Casale T B, Keahey T M, Kaliner M
JAMA. 1986 Apr 18;255(15):2049-53.
To differentiate the diagnoses of exercise-induced anaphylaxis and cholinergic urticaria/anaphylaxis, we developed reproducible diagnostic provocative challenges. The data derived from the study of two representative patients, one with cholinergic urticaria and the other with exercise-induced anaphylaxis, suggest approaches to distinguishing these diagnoses. After specific exercise challenges, both patients developed symptoms consistent with anaphylaxis and had associated increases in plasma histamine levels. After passive heat challenges inducing increases in core body temperature more than 0.7 degrees C, only the patient with cholinergic urticaria developed anaphylactic symptoms and had a rise in the plasma histamine level. Neither patient developed symptoms of anaphylaxis when core body temperatures were increased after administration of intravenous endotoxin. Thus, passive heat challenges are extremely valuable in differentiating these two exercise-related syndromes. Although not important in exercise-induced anaphylaxis, specific thermoregulatory mechanisms appear to play an intricate part in the pathophysiology of cholinergic urticaria/anaphylaxis.
为鉴别运动诱发性过敏反应与胆碱能性荨麻疹/过敏反应的诊断，我们开展了可重复的诊断性激发试验。对两名具有代表性的患者进行研究得出的数据表明了鉴别这些诊断的方法，其中一名患者患有胆碱能性荨麻疹，另一名患有运动诱发性过敏反应。经过特定的运动激发试验后，两名患者均出现了与过敏反应相符的症状，且血浆组胺水平均相应升高。在被动热激发试验使核心体温升高超过0.7摄氏度后，只有胆碱能性荨麻疹患者出现了过敏症状且血浆组胺水平升高。静脉注射内毒素后使核心体温升高时，两名患者均未出现过敏症状。因此，被动热激发试验在鉴别这两种与运动相关的综合征方面极具价值。虽然在运动诱发性过敏反应中并不重要，但特定的体温调节机制似乎在胆碱能性荨麻疹/过敏反应的病理生理学中发挥着复杂的作用。
