria and its effect on quality of life should also be assessed. Weals are due to release of chemical mediators from tissue mast cells and circulating basophils. These chemical mediators include histamineplatelet -activating factor and cytokines. The mediators activate sensory nerves and cause dilation of blood vessels and leakage of fluid into surrounding tissues.

Bradykinin release causes angioedema. Several hypotheses have been proposed to explain urticaria. The immune, arachidonic acid and coagulation systems are involved, and genetic mutations are under investigation.


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