Practice Parameter Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter Chief Editors: John M. Weiler, MD, MBA, President, CompleWare Corporation, Professor Emeritus, University of Iowa, Iowa City, Iowa; Sandra D. Anderson, PhD, DSc, Clinical Professor, Sydney Medical School, Royal Prince Alfred Hospital, Department of Respiratory and Sleep Medicine, Camperdown NSW 2050, Australia; Christopher Randolph, MD, Clinical Professor of Pediatrics, Yale Affiliated Programs, Waterbury Hospital, Center for Allergy, Asthma and Immunology, Waterbury, Connecticut Co-editors: Sergio Bonini, MD, Professor of Medicine, Chair Allergology and Clinical Immunology, Second University of Naples, Naples, Italy; Timothy J. Craig, DO, Professor of Medicine and Pediatrics and Distinguished Educator, Pennsylvania State University, Hershey, Pennsylvania; David S. Pearlman, MD, Clinical Professor of Pediatrics, University of Colorado School of Medicine, Colorado Allergy and Asthma Centers, P.C., Denver, Colorado; Kenneth W. Rundell, PhD, FACSM, Director of Respiratory Research & the Human Physiology Laboratory Center for Healthy Families, Marywood University Professor of the Basic Sciences, The Commonwealth Medical College, Scranton, Pennsylvania; William S. Silvers, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Allergy, Asthma & Immunology Clinic of Colorado, P.C., Englewood, Colorado; William W. Storms, MD, Clinical Professor, University of Colorado Health Sciences Center, Practicing Allergist and Clinical Researcher, The William Storms Allergy Clinic, Colorado Springs, Colorado Task Force Reviewers: David I. Bernstein, MD, Professor of Medicine and Environmental Health, Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine University of Cincinnati, Cincinnati, Ohio; Joann Blessing-Moore, MD, Adjunct Clinical Professor, Department of Immunology, Stanford University Medical Center, Palo Alto, These parameters were developed by the Joint Task Force on Practice UCB, Wallace, Dey, Sciele, Baxter, Accredo, Critical Care, Genentech/ Parameters, representing the American Academy of Allergy, Asthma and Novartis, Sepracor, Meda, Sanofi-Aventis, TEVA, Pfizer, and Verus. He Immunology; the American College of Allergy, Asthma and Immunology; has acted as an advisor or consultant to AstraZeneca, Merck, Glaxo- and the Joint Council of Allergy, Asthma and Immunology. The American SmithKline, and Sanofi-Aventis and provided granted services to Scher- Academy of Allergy, Asthma and Immunology (AAAAI) and the American ingPlough and Novartis/Genentech. Dr Bonini is a member of the expert College of Allergy, Asthma and Immunology (ACAAI) have jointly ac- forums and/or a speaker at sponsored symposia for ALK, Allergen cepted responsibility for establishing “Pathogenesis, Prevalence, Diagnosis, Manufacturers, AstraZeneca, Chiesi, GlaxoSmithKline, Menarini, Merck and Management of Exercise-Induced Bronchoconstriction: A Practice Pa- Sharp & Dohme, Novartis, Nycomed, Phadia, Schering-Plough, Sigma- rameter.” This is a complete and comprehensive document at the current Tau, Scalargenes, and UCB. Dr. Pearlman acts as an ad hoc consultant to time. The medical environment is a changing environment, and not all AstraZeneca. He has also performed contract pharmaceutical research on recommendations will be appropriate for all patients. Because this document EIB as a principal investigator between Colorado Allergy and Asthma incorporated the efforts of many participants, no single individual, including Centers, P.C. (which pays him a salary) and each of the following those who served on the Joint Task Force, is authorized to provide an official companies: Merck, Novartis, Sepracor, GSK. Dr. Pearlman is also on the AAAAI or ACAAI interpretation of these practice parameters. Any request speakers’ bureau of Merck. Dr Storms has provided granted services to for information about or an interpretation of these practice parameters by the Alcon Labs, Amgen, and Sepracor. He has acted as an advisor or AAAAI or ACAAI should