Exercise-induced anaphylaxis is a physical allergy that is precipitated by exercise and exertion. This physical activity results in mast cell degranulation with release of histamine into the blood. The syndrome may range from mild to severe and rarely can result in death.



(1) pruritis

(2) flushing and erythema

(3) urticaria, which may become confluent

(4) angioedema, which may progress to evidence of upper respiratory tract obstruction (laryngeal edema, choking, stridor and/or hoarseness)

(5) gastrointestinal colic

(6) headache

(7) fainting, loss of consciousness

(8) profuse sweating

(9) cardiovascular collapse


Associated with exercise or physical exertion and may start within a few minutes of starting the activity:

(1) jogging, brisk walking, bicycling, tennis, dancing, aerobics

(2) volleyball, skiing

(3) raking leaves or mowing the lawn


In some individuals a variety of factors may contribute to the attack. These factors may include:

(1) food (shellfish, tomatoes, celery, cabbage, etc.)

(2) drugs

(3) alcohol

(4) temperature (either hot or cold)

(5) humidity

(6) menstrual cycle in women.

In these cases the person must exercise or exert to have a reaction, although the factor may intensify the reaction.


Other causes for an anaphylactic reaction should be excluded.

(1) Generalized heat urticaria, or cholinergic urticaria, is associated with an increase of body temperature due to a warm bath or shower, exercise and/or fever.

(2) Peanut or nut allergy.

(3) Drug-induced, occurring not in association with exercise.


The patient usually reports multiple attacks in the year preceding the clinical interview. The disorder tends to be stable and often may decrease with age.


A person may experience a refractory period after an attack, during which they can exercise without symptoms. Some people can avoid attacks by maintaining a regular exercise program.


Serum histamine increases with exercise as compared to pre-exercise serum levels. Patients with more severe symptoms had a greater rise in serum levels.


Taking antihistamines prior to exercise can prevent or reduce the severity of an attack. Epinephrine may be required in more severe attacks.


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