Clinical Management of Exercise-Induced Anaphylaxis and Cholinergic Urticaria

Exercising is both pleasant and healthy. In some individuals, it can trigger adverse reactions. Examples of these reactions include exercise-induced anaphylaxis (EIA) and cholinergic urticaria (ChoIU). EIA presents as food-associated and non-food-associated conditions. Strenuous exertion may provoke both EIA and ChoIU, but with exercise the passive warming will induce solely ChoIU and not EIA. The morphologic size of the urticarial wheals can help distinguish between these 2 types of conditions. Small punctate wheals are present in ChoIU and large ones in EIA. Wheat is the most common food associated with food-dependent exercise-induced anaphylaxis and gluten is its most important antigen. Omega-5-gliadin is the major epitope of gluten. The most common medicines associated with drug-dependent exercise-induced anaphylaxis are the nonsteroidal anti-inflammatory drugs including aspirin. (C) 2020 American Academy of Allergy, Asthma & Immunology.