Exercise urticaria is a condition where patients develop hives in response to physical activity and is associated with cholinergic urticaria and exercise-induced anaphylaxis. Cholinergic urticaria is a mild condition that resolves on its own, while exercise-induced anaphylaxis can be life-threatening. Treatment involves antihistamines and avoiding triggers. Exercise anaphylaxis causes additional symptoms such as flushing, facial swelling, dizziness, and fatigue, and treatment involves immediate adrenaline injection and respiratory support. It can be difficult to distinguish between the two conditions, but cholinergic urticaria is triggered by any increase in body temperature, while exercise anaphylaxis occurs only as a result of exercise.
Exercise urticaria, also known as exercise allergy, is a condition in which patients develop hives, or hives, in response to physical activity. This symptom is associated with two different diseases, cholinergic urticaria and exercise-induced anaphylaxis. Patients with cholinergic urticaria break out in hives whenever their body temperature rises. This is typically a mild condition that resolves on its own. Conversely, exercise-induced anaphylaxis can be life-threatening and is not triggered by changes 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, high outside ambient temperatures, or fever. The disease is most common in people in their 20s and 30s.
The main symptom of cholinergic urticaria is a rash called hives, a condition commonly known as urticaria. With this rash, many small skin lesions appear, which are composed of raised areas of skin surrounded by redness. The rash often comes on suddenly and is associated with itching, tingling, and pain. Occasionally patients may experience other symptoms such as dizziness, shortness of breath, nausea and vomiting.
Typically, the diagnosis of exertional urticaria in association with cholinergic urticaria is made on the basis of the clinical history. Although some tests are available to help make the diagnosis, doctors generally rely on the patient’s account of symptoms and triggering events. The mainstay of treatment for this condition is taking drugs from the class of antihistamines. Patients should also avoid persistent conditions that are known to incite hives, such as strenuous exercise. In most cases, this condition resolves within ten years of diagnosis, and patients no longer need to take medications or avoid certain situations.
Rarely, exercise hives can signal that you will develop a more serious condition called exercise anaphylaxis. Patients with exercise-induced anaphylaxis have much more severe symptoms than patients with cholinergic urticaria. Both conditions cause the rash with associated itching. Exercise anaphylaxis, however, causes additional symptoms including flushing, facial swelling, dizziness, and fatigue. Advanced cases can cause a severe sudden drop in blood pressure that can lead to fainting and collapse.
Treatment of exertional urticaria associated with exercise-induced anaphylaxis is primarily supportive. Patients may be given an injection of adrenaline as an immediate soothing action. They can be supplied with intravenous fluids. Additionally, if swelling in the neck region has sufficiently limited the patient’s ability to breathe, respiratory support with supplemental oxygen or mechanical ventilation may be required until the patient recovers.
It can be difficult to distinguish between exercise urticaria associated with cholinergic urticaria from that associated with exercise anaphylaxis. Often the distinction is obvious in retrospect, especially if the patient develops a life-threatening anaphylactic episode. One way to tell them apart is to understand the triggers that cause hives. Cholinergic urticaria is triggered by any increase in body temperature, whereas exercise anaphylaxis occurs only as a result of exercise and is not related to body temperature.
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