Exercise and Allergies Update

Can someone be allergic to exercise? Well, of course if you are lazy, you may say that you are allergic to exercise, but in fact some individuals will exhibit allergic signs and/or symptoms with exercise. What is going on?

The obvious link between allergies and exercising is tied to increased exposure to inhaled allergens. When an individual exercises, their respiratory rate increases and causes them to breathe in more air. As a result, more allergens such as dust, molds, pollen, and pet dander are inhaled. In someone suffering from allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), or asthma, this increased exposure may cause more allergic and/or asthmatic symptoms such as sneezing, runny nose, nasal congestion, post-nasal drip, itchy throat, sore throat, sinus headaches, snoring, itchy eyes, watery eyes, redness of the eyes, puffy eyes, wheezing, chest tightness, coughing, and/or shortness of breath.

Despite the obvious relationship between exercise and allergies above, there are also other associations between exercise and allergies which will be discussed below.

Exercise-induced asthma – There are many individuals who find that exercise is a trigger for their asthma. Some individuals with asthma are only bothered when they exercise. Other asthmatics may also have other triggers such as cold air, upper respiratory infections, exposure to environmental allergens (e.g., dust, molds, pollens, pet dander, cockroach), strong scents, pollution, certain foods (e.g., peanuts, tree nuts, egg, milk, wheat, fish, shellfish), certain medications (e.g., penicillins, cephalosporins, sulfa drugs), etc. Exercise-induced asthma is sometimes referred to as exercise-induced bronchoconstriction or sports-induced asthma. This condition can occur in people with asthma as well as individuals without chronic asthma.

Exercise-induced urticaria – Some individuals will break out in hives (i.e., urticaria) after exercise. It is not unusual for the hives to occur during the relaxing phase, shortly after the exercise has been completed.

Cholinergic urticaria – Small, itchy hives caused by a rise in body temperature from exercise, hot showers, or emotional stress may occur in some people.

These types of hives usually appear within minutes of sweating. The hives induced by exercise of cholinergic urticaria is a different condition than the hives induced by exercise of exercise-induced urticaria in the above paragraph.

Exercise-induced angioedema – Similar to exercise-induced urticaria above, some people will develop swelling (i.e., angioedema) after exercise. The swelling episode may also occur in the relaxing phase, soon after the person has stopped exercising.

Exercise-induced pruritus – Not unlike the 2 conditions above, exercise-induced urticaria and exercise-induced angioedema, exercise-induced pruritus is when an individual experiences itching during or shortly after exercising.

Exercise-induced anaphylaxis – Occasionally an individual may develop anaphylaxis while or soon after exercising. It is not very common, but this condition does exist. Unfortunately, this disorder is life-threatening, and the symptoms must be addressed as soon as possible after the symptoms begin. Some of the symptoms that may occur with exercise may include hives, flushing, generalized itching, swelling, decreased blood pressure, fainting, wheezing, shortness of breath, and/or abdominal cramping. People with this condition should always carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) or epinephrine-containing nasal spray (e.g., Neffy), as the administration of epinephrine is the treatment of choice. Antihistamines and histamine 2 blockers (i.e., H2 blockers) may also be taken in addition to the epinephrine.

Food-dependent exercise-induced anaphylaxis (FDEIA) – In this malady, the anaphylaxis occurs only when a specific food is eaten within several hours before exercise. Common trigger foods may include wheat, shellfish, nuts, and celery. Generally, either the food alone or exercise alone may be tolerated. It is when exercise occurs after the food is ingested that causes the symptoms of anaphylaxis. As with exercise-induced anaphylaxis in the above paragraph, people with this condition should always carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) or epinephrine-containing nasal spray (e.g., Neffy), as the administration of epinephrine is the treatment of choice. Antihistamines and histamine 2 blockers (i.e., H2 blockers) may also be taken in addition to the epinephrine.

Exercise-induced rhinitis – Some people will experience a runny nose, nasal congestion, post-nasal drip, and/or sneezing during or after exercise. This can occur in both allergic and non-allergic individuals.

Exercise-induced cold-induced urticaria – This condition typically occurs during or soon after outdoor exercise in cold weather. Note that there is also a condition called cold-induced urticaria where an individual will develop hives upon exposure to cold weather without exercise.

Mast cell activation syndrome (MCAS) – Some patients with MCAS develop exacerbations of their mast cell activation symptoms when they exercise. The exercise triggers the release of inflammatory chemical mediators from their mast cells which exacerbates their MCAS symptoms.

Hereditary angioedema – Some individuals with this illness note that although regular routine exercise is generally fine, strenuous exercise, contact sports, and exercise with repetitive pressure may precipitate swelling attacks.

Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. The board certified allergy specialists at Black & Kletz Allergy are extremely knowledgeable regarding the diagnosis and treatment of allergic conditions which are exacerbated by exercise, as well as ones that are not affected by exercise. In addition, we treat patients with environmental allergies, asthma, hives, swelling episodes, generalized itching, food allergies, medication allergies, insect sting allergies, eczema, contact dermatitis, eosinophilic esophagitis, and immune disorders. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been servicing the greater Washington, DC metropolitan area for many years and we look forward to providing you with excellent state-of-the-art allergy care in a welcoming and professional atmosphere.