Why some reactions to exercise are nothing to sneeze at.
Ever joke about clients who seem to be "allergic" to exercise? Well, it may turn out that some of them really are! Take Jay DeFinis, now aged 41, who learned that the coughing and breathlessness he regularly experienced while jogging didn't indicate poor conditioning, but, in fact, were really asthma attacks induced by his exercise sessions. Like Jay, many others find exercise itself to be the trigger that precipitates a variety of allergic responses, ranging from benign hives to rare but potentially life-threatening anaphylactic shock. And if such reactions seem exotic or unusual, you'll be surprised to learn that an astounding 15 to 20 percent of the American population is believed to experience an allergic reaction that is specifically exercise induced (AAAAI 1999; Storms & Joyner 1997). Knowledgeable fitness professionals can help clients recognize the symptoms of exercise-induced allergic reactions and learn appropriate exercise techniques to minimize discomfort during physical activity. This article will focus on three exercise-induced allergic conditions and provide practical recommendations from asthma and allergy experts for sound and safe exercise programs. Understanding these conditions and the experts' recommendations will enable you to deal more effectively with clients who experience exercise-induced allergies; design programs for avoiding allergic-reaction triggers; and market your skills to attract new clients. The three conditions are exercise-induced bronchospasm, exercise-induced cholinergic urticaria and exercise-induced anaphylaxis. They are presented in order of most to least common.
BY TERRIE HEINRICH RIZZO, MAS
Known until recently as exercise-induced asthma (a term often still seen in references), exercise-induced bronchospasm (EIB) is a more exact term that refers to breathing difficulties specifically triggered by physical exertion. Asthma, by contrast, is a chronic disease characterized by inflammation of the lungs; in people with asthma, breathing
September 2001 IDEA HEALTH & FITNESS SOURCE
attacks can occur anytime, after exposure to a wide variety of stimuli (Canadian Lung Association 2001). EIB is defined as the narrowing of the airways, or bronchoconstriction, induced by exercise that is considered strenuous to the individual. Although the exact causes are uncertain, most researchers believe that in affected individuals, exercise-related changes in temperature and moisture levels within the airways trigger immune system reactions, causing respiratory symptoms (AAAAI 1999). How? In "normal" exercisers, the glottis (the space between the vocal cords) naturally widens and the bronchioles dilate (i.e., bronchodilation occurs) to meet increased oxygen demands (Rupp 1996). Additionally, when exercising, most people tend to breathe through the mouth; air reaching the lungs this way is cooler and drier (with 60%-70% relative humidity) than air that passes through the warming, more humid passages of the nose (with 80%-90% relative humidity) (AAAAI 1999). These changes pose no problem for the majority of the population; however, persons with EIB have hypersensitive airways that react differently to sudden changes in temperature and humidity. Instead of dilating, the lower bronchioles constrict, obstructing oxygen intake during strenuous exertion and producing breathing difficulties, particularly when exercise takes place in cold or dry air (Rupp 1996). Not surprisingly, nearly all of America's 18 million asthmatics experience EIB (AAAAI 1999; Rupp 1996). But for millions of others--including up to half of those with allergic rhinitis (hay fever) or other allergic symptoms and up to 10 percent of normal recreational athletes (Disabella & Sherman 1998; AAAAI 1999)--exercise is the only stimulus for EIB symptoms (Lacroix 1999). According to experts, most nonasthmatic individuals do not realize they have EIB and simply attribute difficulties to being out of shape or "the normal exercise experience" (Storms & Joyner 1997). Interestingly, at least one in six of the 1996 U.S. Olympic
athletes had a history of EIB; the condition was most common among cyclists and mountain bikers (AAAAI 1999). Obvious EIB symptoms include chest tightness, shortness of breath and coughing, but more subtle symptoms can also occur (see "Symptoms of Exercise-Induced Allergies" on the next page for a detailed list of symptoms for all conditions). Symptoms typically appear after eight to 10 minutes of vigorous exercise, with maximal decrease in function occurring about 15 minutes after exercise begins. For some individuals, symptoms increase when exercise ends, often related to "rapid cooldown" airway changes that again produce bronchospasm. Pulmonary function usually returns to original levels 30 to 60 minutes after activity has stopped. Interestingly, many EIB sufferers experience a refractory period, a 30- to 90minute period after initial bronchospasm during which symptoms subside. If appropriately managed, this period may be used by affected athletes to exercise longer and more strenuously without difficulty (Disabella & Sherman 1998). Treatment. Once EIB has been diagnosed, incidents can be prevented or reduced most effectively by using pharmaceutical bronchodilators (i.e., inhalers) prior to exercise and by avoiding environmental factors. Exercise modification to prevent triggers is also crucial. Specific recommendations are outlined in the section, "Exercise Choices and Modifications."
Exercise-Induced Cholinergic Urticaria
30 minutes into exercising, plus flushing and itching, particularly on the neck, trunk and upper limbs. These symptoms disappear spontaneously 20 to 90 minutes after exercise has ceased (Terrell, Hough & Alexander 1996). Treatment. Prophylactic treatment with antihistamines, plus topical treatment for itching, usually proves effective. Additionally, common sense is called for: Affected clients should avoid exercising on warm or humid days, reduce the intensity of their workouts and stop exercising at the first sign of flushing, itchiness or hives.
Exercise-induced cholinergic urticaria (EICU) is an allergic response to heat; although uncomfortable and sometimes even excruciating, the condition is rarely life threatening. The major precipitating factor is exercise that raises core body temperature by 0.5 degrees Celsius (
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