Exercise urticaria, more commonly known as exercise allergy, is a skin condition that occurs when patients develop hives, or urticaria, due to physical activity. This symptom is connected with two other diseases, exercise induced anaphylaxis and cholinergic urticaria.
Individuals suffering from cholinergic urticaria experience hives whenever their core body temperature is elevated beyond normal. This is usually a minor condition that disappears on its own. On the other hand, exercise-induced anaphylaxis is not triggered by fluctuations in body temperature and can be life-threatening.
Relationship with Cholinergic Urticaria
Frequently, exercise urticaria is related to cholinergic urticaria. Patients who develop this condition break out into hives whenever their body temperature starts to rise, which often occurs during exercise, fever, or external environmental temperatures. This diseases most commonly develops in people in their 20s and 30s.
The primary symptom of cholinergic urticaria is a skin rash commonly known as hives, but formally known as urticaria. This rash appears as small skin lesions, which form raised areas of skin surrounded by redness.
Frequently the rash develops unexpectedly and tends to cause burning, itchiness, and pain. Sometimes patients can develop other symptoms like shortness of breath, dizziness, vomiting, and nausea.
Relationship with Exercise Anaphylaxis
Most often, the diagnosis of exercise urticaria and cholinergic urticaria is formed after analyzing a patient’s clinical history. Although there are some procedures available to assist in making the diagnosis, generally doctors depend on the patient to recount their experiences and detail their symptoms.
The most common treatment for this condition is to use antihistamine medications. Patients will also be required to avoid conditions that trigger their urticaria as much as possible (e.g. strenuous exercise). In most cases, exercise urticaria subsides within ten years, and patients no longer need to rely on medications or avoid specific situations.
In extreme cases, exercise urticaria can be a precursor of a more severe condition known as exercise anaphylaxis. Individuals who have exercise anaphylaxis experience worse symptoms than patients with cholinergic urticaria. Both diseases have similar symptoms – skin rashes that cause itchiness and irritation.
Exercise anaphylaxis differs in that additional symptoms may arise such as facial swelling, flushing, fatigue, and light-headedness. Advanced cases can lead to sudden severe drops in blood pressure that can result in fainting and collapsing.
Treating exercise urticaria associated with exercise anaphylaxis is generally supportive. Patients are given a hot of epinephrine as a fast-acting alleviating solution. Next, they can be supplied with fluids intravenously.
Furthermore, if swelling develops in the neck region and breathing is becoming difficult, respiratory support or mechanical ventilation will be necessary to provide much needed oxygen until the patient can breathe on their own again.
Differentiating between cholinergic urticaria and exercise urticaria in relation to exercise anaphylaxis can be extremely difficult. Only in hindsight are the distinctions obvious, especially if the patient experiences a life-threatening anaphylactic episode.
A way to determine which is which lies in knowing the triggers that cause urticaria. Cholinergic urticaria appears due to increases in body temperature. Exercise anaphylaxis, on the other hand, only develops due to exercise and is not affected by body temperature.