Pathophysiological mechanisms of exercise-induced anaphylaxis: an EAACI position statement.

This document is the result of a consensus on the mechanisms of exercise-induced anaphylaxis (EIAn), an unpredictable and potentially fatal syndrome. A multidisciplinary panel of experts including exercise physiologists, allergists, lung physicians, paediatricians and a biostatistician reached the given consensus. Exercise-induced anaphylaxis (EIAn) describes a rare and potentially fatal syndrome in which anaphylaxis occurs in conjunction with exercise. The pathophysiological mechanisms underlying EIAn have not yet been elucidated although a number of hypotheses have been proposed. This review evaluates the validity of each of the popular theories in relation to exercise physiology and immunology. On the basis of this evidence, it is concluded that proposed mechanisms lack validity, and it is recommended that a global research network is developed with a common approach to the diagnosis and treatment of EIAn in order to gain sufficient power for scientific evaluation.

Dynamic changes in dna methylation status in peripheral blood Mononuclear cells following an acute bout of exercise: Potential impact of exercise-induced elevations in interleukin-6 concentration.

The aim of the present study was to examine the relationship between interleukin (IL)-6 concentrations and DNA methylation in the peripheral blood mononuclear cells (PBMCs) of trained runners after a bout of prolonged, strenuous exercise. Eight healthy trained males completed a treadmill run at 60% vVO(2max) for 120 min followed by a 5-km time trial in a fasted condition. Whole blood samples were taken prior to, immediately before and 24 h following exercise. From these samples, PBMCs were isolated for analysis and plasma IL-6 concentrations were measured. The methylation status of DNA extracted from PBMCs was analysed using the Illumina 27k methylation beadchip platform. Global DNA methylation status was unaltered immediately and up to 24 hours following a bout of prolonged exercise in comparison to pre-exercise. Despite no change in global DNA methylation, plasma IL-6 concentrations were significantly related to the DNA methylation status of 11 genes. Our study demonstrates that the methylome is stable, while discovering a novel link between exercise-induced increases in circulating IL-6 and the DNA methylation status of 11 individual genes. Based on our preliminary findings, the mechanisms by which changes in plasma IL-6 concentrations and DNA methylation in response to exercise interact require further study.

Airway dysfunction in elite athletes--an occupational lung disease?

Airway dysfunction is prevalent in elite endurance athletes and when left untreated may impact upon both health and performance. There is now concern that the intensity of hyperpnoea necessitated by exercise at an elite level may be detrimental for an athlete's respiratory health. This article addresses the evidence of causality in this context with the aim of specifically addressing whether airway dysfunction in elite athletes should be classified as an occupational lung disease. The approach used highlights a number of concerns and facilitates recommendations to ensure airway health is maintained and optimized in this population. We conclude that elite athletes should receive the same considerations for their airway health as others with potential and relevant occupational exposures.

Misdiagnosis of exercise-induced bronchoconstriction in professional soccer players.

BACKGROUND: Physicians typically rely heavily on self-reported symptoms to make a diagnosis of exercise-induced bronchoconstriction (EIB). However, in elite sport, respiratory symptoms have poor diagnostic value. In 2009, following a change in international sports regulations, all elite athletes suspected of asthma and/or EIB were required to undergo pulmonary function testing (PFT) to permit the use of inhaled ß(2)-agonists. The aim of this study was to examine the diagnostic accuracy of physician diagnosis of asthma/EIB in English professional soccer players. METHODS: Sixty-five players with a physician diagnosis of asthma/EIB were referred for pulmonary function assessment. Medication usage and respiratory symptoms were recorded by questionnaire. A bronchial provocation test with dry air was conducted in 42 players and a mannitol challenge in 18 players. Five players with abnormal resting spirometry performed a bronchodilator test. RESULTS: Of the 65 players assessed, 57 (88%) indicated regular use of asthma medication. Respiratory symptoms during exercise were reported by 57 (88%) players. Only 33 (51%) of the players tested had a positive bronchodilator or bronchial provocation test. Neither symptoms nor the use of inhaled corticosteroids were predictive of pulmonary function tests' outcome. CONCLUSION: A high proportion of English professional soccer players medicated for asthma/EIB (a third with reliever therapy only) do not present reversible airway obstruction or airway hyperresponsiveness to indirect stimuli. This underlines the importance of objective PFT to support a symptoms-based diagnosis of asthma/EIB in athletes.

The reliability of the IL-6, sIL-6R and sgp130 response to a preloaded time trial.

Interleukin-6 (IL-6) is a cytokine that can mediate numerous biological actions including fatigue. Circulating IL-6 increases during prolonged exercise, and furthermore, the signalling receptors sIL-6R and sgp130 are also increased. The variability of the response of these markers to exercise is unknown; therefore, we examined the changes in these markers to a preloaded time trial bout of running. Nine males performed three identical trials where participants ran at 60% vVO2max for 2 h interspersed with 30 s at 90% vVO2max every 10 min, followed by a 5-km time trial. Blood samples were drawn at baseline, following the 2-h bout, post time trial, 1 h post time trial and the following morning. Results showed that between-subject variability (CVg) was greater than within-subject variation (CVi) for the three markers. IL-6, sIL-6R and sgp130 demonstrated a CVi of 15.3-25.5%, 15.0-17.6% and 6.2-9.4% variation, respectively, across the time points. When the data from the second and third trials were analysed independently, CVi was reduced which is supported by the time trial results for which CVi improve (4.7-2.4%). In conclusion, the results indicate that a large variation in response to exercise can be reduced following a habituation trial.

