scholarly journals Exercise-induced anaphylaxis unrelated to food ingestion and with hyperleukotrieneuria during challenge testing

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Chikako Motomura ◽  
Koji Ide ◽  
Terufumi Shimoda ◽  
Hiroshi Odajima
Keyword(s):  
Cold Water ◽  
Challenge Test ◽  
Food Allergies ◽  
Strenuous Exercise ◽  
Food Ingestion ◽  
Post Challenge ◽  
Loading Test ◽  
Plasma Adrenaline ◽  
Challenge Testing ◽  
Exercise Induced

Abstract Background Exercise-induced anaphylaxis (EIA) is a rare and potentially life-threatening disorder that can develop independently without food ingestion. Cold drinks can also trigger symptoms in some patients with cold-induced anaphylaxis. We present a case of a patient with EIA that was diagnosed on the basis of positive exercise loading test with hyperleukotrieneuria. Case presentation A 12-year-old girl presented with acute flushing, cyanosis, swollen eyelids, and dyspnea after an endurance run in winter or swimming in a cold-water pool. She also developed dyspnea after having a cold drink. She had no history of food allergies, atopy, or asthma. No association was noted between anaphylaxis and food intake in her history. On the first day, she ingested 200 mL of 5 °C cold water in 30 s, which did not trigger symptomatic responses, but her urinary leukotriene E4 (LTE4) level increased (pre-challenge test: 295 pg/mg-creatinine (cr), post-challenge test: 400 pg/mg-cr). On the second day, she underwent the exercise loading test according to the Bruce protocol by using an ergometer to increase the power of exercise every 2 min. She had been fasting for > 15 h and did not have breakfast. Just after the exercise loading test, the plasma adrenaline and noradrenaline increased. At 15 min after the exercise loading test, her plasma adrenaline and histamine (pre-challenge test: 0.7 ng/mL, 15 min post-challenge test: 81 ng/mL) rose sharply with anaphylaxis symptoms accompanied by increasing urinary LTE4 (pre-challenge test: 579 pg/mg-cr, post-challenge test: 846 pg/mg-cr). After she was discharged, she was restricted from strenuous exercise especially in cold environments and prescribed an adrenaline autoinjector. Conclusion Cold stimulation can become a co-effector of EIA. Measurements of urinary LTE4 levels during challenge testing are useful for diagnosing EIA and capture the pre-anaphylaxis stage.

Anaphylaxis Induced by Exercise or Cold Stimulation with Hyperleukotrieneuria During a Challenge Testing Not Containing Food Ingestion

2020 ◽  
Author(s):  
Chikako Motomura ◽  
Koji Ide ◽  
Terufumi Shimoda ◽  
Hiroshi Odajima
Keyword(s):  
Cold Water ◽  
Challenge Test ◽  
Food Allergies ◽  
Food Ingestion ◽  
Post Challenge ◽  
Loading Test ◽  
Cold Stimulation ◽  
Plasma Adrenaline ◽  
Challenge Testing ◽  
Cold Drink

Abstract Background: Exercise-induced anaphylaxis (EIA) is rare and a potentially life-threatening disorder that can develop independently without food ingestion. Cold drinks can also trigger symptoms in some patients with cold-induced anaphylaxis. We present the case of a patient with exercise and cold-induced anaphylaxis that was diagnosed based on hyperleukotrieneuria in exercise loading and cold-drink challenge testing.Case presentation: A 12-year-old girl presented with acute flushing, cyanosis, swollen eyelids, and dyspnea after an endurance run in winter or swimming in a cold-water pool. She also developed dyspnea after having a cold drink. She had no history of food allergies or atopy. No association was noted between anaphylaxis and food intake in her history. On the 1st day, she ingested 200 mL cold water at a temperature of 5°C in 30 s, which did not trigger any symptomatic responses, but urinary LTE4 level increased (pre-challenge test 295 pg/mg.cr, post-challenge test 400 pg/mg.cr). On the 2nd day, she underwent the exercise loading test according to the Bruce protocol by increasing the power of exercise every 2 min using an ergometer. She had been fasting for >15 h and did not have breakfast. Just after the exercise loading test, the plasma adrenaline and noradrenaline increased. At 15min. after the exercise loading test, the plasma adrenaline and histamine (pre-challenge test 0.7 ng/mL, 15min.post-challenge test 81 ng/mL) rised sharply with anaphylaxis symptom accompaneid by increasing of urinary LTE4 (pre-challenge test 579 pg/mg.cr, post-challenge test 846 pg/mg.cr). After she was discharged, she was restricted from strenuous exercise especially in cold environments and prescribed an adrenaline autoinjector.Conclusion: To our knowledge, cold stimulation becomes a co-effector for EIA. Measurements of urinary LTE4 levels during challenge testing are useful to diagnose anaphylaxis induced by exercise or cold stimulation.

