EXERCISE

Systemic reactions to exercise occur primarily in the form of choliner gic urticaria or exercise anaphylaxis. The diagnosis can typically be clarified on the basis of a careful history and physical examination, including emphasis on precipitating events, urticaria morphology, and the presence or absence of cardiovascular collapse or bronchospasm Rar ely, passive heat or exercise challenges may be necessary to confirm t he diagnosis. Although medications are important for breakthrough atta cks, the most effective management of systemic reactions to exercise i nvolves avoidance of known precipitating triggers.