Exercise-Induced Allergies

Can Exercise Cause Angioedema and Anaphylaxis?

Soccer player using inhaler
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The headline of a Daily News article reads UK Woman Diagnosed as Allergic to Exercise. Can exercise actually cause angioedema and anaphylaxis because you are allergic to physical activity? This is actually a tricky question, and the science isn't very clear. While exercise-induced allergy symptoms are well documented, this rare phenomenon is not well understood. In fact, there are multiple sub-types of exercise-induced allergies or related conditions which may occur alone or together.

These include:

  • exercise-induced asthma (also called exercise-induced bronchoconstriction)
  • exercise-induced urticaria
  • exercise-induced rhinitis
  • exercise-induced angioedema
  • exercise-induced anaphylaxis
  • exercise-induced food allergies

The most likely explanation, is physiological changes that can occur in your body in a state of exercise. These changes must then activate your immune response causing an allergic-like response triggering or exacerbating your symptoms.

How Exercise Can Cause an Allergic Response

As previously mentioned the exact physiology of exercise-induced allergies is not entirely clear. Symptoms can be triggered by any kind of physical activity but may often be associated with running or jogging. Several theories on the mechanisms involved exist. People with exercise-induced allergies often have elevated blood levels of histamine and a substance called tryptase as well as degranulated mast cells (a type of white blood cell).

Therefore, some theories include:

  • changes in your intestinal tract or gut (increased permeability)—thought to only occur in sports where you are exercising at 80 percent of your maximal oxygen uptake for 60 or more minutes.
  • stress-induced enzyme activity in your gut—tissue transglutaminase (tTG) responds to some immune system mediators that are released during exercise. Alterations to this enzyme may make you susceptible to allergies during exercise if you have had gluten recently.
  • activation of mast cells from the redistribution of blood flow during exercise—it is normal to redistribute blood flow during exercise away from your kidneys, liver, stomach and intestine to your muscles and skin. It is thought that the redistribution of blood flow in susceptible individuals could move inflammatory mediators and allergens to other parts of the body with a different group of mediators that could trigger an allergic response.
  • dehydration leading to increased concentration of your blood volume (blood osmolality)—the increased concentration can induce the release of histamine and basophils causing an allergic response.
  • change in your body's acid-base balance—breathing is closely tied to the management of your body's pH (acid-base balance of hydrogen). When exerting for long periods of time, it is possible for your blood to become more acidic. In susceptible individuals, this may lead to the triggering of your immune system and cause urticaria (hives) or anaphylaxis.

While these are the hypothesized reasons for having an allergic-response, there are different manifestations that can occur from an exercise-induced allergic response.

Exercise-induced Asthma (Bronchoconstriction)

Symptoms of exercise-induced asthma include:

Symptoms of exercise-induced asthma usually begin a few minutes after you start exercising and subside approximately 15 minutes after your workout is complete. Treatments for exercise-induced asthma may include making changes to the types of exercise you engage in, not exercising in cold or dry air, and avoiding exercise outdoors when levels of pollutants are high. Environmental factors such as chemicals in the air or high levels of pollen may be a factor. Medications used to treat exercise-induced asthma include inhalers (corticosteroids or bronchodilators).

Exercise-induced Urticaria

This condition may also be called cholinergic urticaria. Urticaria is the medical term for hives. Urticaria may be present alone or may occur along with exercise-induced angioedema and anaphylaxis. The rash usually begins on the chest and neck but may spread to the entire body. Mild rashes not covering large areas of the body may resolve without treatment. Severe rashes, especially if accompanied by other symptoms may require treatment. Treatment often involves using antihistamines, (for example Allegra or Benadryl), either prior to or after working out.

Exercise-induced Rhinitis

Rhinitis is a medical term for nasal inflammation. Common rhinitis symptoms include runny nose and congestion. Studies show that exercise-induced rhinitis can occur regardless of whether or not you have a have a history of allergies.

Exercise-induced Angioedema

Angioedema is a fancy medical term for swelling. Exercise-induced angioedema usually occurs along with either urticaria or anaphylaxis. In some cases, all three symptoms occur at the same time.

Exercise-induced Anaphylaxis

Anaphylaxis is a life-threatening allergic reaction. Symptoms of exercise-induced anaphylaxis include:

  • itching
  • redness or flushing
  • hives
  • swelling - often of the face, eyes, or lips
  • shortness of breath or wheezing
  • difficulty swallowing
  • difficulty speaking or slurring words
  • dizziness or feeling like you will pass out
  • fainting
  • profuse sweating
  • headache
  • stomachache, nausea, diarrhea, vomiting
  • feeling like there is a lump in your throat or like you are choking

Anaphylaxis is a medical emergency. If you experience symptoms of anaphylaxis while working out you should stop exercising immediately and call 911.

Exercise-induced Food Allergies

Exercise-induced food allergies occur when someone eats a specific food prior to working out. The actual allergic reaction occurs while they are exercising and usually involves typical allergy symptoms such as itching and hives. In some cases, this may progress to more severe symptoms including anaphylaxis. If you suspect exercise-induced food allergies you may wish to see a doctor called an immunologist.

Once exercise-induced food allergies are identified the treatment is simple enough: stop eating the food that triggered your reaction at least two hours before working out.

Sources:

Exercise Induced Asthma. American College of Allergy Asthma & Immunology website. Exercise Induced Asthma. http://acaai.org/asthma/exercise-induced-asthma-eib

UK woman diagnosed as allergic to exercise. Daily News Website. http://www.nydailynews.com/news/world/uk-woman-diagnosed-allergic-exercise-article-1.1297236

Exercise-induced Anaphylaxis. Medscape website. http://emedicine.medscape.com/article/886641-overview. Updated August 24, 2017. 

Ansley, L, Bonini, M, Delgado, L, Del Giacco, S, Du Toit, G ... Robson-Ansley, PJ. (2015). Pathophysiological mechanisms of exercise-induced anaphylaxis: an EAACI position statement. Allergy. 70(10):1212-21. doi: 10.1111/all.12677