What Is Exercise-Induced Anaphylaxis?

You might know that anaphylaxis — a severe allergic reaction — can occur in response to triggers such as nuts, insect bites, and certain medications. But physical activity can also induce anaphylaxis.

Keep reading to learn more about EIA, including how food can be involved in these reactions and how to exercise safely with the condition.

EIA is a subgroup of anaphylaxis associated with physical activity, with or without another trigger. “In its classic form, someone goes for a jog in the park, for example, and along the way — oftentimes with strenuous exertion — they begin to develop features of anaphylaxis,” says Sebastian Lighvani, MD, a board-certified allergist at Northwell Health’s Lenox Hill Hospital in New York City. “That reaction can be anything from itching, hives, and swelling all the way to difficulty breathing and even anaphylactic shock.”

Like regular anaphylaxis, “This reaction can happen in someone who’s never had issues before,” he says.

• Confusion
• Difficulty breathing
• Feeling dizzy or faint
• Hives
• Nausea and vomiting
• Pale, clammy skin
• Sudden cough or wheezing
• Sudden sleepiness
• Swelling of the throat, tongue, or upper airway, which can cause difficulty swallowing or a hoarse voice

If any of these symptoms starts, stop exercising right away. “You’re not going to fix this problem just by stopping exercise,” though, says Dr. Lighvani. You’ll also need to treat yourself with an injectable epinephrine device or nasal spray and get to the emergency room right away.

Sometimes, exercise alone can trigger EIA. “Cardio activities like running, dancing, or aerobic workouts are more commonly associated with it, but any exercise — including strength training or walking — can be a trigger in sensitive individuals,” says Inderpal Randhawa, MD, a board-certified allergist and pulmonologist and the founder of the Food Allergy Institute in Long Beach, California.

• Alcohol
• Apples
• Beef
• Eggs
• Fish
• Milk
• Mushrooms
• Nuts — specifically, peanuts and hazelnuts
• Peaches
  
• Pork
• Shellfish
• Tomatoes

You’ll need to see an allergist, who can begin the formal diagnostic process. They’ll review your medical history and may conduct food allergy testing or supervised exercise.

What sets these conditions apart is that EIA comes with a host of symptoms, says Lighvani. “It’s a multisystemic disorder, causing breathing issues, dizziness, [gastrointestinal] distress, while cholinergic urticaria is predominantly itchiness.”

You may always be at risk of a reaction during physical activity if you have EIA. That said, staying active is possible if you take precautions.

Make sure to work with your allergist to fully understand what triggers anaphylaxis for you and develop an individualized action plan in the event of anaphylaxis. Dr. Randhawa also recommends the following steps to exercise safely:

• Avoid trigger foods for 4 to 6 hours before exercise.
• Exercise with a partner who knows how to use epinephrine.
• Always carry two epinephrine auto-injectors or nasal sprays.
• Avoid exercising in extreme heat or when you’re sick.
• Wear a medical ID bracelet that states you have EIA.

“It’s important for patients to know there are therapeutic options beyond avoidance,” says Lighvani. “But they need to be educated about how to appropriately treat reactions.”

• Anaphylaxis can occur during or shortly after physical activity. This is known as exercise-induced anaphylaxis (EIA). The most common type of EIA is food-dependent, exercise-induced anaphylaxis (FDEIA), which occurs when a trigger food is eaten before exercising.
• If you think you’re experiencing EIA, stop exercising immediately, administer epinephrine, and seek emergency medical care.
• You can work with an allergist to formally diagnose EIA and come up with an action plan to keep yourself safe. That plan may include exercising with a partner who knows how to administer epinephrine, avoiding certain types of exercise, and limiting exercise in extreme temperatures.