scholarly journals Cryotherapy Models and Timing-Sequence Recovery of Exercise-Induced Muscle Damage in Middle- and Long-Distance Runners

2020 ◽  
Vol 55 (4) ◽  
pp. 329-335
Author(s):  
Chaoyi Qu ◽  
Zhaozhao Wu ◽  
Minxiao Xu ◽  
Fei Qin ◽  
Yanan Dong ◽  
...  
Keyword(s):  
Muscle Damage ◽  
Cold Water ◽  
Water Immersion ◽  
Whole Body ◽  
Strenuous Exercise ◽  
Distance Runners ◽  
Long Distance ◽  
Positive Effects ◽  
Exercise Induced ◽  
Recovery Methods

Context Among sports-recovery methods, cold-water immersion (CWI), contrast-water therapy (CWT), and whole-body cryotherapy (WBC) have been applied widely to enhance recovery after strenuous exercise. However, the different timing effects in exercise-induced muscle damage (EIMD) after these recovery protocols remain unknown. Objective To compare the effects of CWI, CWT, and WBC on the timing-sequence recovery of EIMD through different indicator responses. Design Crossover study. Setting Laboratory. Patients or Other Participants Twelve male middle- and long-distance runners from the Beijing Sport University (age = 21.00 ± 0.95 years). Intervention(s) Participants were treated with different recovery methods (control [CON], CWI, CWT, WBC) immediately postexercise and at 24, 48, and 72 hours postexercise. Main Outcome Measure(s) We measured perceived sensation using a visual analog scale (VAS), plasma creatine kinase (CK) activity, plasma C-reactive protein (CRP) activity, and vertical-jump height (VJH) pre-exercise, immediately postexercise, and at 1, 24, 48, 72, and 96 hours postexercise. Results For the VAS score and CK activity, WBC exhibited better timing-sequence recovery effects than CON and CWI (P < .05), but the CWT demonstrated better effects than CON (P < .05). The CRP activity was lower after WBC than after the other interventions (P < .05). The VJH was lower after WBC than after CON and CWI (P < .05). Conclusions The WBC positively affected VAS, CK, CRP, and VJH associated with EIMD. The CWT and CWI also showed positive effects. However, for the activity and timing-sequence effect, CWT had weaker effects than WBC.

scholarly journals Exercise-Induced Pulmonary Edema in a Triathlon

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Hirotomo Yamanashi ◽  
Jun Koyamatsu ◽  
Masaharu Nobuyoshi ◽  
Kunihiko Murase ◽  
Takahiro Maeda
Keyword(s):  
Oxygen Saturation ◽  
Pulmonary Edema ◽  
Medical Staff ◽  
Cold Water ◽  
Ground Glass Opacity ◽  
First Aid ◽  
Strenuous Exercise ◽  
Neurogenic Pulmonary Edema ◽  
Endurance Sports ◽  
Exercise Induced

Introduction. Family physicians have more opportunities to attend athletic competitions as medical staff at first-aid centers because of the increasing popularity of endurance sports.Case. A 38-year-old man who participated in a triathlon race experienced difficulty in breathing after swimming and was moved to a first-aid center. His initial oxygen saturation was 82% and a thoracic computed tomography scan showed bilateral ground glass opacity in the peripheral lungs. His diagnosis was noncardiogenic pulmonary edema associated with exercise or swimming: exercise-induced pulmonary edema (EIPE) or swimming-induced pulmonary edema (SIPE). Treatment with furosemide and corticosteroid relieved his symptoms of pulmonary edema.Discussion. Noncardiogenic pulmonary edema associated with endurance sports is not common, but knowledge about EIPE/SIPE or neurogenic pulmonary edema associated with hyponatremia, which is called Ayus-Arieff syndrome, is crucial. Knowledge and caution for possible risk factors, such as exposure to cold water or overhydration, are essential for both medical staff and endurance athletes.Conclusion. To determine the presence of pulmonary edema associated with strenuous exercise, oxygen saturation should be used as a screening tool at a first-aid center. To avoid risks for EIPE/SIPE, knowledge about these diseases is essential for medical staff and for athletes who perform extreme exercise.