be directed to the Executive Offices of the consultant to Alcon Labs, AstraZeneca, Consumer Reports/Consumers AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immu- nology. These parameters are not designed for use by pharmaceutical com- Union, Merck, Nexcura, Novartis, Sepracor, Strategic Pharmaceutical panies in drug promotion. Advisors, TEVA, and the TREAT Foundation. He also serves on the Reprint requests: Joint Task Force on Practice Parameters; 50 N. Brock- speakers’ bureau for Alcon Labs, AstraZeneca, Meda, Merck, Novartis, way St., #3-3; Palatine, IL 60067. Sepracor, Strategic Pharmaceutical Advisors, and the TREAT Founda- Disclosures: Dr Weiler is an employee of CompleWare Corporation. tion. Dr. Rundell is currently employed by Pharmaxis Inc. Dr. Oppen- He also holds stock in CompleWare Corporation and Iowa Clinical heimer has performed research, acted as a consultant, or served on the Research Corporation, neither of which is an ACCME defined Commer- speakers’ bureau for AstraZeneca, Merck, GlaxoSmithKline, Alcon Labs, cial Interest, and he sold shares of Johnson & Johnson. CompleWare and Novartis. Drs Craig, Silvers, Bernstein, Blessing-Moore, Cox, Khan, Corporation and Iowa Clinical Research Corporation provided contracted Lang, Nicklas, Portnoy, Schuller, Spector, Tilles, and Wallace have or granted services to MedImmune, Sandoz, GlaxoSmithKline, NIH, nothing to disclose. ALK, Pharmaxis, Novartis, Abbott, TEVA, Boehringer Ingelheim, Sche- Received for publication September 2, 2010; Accepted for publication ring-Plough/Merck, Forest, Roxane Labs, Amgen, Repros, and Watson. September 26, 2010. Dr Anderson is the inventor of the mannitol test and receives a percentage © 2010 American College of Allergy, Asthma & Immunology. of the royalties paid to her employer, Sydney South West Area Health Published by Elsevier Inc. All rights reserved. Service. Dr Randolph has been a member of the speakers’ bureau for doi:10.1016/j.anai.2010.09.021 Alcon, ISTA, GlaxoSmithKline, AstraZeneca, ScheringPlough/Merck, VOLUME 105, DECEMBER, 2010 S1 California; Linda Cox, MD, Associate Clinical Professor, Department of Medicine, Nova Southeastern University, Davie, Florida; David A. Khan, MD, Department of Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas; David M. Lang, MD, Allergy/Immunology Section, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Richard A. Nicklas, MD, Clinical Professor of Medicine, George Washington Medical Center, Washington, DC; John Oppenheimer, MD, Department of Internal Medicine, New Jersey Medical School, Morristown, New Jersey; Jay M. Portnoy, MD, Section of Allergy, Asthma & Immunology, The Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Diane E. Schuller, MD, Professor of Pediatrics, Emeritus Chief of Allergy and Immunology, Department of Pediatrics, Pennsylvania State University, Milton S. Hershey Medical College, Hershey, Pennsylvania; Sheldon L. Spector, MD, Department of Medicine, UCLA School of Medicine, Los Angeles, California; Stephen A. Tilles, MD, Clinical Associate Professor of Medicine, University of Washington School of Medicine, Seattle, Washington; Dana Wallace, MD, Associate Clinical Professor, Department of Medicine, Nova Southeastern University, Davie, Florida Reviewers: William Henderson, MD, Seattle, Washington; Lawrence Schwartz, MD, PhD, Richmond, Virginia; David Kaufman, MD, Shreveport, Louisiana; Talal Nsouli, MD, Washington, DC; Lawrence Shieken, MD, Owings Mills, Maryland; Nelson Rosario, MD, Curitiba, Brazil Published Practice Parameters of the Joint Task Force on 15. Disease management of atopic dermatitis: an updated Practice Parameters for Allergy & Immunology include the practice parameter. Ann Allergy. 2004;93:S1–S21. following: 16. Stinging insect hypersensitivity: a practice parameter up- 1. Practice parameters for the diagnosis and treatment of date. J Allergy Clin Immunol. 2004;114:869–886. asthma. J Allergy Clin Immunol. 1995;96(suppl):S707– 17. 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