Exercise-Induced Asthma Differential Diagnoses

  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Craig C Young, MD   more...
 
Updated: Mar 29, 2011
 
 

Diagnostic Considerations

Exercise-induced urticaria, also known as exercise-induced anaphylaxis, is a rare and unrelated condition to exercise-induced asthma (EIA). Only 500-1000 cases of exercise-induced urticaria have been reported in the literature. In this condition, there is an early stage of exercise-related fatigue and itchiness, followed by early onset of urticaria and angioedema, which is initially mild.[13]

If progression occurs in exercise-induced urticaria, there is choking, stridor, nausea, vomiting, and even hypotension. A late stage that is marked by headache may also occur. As implied by the alternative name of anaphylaxis, exercise-induced urticaria can be life threatening; however, this can be prevented by exercise modification or avoidance of certain conditions.

Professionals caring for athletes must also keep a high index of suspicion for vocal cord dysfunction, which manifests as stridor with exercise due to paradoxical contraction of the vocal cords with inspiration and does not respond to the same treatment. The highly driven, high-performing adolescent athlete, especially the female athlete, is at high risk for this condition. Vocal cord dysfunction can be evaluated via laryngoscopy after an exercise challenge (see Laryngoscopy and Challenge Tests).

The physician, trainer, or other medical staff must always consider bronchospasm in athletes with the previously described complaints. A high index of suspicion diminishes the possibility of missed diagnoses. A thorough knowledge of the differential diagnosis (see Differentials) and how to work up the possibilities are also important (see Workup).

Other problems to be considered in patients with EIA include deconditioning syndrome, seasonal asthma, and upper airway obstruction.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Joseph P Garry, MD, FACSM, FAAFP  Associate Professor, Sports Medicine Faculty, Department of Family and Community Medicine, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group

Disclosure: Nothing to disclose.

Specialty Editor Board

Anthony J Saglimbeni, MD  President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD, is a member of the following medical societies: California Medical Association and Santa Clara County Medical Association

Disclosure: South Bay Sports and Preventive Medicine Associates, Inc Ownership interest Other

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

  1. National Heart, Lung,and Blood Institute, National Asthma Education and Prevention Program. Expert Panel Report 3:Guidelines for the Diagnosis and Management of Asthma: Full Report 2007. Publication no. 07-4051. Bethesda, Md: NHLBI; August 2007.

  2. Anderson SD. How does exercise cause asthma attacks?. Curr Opin Allergy Clin Immunol. Feb 2006;6(1):37-42. [Medline].

  3. Hough DO, Dec KL. Exercise-induced asthma and anaphylaxis. Sports Med. Sep 1994;18(3):162-72. [Medline].

  4. Smith BW, MacKnight JM. Pulmonary. Safran MR, McKeag DB, Van Camp SP, eds. Manual of Sports Medicine. Vol 1. Philadelphia, Pa: Lippincott-Raven; 1998:244-9.

  5. Storms W. Update on montelukast and its role in the treatment of asthma, allergic rhinitis and exercise-induced bronchoconstriction. Expert Opin Pharmacother. Sep 2007;8(13):2173-87. [Medline].

  6. Steinshamn S, Sandsund M, Sue-Chu M, Bjermer L. Effects of montelukast and salmeterol on physical performance and exercise economy in adult asthmatics with exercise-induced bronchoconstriction. Chest. Oct 2004;126(4):1154-60. [Medline].

  7. Wilson JJ, Wilson EM. Practical management: vocal cord dysfunction in athletes. Clin J Sport Med. Jul 2006;16(4):357-60. [Medline].

  8. Kenn K. [Vocal Cord Dysfunction--what do we really know? A review]. Pneumologie. Jul 2007;61(7):431-9. [Medline].

  9. Stensrud T, Berntsen S, Carlsen KH. Exercise capacity and exercise-induced bronchoconstriction (EIB) in a cold environment. Respir Med. Jul 2007;101(7):1529-36. [Medline].

  10. Butcher JD. Exercise-induced asthma in the competitive cold weather athlete. Curr Sports Med Rep. Dec 2006;5(6):284-8. [Medline].

  11. Dickinson JW, Whyte GP, McConnell AK, Harries MG. Screening elite winter athletes for exercise induced asthma: a comparison of three challenge methods. Br J Sports Med. Feb 2006;40(2):179-82; discussion 179-82. [Medline]. [Full Text].

  12. Kaplan TA. Exercise challenge for exercise-induced bronchospasm: confirming presence, evaluating control. Phys Sports Med. 1995;23(8):47-57.

  13. Beaudouin E, Renaudin JM, Morisset M, Codreanu F, Kanny G, Moneret-Vautrin DA. Food-dependent exercise-induced anaphylaxis--update and current data. Eur Ann Allergy Clin Immunol. Feb 2006;38(2):45-51. [Medline].

  14. Rundell KW, Anderson SD, Spiering BA, Judelson DA. Field exercise vs laboratory eucapnic voluntary hyperventilation to identify airway hyperresponsiveness in elite cold weather athletes. Chest. Mar 2004;125(3):909-15. [Medline].

 
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