What is an exercise-induced allergic reaction? – Cleveland Clinic
You live to close those rings or reach that daily step goal. For you, exercise is never a chore. But one day, while exercising, you start to wheeze, itch and break out in hives. And it doesn’t happen just once. It keeps happening. Why are you living this? A rare disorder known as exercise-induced anaphylaxis might be to blame.
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So what is it and how can it be avoided? Allergist and immunologist Roula Altisheh, MD, helps us understand this mysterious disease.
What does anaphylaxis mean?
“The term ‘anaphylaxis’ refers to a severe allergic reaction,” says Dr. Altisheh. “It could also be called a severe systemic reaction.” She adds that while anaphylaxis is a life-threatening condition and anyone can experience it at any time in life, exercise-induced anaphylaxis is not very common.
“This condition is rare but it can be life-threatening. When patients come to me about it, they can usually relate their reactions to physical activity. It is not necessarily caused by low-intensity activities like walking down the street. It’s more common with moderate-to-high intensity activities like running or tennis,” says Dr. Altisheh.
What Happens When You Experience Exercise-Induced Anaphylaxis?
During an allergic reaction, your immune system goes into overdrive and releases certain mediators such as tryptase and histamine. These chemicals come from what are called mast cells and cause the symptoms of an allergic reaction. Dr. Altisheh says the exact cause of exercise-induced anaphylaxis is not entirely clear.
Symptoms of exercise-induced anaphylaxis
Symptoms of exercise-induced anaphylaxis can appear at any stage of physical activity. They can also affect your skin, heart, and lungs. These symptoms include coughing, difficulty breathing, or wheezing, as well as other symptoms such as flushing, generalized itching, facial swelling, hives, or a feeling of the throat closing up.
“You might even experience gastrointestinal symptoms like upset stomach, abdominal cramps, diarrhea, and vomiting. Anaphylaxis can even involve your cardiovascular system, causing your blood pressure to drop or making you feel dizzy or lightheaded,” says Dr. Altisheh.
Triggers of exercise-induced anaphylaxis
An allergist will take a closer look at what’s going on to identify what could be triggering anaphylaxis. These can be drugs (for example, nonsteroidal anti-inflammatory drugs or NSAIDs) or alcohol-related. Dr. Altisheh says some people even experience exercise-induced anaphylaxis after eating certain foods.
Some common dietary triggers of exercise-induced anaphylaxis include:
- Wheat/wheat protein.
“A person may be able to eat these foods and not have a reaction if they haven’t exercised. But if they’ve exercised, it’s possible to experience anaphylaxis for up to three or four hours after eating a food that triggered it,” Dr. Altisheh notes, adding that wheat or wheat protein and shellfish are the most common food triggers.
How exercise-induced anaphylaxis is diagnosed
Diagnosing anaphylaxis on an outpatient basis comes with some challenges. Dr. Altisheh says allergists not only have to decide if the reported event is consistent with anaphylaxis, but they also have to determine possible triggers while ruling out other health issues.
Testing options for exercise-induced anaphylaxis include blood tests, which can show if tryptase levels in your blood are elevated during anaphylaxis. Tryptase is a substance that is released by mast cells during allergic reactions, so high levels are an indicator.
Your healthcare provider may also perform a scratch test where they use a fine needle to prick/scratch your skin to identify possible triggers based on your history.
And if you’re up for a challenge, your healthcare provider might suggest this: a challenge test. An allergist can do a food challenge to make sure you can tolerate the affected foods at rest. During one, you will eat a small amount of the food in question and your allergist will monitor you. If you go into anaphylaxis, they’ll give you an epinephrine injection to stop it.
Some healthcare providers may recommend an exercise challenge where you run on a treadmill or perform another physical activity. Dr Altisheh says there is no set protocol for this type of challenge “If an exercise challenge is pursued, it should be performed by an allergist in a setting where they are able to treat anaphylaxis” , she says. Dr. Altisheh adds that she avoids this route of testing because the risk is much greater.
Does exercise-induced anaphylaxis mean you can’t work out?
This is not the case. You might just need to discover new ways to move your body.
says Dr. Altisheh.
“I would never advise against exercising. There are so many health benefits of exercise. People usually know the level at which this anaphylactic event has occurred. It is important to understand the importance to stop all efforts at the first sign of symptoms and never exceed them.
Is there a cure for exercise-induced anaphylaxis?
Not much is known about why this condition occurs. Some believe that when exercise brings your heart rate up to a certain level, your blood circulation is much faster and you can absorb more allergens that are released into your bloodstream. However, Dr. Altisheh says this theory and others are not 100% proven. She also says there is no specific heart rate range where anaphylaxis triggers.
How to Manage Exercise-Induced Allergies
If you are diagnosed with exercise-induced anaphylaxis, Dr. Altisheh says it’s very important to understand the importance of stopping activity at the first sign of symptoms. Living with this condition will also require you to carry an epinephrine auto-injector like an EpiPen® to stop a reaction.
“Always carry your EpiPen with you and be sure to exercise with someone who is able to recognize the symptoms of anaphylaxis and who can administer the EpiPen if you are unable to. Most importantly, know your limits,” says Dr. Altisheh.
If you need to use your EpiPen, always call 911. That way you can get help right away and go to the hospital for further monitoring.