Exercise-Induced Fibrinolysis – Fact or Fiction?

1982 ◽  
Vol 48 (02) ◽  
pp. 201-203 ◽  
Author(s):  
N A Marsh ◽  
P J Gaffney
Keyword(s):  
Plasminogen Activator ◽  
Degradation Products ◽  
Coagulation Factors ◽  
Vascular Wall ◽  
Strenuous Exercise ◽  
Fibrin Degradation Products ◽  
Real Increase ◽  
Exercise Induced ◽  
Male Subjects

SummaryThe effect of strenuous exercise on the fibrinolytic and coagulation mechanisms was examined in six healthy male subjects. Five min bicycle exercise at a work-rate of 800 to 1200 kpm. min−1 produced an abrupt increase in plasma plasminogen activator levels which disappeared after 90 min. However, there was no change in early or late fibrin degradation products nor was there a change in fibrinopeptide A levels or βthromboglobulin levels after exercise although activated partial thromboplastin times were significantly shortened. It is concluded that strenuous exercise does not produce any real increase in fibrinogen-fibrin conversion nor any real increase in the breakdown of these proteins. The role of exercise-induced release of plasminogen activator remains unclear, but probably helps to maintain plasma levels in a discontinuous manner concurrently with the continuous low-level secretion from the vascular wall. The shortening of partial thromboplastin time may be due to the raised levels of plasminogen activator changing the activation state of other coagulation factors.

A study of the state of implementation of oral challenge testing for food allergies

2014 ◽  
Vol 28 (3) ◽  
pp. 356-363
Author(s):  
Seigo Korematsu ◽  
Masafumi Zaitsu ◽  
Michiko Fujitaka ◽  
Kazuyo Kuzume ◽  
Mika Ogata ◽  
...  
Keyword(s):  
The State ◽  
Oral Challenge ◽  
Food Allergies ◽  
Challenge Testing

scholarly journals Regular consumption of cod liver oil is associated with reduced basal and exercise-induced C-reactive protein levels; a prospective observational trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Mette Wærstad Hansen ◽  
Stein Ørn ◽  
Christine B. Erevik ◽  
Magnus Friestad Bjørkavoll-Bergseth ◽  
Øyvind Skadberg ◽  
...  
Keyword(s):  
Fatty Acid ◽  
Strenuous Exercise ◽  
Cod Liver Oil ◽  
Omega 3 ◽  
C Reactive Protein ◽  
Omega 3 Fatty Acid ◽  
Recreational Athletes ◽  
Reactive Protein ◽  
Supplement Use ◽  
Exercise Induced

Abstract Background Dietary supplement use among recreational athletes is common, with the intention of reducing inflammation and improving recovery. We aimed to describe the relationship between omega-3 fatty acid supplement use and inflammation induced by strenuous exercise. Methods C-reactive protein (CRP) concentrations were measured in 1002 healthy recreational athletes before and 24 h after a 91-km bicycle race. The use of omega-3 fatty acid supplements was reported in 856 out of 1002 recreational athletes, and the association between supplement use and the exercise-induced CRP response was assessed. Results Two hundred seventy-four subjects reported regular use of omega-3 fatty acid supplements. One hundred seventy-three of these used cod liver oil (CLO). Regular users of omega-3 fatty acid supplements had significantly lower basal and exercise-induced CRP levels as compared to non-users (n = 348, p < 0.001). Compared to non-users, regular users had a 27% (95% confidence interval (CI): 14–40) reduction in Ln CRP response (unadjusted model, p < 0.001) and 16% (95% CI: 5–28, p = 0.006) reduction after adjusting for age, sex, race duration, body mass index, delta creatine kinase, MET hours per week, resting heart rate and higher education. CLO was the primary driver of this response with a 34% (95% CI: 19–49) reduction (unadjusted model, p < 0.001) compared to non-users. Corresponding numbers in the adjusted model were 24% (95% CI: 11–38, p < 0.001). Conclusion Basal CRP levels were reduced, and the exercise-induced CRP response was attenuated in healthy recreational cyclists who used omega-3 fatty acid supplements regularly. This effect was only present in regular users of CLO. Trial registration NCT02166216, registered June 18, 2014 – Retrospectively registered.

