What is the clinical diagnosis name for hives associated with exercise?

Clinical Diagnosis of Exercise-Associated Hives

The clinical diagnosis depends on the specific presentation: isolated hives triggered by exercise are termed "exercise-induced urticaria," while hives accompanied by systemic symptoms (respiratory distress, hypotension, angioedema) constitute "exercise-induced anaphylaxis." 1

Diagnostic Categories

Exercise-Induced Anaphylaxis

This is the diagnosis when hives progress beyond isolated skin manifestations to include systemic involvement. 1

• Initial symptoms include diffuse warmth, pruritus, erythema, and urticaria that progress to angioedema, gastrointestinal symptoms, laryngeal edema, and/or vascular collapse 1
• Approximately one-third of patients experience transient loss of consciousness due to vascular collapse 1
• Nearly two-thirds develop upper respiratory tract obstruction symptoms 1
• Symptoms can persist for 30 minutes to hours 1

Cholinergic Urticaria

This distinct entity must be differentiated from exercise-induced anaphylaxis, as it presents with characteristic punctate wheals rather than larger confluent hives. 1

• Characterized by punctate (1-3 mm diameter) intensely pruritic wheals with erythematous flaring 1
• Triggered by increase in core body temperature or stress 1
• Classically associated with increased core body temperature without vascular collapse 1
• Can be elicited by passive warming (hot bath, sauna), unlike exercise-induced anaphylaxis which requires actual exercise 1
• A minority of exercise-induced anaphylaxis patients may have cutaneous lesions consistent with cholinergic urticaria, and these syndromes rarely appear concurrently 1

Food-Dependent Exercise-Induced Anaphylaxis (FDEIA)

This important subtype occurs only when specific food ingestion is followed by exercise within a critical time window. 1

• Requires both food ingestion AND exercise to produce the reaction 1
• Patients can ingest the culprit foods without symptoms if they avoid exercise for 4-6 hours afterward 1
• In 54% of cases, postprandial exercise triggers anaphylaxis without identification of a specific food 1
• Common culprit foods include crustaceans and wheat flour 2
• Aspirin or other NSAIDs before exercise have been reported in 13% of affected individuals 1

Key Distinguishing Features

Critical Differentiators

Proper diagnosis requires distinguishing exercise-induced anaphylaxis from other exercise-associated conditions that can mimic it. 1

• Cardiac arrhythmias: Present with vascular collapse but lack pruritus, erythema, urticaria-angioedema, or upper respiratory obstruction 1
• Exercise-induced bronchospasm: Symptoms referable only to lower respiratory tract, without cutaneous or systemic manifestations 1
• Cholinergic urticaria: Punctate wheals without progression to systemic symptoms or vascular collapse 1

Clinical Pearls

Important Diagnostic Considerations

• Patients with exercise-induced anaphylaxis may have higher incidence of personal and/or family history of atopy 1
• Activities commonly precipitating attacks include jogging, brisk walking, bicycling, racquet sports, skiing, and aerobic exercise 1
• A detailed history should include antecedent use of aspirin or NSAIDs, as well as any seasonality to attacks 1
• Provocation of exercise-induced anaphylaxis with latency periods up to 24 hours after food consumption has been reported 1

Common Pitfalls

Do not diagnose exercise-induced anaphylaxis based solely on hives without assessing for systemic symptoms, as this distinction fundamentally changes management and prognosis. 1

• Simply increasing core body temperature does not necessarily produce symptoms of exercise-induced anaphylaxis, unlike cholinergic urticaria 1
• The term "exercise-induced urticaria" is appropriate only when isolated cutaneous manifestations occur without systemic involvement 3, 4, 5