Rapid detection of opioids in vitreous humor by enzyme immunoassay.

Comprehensive and rapid screening of specimens that enter a postmortem forensic toxicology laboratory is essential. Although blood and urine specimens are most commonly utilized for immunoassay screening, this study illustrates the use of vitreous humor for similar purpose. Over a 2-year period, 1233 out of 5471 cases submitted for drug analysis were screened for the presence of opioids in vitreous humor by the Microgenics Cloned Enzyme Donor Immunoassay (CEDIA) DAU opiate assay. Eighty-five of these cases were presumptively opioid positive by the opiate assay. In 75 of the 85 cases (88.2%), at least one opioid | was subsequently confirmed in blood and/or bile. The gas chromatography-nitrogen-phosphorus detection (GC-NPD) screening method employed by this laboratory detected the presence of opioids in 20 of the 75 opioid-confirmed cases (26.6%). Codeine and oxycodone were readily identified by the GC-NPD screen; however, morphine, hydrocodone, hydromorphone, and 6-acetylmorphine were detected primarily by gas chromatography-mass spectrometry. In summary, the CEDIA DAU opiate assay improved the detection of opioids in our casework for the period studied by 1.0% (55/5471).

The effects of head cooling on endurance and neuroendocrine responses to exercise in warm conditions.

The present study investigated the effects of head cooling during endurance cycling on performance and the serotonergic neuroendocrine response to exercise in the heat. Subjects exercised at 75 % VO(2max) to volitional fatigue on a cycle ergometer at an ambient temperature of 29+/-1.0 degrees C, with a relative humidity of approximately 50 %. Head cooling resulted in a 51 % (p<0.01) improvement in exercise time to fatigue and Borg Scale ratings of perceived exertion were significantly lower throughout the exercise period with cooling (p<0.01). There were no indications of peripheral mechanisms of fatigue either with, or without, head cooling, indicating the importance of central mechanisms. Exercise in the heat caused the release of prolactin in response to the rise in rectal temperature. Head cooling largely abolished the prolactin response while having no effect on rectal temperature. Tympanic temperature and sinus skin temperature were reduced by head cooling and remained low throughout the exercise. It is suggested that there is a co-ordinated response to exercise involving thermoregulation, neuroendocrine secretion and behavioural adaptations that may originate in the hypothalamus or associated areas of the brain. Our results are consistent with the effects of head cooling being mediated by both direct cooling of the brain and modified cerebral artery blood flow, but an action of peripheral thermoreceptors cannot be excluded.

The effect of breathing an ambient low-density, hyperoxic gas on the perceived effort of breathing and maximal performance of exercise in well-trained athletes.

BACKGROUND: The role of the perception of breathing effort in the regulation of performance of maximal exercise remains unclear. AIMS: To determine whether the perceived effort of ventilation is altered through substituting a less dense gas for normal ambient air and whether this substitution affects performance of maximal incremental exercise in trained athletes. METHODS: Eight highly trained cyclists (mean SD) maximal oxygen consumption (VO(2)max) = 69.9 (7.9) (mlO(2)/kg/min) performed two randomised maximal tests in a hyperbaric chamber breathing ambient air composed of either 35% O(2)/65% N(2) (nitrox) or 35% O(2)/65% He (heliox). A ramp protocol was used in which power output was incremented at 0.5 W/s. The trials were separated by at least 48 h. The perceived effort of breathing was obtained via Borg Category Ratio Scales at 3-min intervals and at fatigue. Oxygen consumption (VO(2)) and minute ventilation (V(E)) were monitored continuously. RESULTS: Breathing heliox did not change the sensation of dyspnoea: there were no differences between trials for the Borg scales at any time point. Exercise performance was not different between the nitrox and heliox trials (peak power output = 451 (58) and 453 (56) W), nor was VO(2)max (4.96 (0.61) and 4.88 (0.65) l/min) or maximal V(E) (157 (24) and 163 (22) l/min). Between-trial variability in peak power output was less than either VO(2)max or maximal V(E). CONCLUSION: Breathing a less dense gas does not improve maximal performance of exercise or reduce the perception of breathing effort in highly trained athletes, although an attenuated submaximal tidal volume and V(E) with a concomitant reduction in VO(2) suggests an improved gas exchange and reduced O(2) cost of ventilation when breathing heliox.

A core system for the implementation of task sets.

When performing tasks, humans are thought to adopt task sets that configure moment-to-moment data processing. Recently developed mixed blocked/event-related designs allow task set-related signals to be extracted in fMRI experiments, including activity related to cues that signal the beginning of a task block, "set-maintenance" activity sustained for the duration of a task block, and event-related signals for different trial types. Data were conjointly analyzed from mixed design experiments using ten different tasks and 183 subjects. Dorsal anterior cingulate cortex/medial superior frontal cortex (dACC/msFC) and bilateral anterior insula/frontal operculum (aI/fO) showed reliable start-cue and sustained activations across all or nearly all tasks. These regions also carried the most reliable error-related signals in a subset of tasks, suggesting that the regions form a "core" task-set system. Prefrontal regions commonly related to task control carried task-set signals in a smaller subset of tasks and lacked convergence across signal types.