Is there an exercise duration threshold for exercise-induced troponin elevation in healthy recreational athletes? The NEEDED 2014 advanced heart rate monitor substudy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Bjorkavoll-Bergseth ◽  
B Auestad ◽  
O Kleiven ◽  
O Skadberg ◽  
T Eftestol ◽  
...  
Keyword(s):  
Heart Rate ◽  
Clinical Status ◽  
Exercise Duration ◽  
Strenuous Exercise ◽  
Clinical Consequence ◽  
Funding Source ◽  
Recreational Athletes ◽  
National Budget ◽  
Exercise Induced ◽  
Public Grant

Abstract Background/Introduction Following prolonged strenuous exercise there is an exercise-induced troponin (cTn) elevation in healthy individuals. The precise mechanisms and clinical consequence of this cTn elevation remain to be determined. It has recently been demonstrated that exercise intensity, exceeding a heart rate (HR) of 150 bpm, is correlated with exercise-induced cTn elevation. Purpose The present work aims to determine if there is a threshold for exercise duration with a HR exceeding 150 bpm associated with an excessive exercise-induced cTn elevation. Methods A total of 177 healthy subjects were included in the present analysis of HR data obtained from sport watches used during a 91-km recreational mountain bike cycle race. Clinical status, cTnI, ECGs, blood pressure and demographics were obtained 24 h prior to- and at 3 h and 24 h after the race. Results are reported as median and 25th and 75th percentile. We used Tree regression to determine the association between elevated cTnI and exercise duration exceeding a HR of 150 bpm. Results Subjects were 82% (n=146) males, 44 (39–51) years, with a race time of 3.5 (3.1–3.9) h. Baseline cTnI was 1.9 (1.6–3.3) ng/L. There was a cTnI elevation in all study participants at 3 h, cTnI: 60.0 (36.0–99.3) ng/L, with a significant (p&lt;0.001) reduction at 24 hours following exercise, cTnI: 10.9 (6.1–22.4) ng/L. Tree regression identified 168 min of exercise, with a HR exceeding 150 bpm, to be associated with an excessive increase in cTnI both at 3 h, and at 24 h following the race (figure). The median cTn values above and below the threshold are presented in the Table. Conclusion The present analysis suggests that exceeding a specific duration of high intensity exercise may be associated with excessive cTn elevation in susceptible individuals. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Health authoritites.

Grading, Time Course, and Incidence of Exercise-Induced nduced Airway Obstruction and Hyperinflation in Asthmatic Children

PEDIATRICS ◽  
1975 ◽  
Vol 56 (5s) ◽  
pp. 868-879
Author(s):  
Gerd J. A. Cropp ◽  
I. J. Schmultzler
Keyword(s):  
Pulmonary Function ◽  
Airway Obstruction ◽  
Clinical Status ◽  
Small Airway ◽  
Strenuous Exercise ◽  
Normal Children ◽  
Asthmatic Children ◽  
Ergometer Exercise ◽  
Exercise Induced ◽  
Small Airway Obstruction

We evaluated clinical status and pulmonary function in 60 perennially asthmatic and 11 normal children before and repeatedly after incrementally increasing bicycle ergometer exercise. The changes in clinical status and pulmonary function which were elicited by strenuous exercise were graded by an air exchange and a physiological grading system respectively. Normal children showed no significant clinical or physiological changes after exercise. Strenuous exercise elicited significant deteriorations in clinical and physiological measurements in 36% to 77% of asthmatic girls and 46% to 90% of asthmatic boys, the frequency depending on the test used to determine exercise-induced abnormalities. The incidence of exercise-induced asthma (EIA) was statistically significantly higher in asthmatic boys than girls. The higher incidence of EIA in boys was primarily due to a larger number of very severe attacks in boys than girls; mild and moderate EIA was about equally common in the two sexes. Most patients with EIA developed large and small airway obstruction, although large airway obstruction tended to be the predominant and the more severe abnormality. Clinical and physiological abnormalities, regardless of severity, were usually most marked during the first ten minutes after exercise and lessened thereafter. Mild EIA usually lasted for only 15 minutes or less; severe EIA improved, but usually did not resolve within 35 minutes of exercise. There were three patients in whom the severity of EIA got worse after exercise and an additional seven in whom the improvement was minimal. In these ten patients isoproterenol aerosol terminated EIA, indicating that exercise-induced large and small airway obstruction in asthmatic children is primarily. if not solely. due to bronchospasm.

