A case of cold-dependent exercise-induced anaphylaxis

Exercise-induced anaphylaxis (EIA) is a form of physical urticaria that is induced by exercise. A 16-year-old Japanese boy had a 4-year history of recurrent wealing and dyspnoea after physical exercise such as jogging, playing handball or riding a bicycle in winter. The episodes were not associated with ingestion of foods including wheat or soya bean. A provocation test, with 15 min of exercise and 2 min of cold stimulation immediately before or immediately after the exercise, elicited a weal that was localized to the test area. A challenge test with ingestion of boiled soya beans and exercise did not elicit a weal. Therefore, in this case, cold exposure, but not food ingestion, was essential for inducing EIA. Cold-dependent EIA is different from cold urticaria, food-dependent EIA, cholinergic urticaria and cold-induced cholinergic urticaria, and may be a distinct entity.