Exercise-Induced Anaphylaxis Differential Diagnoses
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Passive heat challenges are valuable in differentiating between cholinergic urticaria and exercise-induced anaphylaxis. [29] In cholinergic urticaria, passive heating (eg, from hot baths or saunas) with an increase in core body temperature of more than 0.7° C causes histamine release, urticaria, and anaphylactic symptoms. In contrast, patients with exercise-induced anaphylaxis do not react with passive heating.
Idiopathic cold urticaria is a form of physical urticaria characterized by the development of urticaria and/or angioedema after cold exposure. Other organ systems may become involved, which may progress to frank anaphylaxis. Anaphylaxis has resulted in deaths either directly from the anaphylactic reaction or by drowning when swimming in cold water. [30]
Mastocytosis is a disorder characterized by mast cell proliferation and accumulation within various organs, most commonly the skin. [31] Patients with mastocytosis are susceptible to anaphylaxis from various triggers, including exercise.
Hereditary angioedema is an inherited disease resulting from a deficiency or dysfunction of the C1 inhibitor enzyme (C1-INH). [32] Acquired angioedema is caused by autoimmune interference with C1-INH function. [33]