Allergies to Exercise

Is it possible to be allergic to exercise? Well, not really, however, exercise can cause the body to exhibit the signs and symptoms of allergies! We are also not talking about an excuse not to exercise! The mechanism by which exercise causes “allergy” symptoms is not completely understood but it seems to be related to an exaggerated cholinergic response to the warming that occurs with exercise and not due to an allergy at all. There is an increased level of histamine during and or following exercise in many of the conditions associated with this phenomenon. The severity of the “allergic” symptoms can range from mild to severe and in some cases they may be life-threatening. As a general rule, patients should stop exercising at the first sign of an “allergic” or asthmatic reaction. It may be recommended by a board certified allergist that individuals with any of the following conditions carry an epinephrine self-injectable device (i.e., EpiPen,Auvi-Q, Adrenaclick). It should also be noted that if one uses such as device, he or she should go immediately to the closest emergency room. Below are some examples of conditions where exercise causes symptoms that mimic allergies:

Exercise-induced asthma: Many individuals with asthma have external factors which exacerbate their asthma. Some of these triggers may include allergies to environmental allergens such as dust mites, molds, pollens, pets, and cockroaches. Others may include non-allergic triggers such as pollution, organic dusts, strong scents, increased humidity, changes in temperature, cold air, and certain chemicals. Still other asthmatics will complain of increased asthma symptoms when exercising. When an individual develops asthma symptoms (i.e., wheezing, shortness of breath, chest tightness, coughing) with exercise only, that person is said to have exercise-induced asthma. These patients have no other triggers for their asthma other than exercise. To an outsider, this person looks as though they are “allergic” to exercise since they have asthma symptoms whenever they exercise. Most individuals with exercise-induced asthma are given an inhaler that can both be used to treat the asthma as well as be used prophylactically to prevent the asthma symptoms prior to exercise. Leukotriene antagonists [i.e., Singulair (monteleukast)] may also be utilized to help prevent the symptoms from occurring.

Exercise-induced urticaria (i.e., hives): In this condition, individuals develop hives whenever exercising or immediately following exercise. This is very confusing to the patients that are plagued with this disease. Individuals with this disorder often complain that they are “allergic” to exercise or that they are “allergic” to their own sweat. In reality, it is not an allergy at all. The hives are best controlled by avoiding exercise, but in individuals who want to exercise, there are medications (i.e., antihistamines, leukotrienes antagonists, H2-blockers) that can be given to both treat and prevent such reactions.

Exercise-induced pruritus (i.e., itching): Individuals who have generalized itching without the accompaniment of a rash after exercising have a condition called exercise-induced pruritus. It is very similar to exercise-induced urticaria except that the person gets itching without the hives. These individuals also feel that they are “allergic” to either exercise or their own sweat. In fact, it is not an allergy but rather an exaggerated cholinergic response to the warming of exercise. Avoiding exercise is an option but it does not prevent itching from occurring in exercise that occurs in emergency circumstances where exercise is a must and not an option. Medications used to prevent and treat this malady is the same as with exercise-induced urticaria.

Exercise-induced angioedema (i.e., swelling): In some individuals, exercise may trigger random swelling episodes that can occur anywhere on the body. The swelling can be on the skin or it can be internal. The most common locations for swelling to occur are the face, eyes, lips, throat, tongue, hands, and/or feet. Needless to say, that swelling of the throat can be life-threatening, so it is important to recognize the early signs and symptoms of this type of swelling. There are various medications that can be used to prevent and treat swelling episodes. Again, avoiding exercise is an option but it does not prevent swelling from occurring in exercise that occurs in emergent situations where exercise is a must. The medicines are similar to the ones used for the prevention and treatment of exercise-induced urticaria and pruritus.

Exercise-induced anaphylaxis: Occasionally, exercise can trigger a more serious and exaggerated response whereby an individual may experience life-threatening anaphylaxis. Again, it is very important for the affected individual to understand the signs and symptoms of early anaphylaxis so they are able to treat it appropriately in its early phase. Medications used to prevent and treat exercise-induced urticaria, pruritis, and angioedema are also used to manage exercise-induced anaphylaxis. Avoiding exercise completely is the best option in these individuals. As with all of the above conditions, carrying an epinephrine self-injectable device is very important. Once again, if the epinephrine self-injectable device is used, it is important that the individual go immediately to the closest emergency room.

Food-dependent exercise-induced anaphylaxis: This condition is an off-shoot of exercise-induced anaphylaxis. It is very similar to exercise-induced anaphylaxis except that in these individuals, exercise by itself does not cause anaphylaxis. Approximately 30-50% of patients with exercise-induced anaphylaxis have food-dependent exercise-induced anaphylaxis. Likewise, food itself does not cause anaphylaxis. However, if a person with this condition eats a certain food and then exercises within usually 2 hours after consumption, anaphylaxis will develop. Interestingly, these patients generally are not allergic to that specific food and as mentioned above, do not have anaphylaxis after eating that food. The anaphylaxis only occurs if that person exercises within 2 hours after eating that food. The most common foods that cause this type of reaction include wheat, shellfish, fruit, milk, celery, fish, alcohol, tomato, strawberries, and peach. Avoiding the combination of the trigger food with exercise is the key to preventing the anaphylaxis. As stated above, carrying an epinephrine self-injectable device is very important. If the epinephrine self-injectable device is used, it is important that the individual go immediately to the closest emergency room.

The board certified allergy doctors at Black & Kletz Allergy located in the Washington, DC, Northern Virginia, and Maryland metropolitan area will readily answer any questions you have regarding your exercise-induced asthma and other exercise-induced allergic disorders. We also diagnose and treat allergic rhinitis (i.e., hay fever), asthma, sinus disease, eosinophilic esophagitis, hives (urticaria), swelling (angioedema), generalized itching (i.e., pruritus), eczema (i.e., atopic dermatitis), medication allergies, food allergies, insect sting allergies, and immune disorders. We have 3 offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices offer on-site parking. In addition, our Washington, DC and McLean, VA offices are accessible by Metro. There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please make an appointment by calling any one of our 3 offices, or alternatively, you can click Request an Appointment and we will answer you within 24 hours by the next business day. Black & Kletz Allergy diagnoses and treats both adults and children and we are proud to serve the Washington, DC metro area residents for which we have done for more than 5 decades.