- History and Clinical Presentation
- Exercise-induced urticaria was first described in the 1970s.
- Relatively rare condition.
- Symptoms: pruritic, white or erythematous, nonpitting edematous plaques during exercise, mainly jogging or running.
- May progress to anaphylaxis.
- Pathophysiology
- Likely caused by increased body temperature leading to capillary vasodilation and fluid transudation into the dermis.
- Thermoregulatory mechanisms and exaggerated cholinergic response may play roles.
- Increase in temperature > 0.7 °C, mast cell degranulation, and increased plasma histamine proposed as contributing factors.
- Types of Exercise-Induced Urticaria
- Cholinergic Urticaria
- Induced by exercise, body warming, and emotional stress.
- Small papules surrounded by erythematous halos.
- Typically, it starts around the thorax and neck, and can spread to the whole body.
- Variant EIA
- Similar to cholinergic urticaria but triggered only by exercise.
- Classic EIA
- Accompanied by upper respiratory obstruction and hypotension.
- Cholinergic Urticaria
- Diagnosis
- Primarily based on patient history.
- Exercise challenge test or methacholine skin test may be used.
- Methacholine test positive in only one-third of patients.
- Routine plasma histamine and serum immunoglobulin levels not typically ordered.
- Case report diagnosis: typical history and positive exercise challenge test.
- Treatment and Management
- Prophylactic Treatment
- Avoidance of exercise.
- Modification of physical activities is recommended due to the health benefits of exercise.
- Medications
- Antihistamines: loratadine, fexofenadine, and hydroxyzine may be somewhat effective.
- Mast cell stabilizers and leukotriene-modifying agents mentioned but need more studies for effectiveness.
- Preventive Measures
- Avoiding food for at least 4-6 hours before exercise to prevent food-dependent exercise-induced urticaria.
- Prophylactic Treatment
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