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Exercise-Induced Urticaria, Sports Medicine

Mark Halstead, MD, FAAP Reviewed 04/2019
 


BASICS

DESCRIPTION

  • Spectrum of allergic response to exercise ranging from itching, flushing, and cutaneous warmth to development of well-circumscribed wheals (large papular lesions with pale centers an...

DIAGNOSIS

HISTORY

  • Diagnosis usually is made by history.

  • Initially, patients describe generalized feeling of tingling, warmth, and itching.

  • May start as early as 5 min after initiating exercise or can occ...

TREATMENT

MEDICATION

  • Epinephrine (EpiPen) 0.2 to 0.5 mg intramuscular (IM) for severe anaphylactic reaction in adults; 0.01 mg/kg in children

  • Diphenhydramine (Benadryl) 25 to 50 mg PO q4–6h (children: 5...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Referral to an allergist may be beneficial for skin testing and controlled exercise challenge testing.

  • Preventative medication has been reported to decrease or sta...

REFERENCES

1
Aihara Y, Takahashi Y, Kotoyori T, et al. Frequency of food-dependent, exercise-induced anaphylaxis in Japanese junior-high-school students. J Allergy Clin Immunol.  2001;108(6):1035–...

ADDITIONAL READING

  • Chong SU, Worm M, Zuberbier T. Role of adverse reactions to food in urticaria and exercise-induced anaphylaxis. Int Arch Allergy Immunol.  2002;129(1):19–26.

  • Feldweg AM. Exercis...

CLINICAL PEARLS

  • Exercise may be continued as long as precautions are taken by avoiding all food 6 to 8 hr before exercise and 12 hr after eating food suspected of causing reactions.

  • Epinephrine should ...

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