Relationship between exercise-induced systemic inflammatory like reaction and racing performance in endurance horses

2012 ◽  
Vol 8 (3-4) ◽  
pp. 213-218 ◽  
Author(s):  
D. Serteyn ◽  
I. Caudron ◽  
J.-P. Lejeune ◽  
D. Votion ◽  
J. Ceusters ◽  
...  
Keyword(s):  
Plasma Concentrations ◽  
Significant Negative Correlation ◽  
Strenuous Exercise ◽  
Related Factors ◽  
Mean Values ◽  
Racing Performance ◽  
Intrinsic Capacity ◽  
Exercise Induced ◽  
Race Performance ◽  
Voluntary Basis

Endurance race induces a rise of serum creatine kinase (CK) activity and a systemic inflammatory like response characterised by an increase of neutrophil counts, plasma and muscle myeloperoxidase (MPO) and elastase (ELT) concentrations in horses. Horses performing the same standardised exercise test do not respond with the same magnitude of inflammatory reaction. The aim of the present study was to measure the total neutrophil count, the ratio neutrophil:lymphocyte, the MPO and ELT plasma concentrations and concomitant increases of serum CK activities in competing endurance horse and to relate these results to their race performance. Twenty one horses participating in a 120 km 4 star endurance race recruited on a voluntary basis finished the race with a mean speed ranging from 13.1 to 19.8 km/h. Blood was taken the day before the race and two hours after the race. Mean values of neutrophil counts, ratio neutrophil:lymphocyte, plasma MPO and ELT concentrations and serum CK activities after the race were significantly higher than the pre-race values. There was no correlation between neutrophil counts, MPO, ELT or CK and the mean speed of the horses during the race except for the ratio neutrophil:lymphocyte where a significant negative correlation was observed. These results showed that systemic responses induced by strenuous exercise such as an endurance race is not clearly related to performance but also to horse-related factors, such as intrinsic capacity or training.

scholarly journals ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing

2018 ◽  
Vol 52 (5) ◽  
pp. 1801033 ◽  
Author(s):  
Teal S. Hallstrand ◽  
Joerg D. Leuppi ◽  
Guy Joos ◽  
Graham L. Hall ◽  
Kai-Håkon Carlsen ◽  
...  
Keyword(s):  
Airway Hyperresponsiveness ◽  
Task Force ◽  
Challenge Test ◽  
Technical Standard ◽  
Bronchial Challenge ◽  
Airway Narrowing ◽  
Airway Function ◽  
Challenge Testing ◽  
Challenge Tests ◽  
Indirect Tests

Recently, this international task force reported the general considerations for bronchial challenge testing and the performance of the methacholine challenge test, a “direct” airway challenge test. Here, the task force provides an updated description of the pathophysiology and the methods to conduct indirect challenge tests. Because indirect challenge tests trigger airway narrowing through the activation of endogenous pathways that are involved in asthma, indirect challenge tests tend to be specific for asthma and reveal much about the biology of asthma, but may be less sensitive than direct tests for the detection of airway hyperresponsiveness. We provide recommendations for the conduct and interpretation of hyperpnoea challenge tests such as dry air exercise challenge and eucapnic voluntary hyperpnoea that provide a single strong stimulus for airway narrowing. This technical standard expands the recommendations to additional indirect tests such as hypertonic saline, mannitol and adenosine challenge that are incremental tests, but still retain characteristics of other indirect challenges. Assessment of airway hyperresponsiveness, with direct and indirect tests, are valuable tools to understand and to monitor airway function and to characterise the underlying asthma phenotype to guide therapy. The tests should be interpreted within the context of the clinical features of asthma.

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