Exercise-induced anaphylaxis as a manifestation of cholinergic urticaria

Kaplan, Allen P.; Natbony, Sheila; Tawil, Arfan P.; Fruchter, Lazar; Foster, Michael

doi:10.1016/0091-6749(81)90158-5

Cited by 83 publications

(19 citation statements)

References 9 publications

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“…[170][171][172] In some patients exerciseinduced anaphylaxis will only occur after ingestion of a specific food or medication, such as aspirin or other nonsteroidal anti-inflammatory agents. Ingestion of these medications before exercise has been reported by 13% of affected individuals, 173 and their elimination might enable the patient to tolerate exercise.…”

Section: Diagnosismentioning

confidence: 99%

The diagnosis and management of anaphylaxis: An updated practice parameter

Lieberman¹,

Kemp²,

Oppenheimer³

et al. 2005

Journal of Allergy and Clinical Immunology

459

254

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Section: Diagnosismentioning

confidence: 99%

The diagnosis and management of anaphylaxis: An updated practice parameter

Lieberman¹,

Kemp²,

Oppenheimer³

et al. 2005

Journal of Allergy and Clinical Immunology

459

254

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“…CU is frequently associated with atopy, especially with atopic dermatitis (AD) [10]. Occasionally, angioedema, bronchial asthma, and/or anaphylaxis are associated with this disorder [3,[11][12][13]. Association with cold urticaria may sometimes be observed [14].…”

Section: Introductionmentioning

confidence: 98%

New concepts of hive formation in cholinergic urticaria

Horikawa

Fukunaga²,

Nishigori³

2009

Curr Allergy Asthma Rep

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Patients with cholinergic urticaria (CU) show a number of small, short-lasting hives when their body core temperature increases, usually during sweating following exercise or bathing. The precise mechanism(s) of hive formation in CU has been unclear except for the involvement of acetylcholine. We recently reported that most CU patients show immediate-type skin responses to their own sweat, whereas the rest of CU patients have positive autologous serum skin tests (ASSTs). The former group produced satellite wheals following acetylcholine injection, whereas the latter group produced hives in conjunction with hair follicles. We propose two subtypes of CU: 1) a sweat-hypersensitivity type with strong hypersensitivity to autologous sweat, nonfollicular hives, development of satellite wheals, and lack of positive ASST; and 2) a follicular type with follicular hives and positive ASST, but no hypersensitivity to autologous sweat or satellite wheals. We discuss the mechanisms of hive formation in these subtypes.

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“…Actually the past literature mentioned the refractory period of CU that was relatively symptom free for a day or more after a severe attack of urticaria produced by a hot bath or exercise. Although it has mainly been speculated to be associated with the diminished histamine release from exhausted mast cells [6, 7, 8, 9], the effect of the elimination of poral occlusion by forced sweating could not be excluded.…”

Section: Discussionmentioning

confidence: 99%

Cholinergic Urticaria, a New Pathogenic Concept: Hypohidrosis due to Interference with the Delivery of Sweat to the Skin Surface

et al. 2002

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Background: Acetylcholine has been suspected to be a pathogenetic factor for cholinergic urticaria (CU), without definite evidence. In contrast, there are scattered reports of CU associated with acquired generalized hypohidrosis. We have recently examined 2 patients with CU in both of whom we noticed the presence of extensive hypohidrosis that occurred only in winter. Objective: In these 2 patients, acquired hypohidrosis due to superficial obstruction of the acrosyringium was suspected as the cause. Both case 1, a 22-year-old Japanese man, and case 2, a 21-year-old Japanese man, began to have anhidrosis and numerous red macules on their body whenever they felt hot in winter. These symptoms ceased to appear in summer. Methods: We studied histologically their lesional skin in addition to provocation tests for CU. Results: The diagnosis of CU was confirmed by the provocation of typical wheals after physical exercise in both cases. Histological study revealed findings suggestive of the presence of occlusion of the superficial acrosyringium. Conclusion: We think that such a hypohidrosis due to occlusion of superficial sweat ducts may also play a role in many other patients with CU of unknown etiology that becomes exacerbated in winter when sweating is not a frequent event.

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Exercise-induced anaphylaxis as a manifestation of cholinergic urticaria

Cited by 83 publications

References 9 publications

The diagnosis and management of anaphylaxis: An updated practice parameter

The diagnosis and management of anaphylaxis: An updated practice parameter

New concepts of hive formation in cholinergic urticaria

Cholinergic Urticaria, a New Pathogenic Concept: Hypohidrosis due to Interference with the Delivery of Sweat to the Skin Surface

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