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Am I Allergic to Exercise?

Exercise-Induced Anaphylaxis

It’s important to note a separate and dangerous form of exertion reaction: exercise-induced anaphylaxis or EIAn. This is a condition in which anaphylaxis, the most severe form of allergic reaction, results when a susceptible person exercises. It can also occur during strenuous chores, such as shoveling snow.

Unlike cholinergic urticaria, EIAn is only triggered by exercise, not heat stimuli. The reaction starts within minutes of exercise with flushing, itching and half-inch or larger hives (unlike cholinergic urticaria’s tiny hives). If exercising continues, the reaction can progress to anaphylaxis with swelling (face, throat, fingers, toes), nausea, abdominal cramps, diarrhea and loss of blood pressure.

There’s a sub-type of EIAn that only occurs when exercising within two to four hours after eating a specific food. The individual can exercise without symptoms, as long as the incriminated food is not consumed beforehand. Likewise, the person can eat that food with no reactions as long as no exertion follows for more than four hours after eating the food.

This condition, known as Food-Dependent EIAn, is challenging to diagnose. If you suspect symptoms of this, be sure to see an allergist for testing.

In fact, Ostro recommends that individuals who start to experience flushing, itching or hives during exercise immediately stop the activity, and consult an allergist before resuming a workout regime. When EIAn is diagnosed, the person will be prescribed an epinephrine auto-injector.

“Cholingeric urticaria is bothersome but non-life threatening, while EIAn is a potentially life-threatening condition,” Ostro says. Fortunately, the former condition is the more prevalent.

So can the person with cholingeric urticaria hives stay fit and exercise? Yes, but it may involve finding a less heat-inducing sport such as swimming, or inclining to winter sports such as skiing.

Kavanagh, who lives in New Brunswick, Canada, enjoys both. But she doesn’t limit herself to them. She races dirt bikes and rappels off mountains, too. She just ensures that she takes appropriate safeguards to avoid and minimize her body heat reactions.

Besides staying out of direct sunlight and taking medication, Kavanagh layers her clothing for temperature changes, and wears a “cold” shirt that wicks away sweat while maintaining her active lifestyle. “I refuse to let my allergy get the best of me.”

First published in Allergic Living magazine.
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