Yes, you really can be allergic to working out
Key Takeaways
Exercise-induced anaphylaxis is a rare but serious allergic reaction associated with physical activity.
The condition is often (but not always) triggered by certain foods consumed before exercise.
While it’s easy to joke about being “allergic” to working out when you don’t feel like leaving the comfort of the couch, it turns out this is the reality for some.
A November 2024 Independent article shared the story of Maggie Habashy, a Minnesota woman diagnosed with a potentially life-threatening condition that all started when she went out on a run.[]
Intensifying (sometimes life-threatening) symptoms
Habashy’s condition, exercise-induced anaphylaxis (EIA), is rare but serious. During her first anaphylactic episode a decade ago, Habashy experienced hives and itching while running. Her episodes and symptoms intensified over time with subsequent workouts, Habashy shared, including her eyes swelling shut, facial swelling, and not being able to speak.
@rubin_allergy @Daryl✌🏾 Can you be allergic to exercise? What is cholinergic urticaria? What is exercise induced anaphylaxis? For general educational purposes only. #exercise #allergies #tiktokdoc #learnontiktok @Daryl✌🏾 ♬ original sound - Dr. Rubin, MD
After numerous tests and consultations with allergy specialists, Habashy was eventually diagnosed with EIA. She said she has learned how to manage the condition by adapting her exercise routines and carrying epinephrine injectors for episodes.[]
Suffice to say, this condition is no joke. Here’s what to know about EIA.
EIA is a severe allergic reaction during physical activity in which the immune system releases mediators, causing the symptoms of the reaction—which may manifest in the respiratory system, gastrointestinal system, skin, and heart. But the root causes of EIA are still unclear. Severe episodes of EIA can be fatal if the reaction is not adequately managed and stopped.
Triggers and symptoms
Early signs of EIA are often respiratory, and include coughing, wheezing, difficulty breathing, facial flushing or swelling, and hives.[] Symptoms can escalate, leading to a life-threatening situation. If breathing becomes difficult or blood pressure drops, patients start feel dizzy and may pass out.[]
For some patients, EIA is associated with specific food triggers. For some, it occurs only if they eat a specific food (shrimp or wheat, in particular) before exercising.[] Other possible food and drink triggers include alcohol, eggs, fish, milk, nuts, and soy.[]
However, it is not just the food that triggers EIA, but rather a combination of the specific food followed by vigorous exercise. “About 30% to 50% of EIA is food dependent, only occurring with the combination of a specific food and exercise,” states the author of a case report in Canadian Family Physician.[] “In these patients exercise or food on their own do not cause anaphylaxis; only in combination do they trigger the reaction.”
In more rare circumstances, EIA may not be triggered by food at all—this was the case for Habashy. She noted that her first episode happened during Ramadan, when she was fasting and therefore had not consumed any potential trigger foods. Nevertheless, episodes continued during her exercise classes.
In cases where food is not the culprit, other factors are thought to be a trigger for EIA, including certain medications (nonsteroidal anti-inflammatory drugs), cold or warm temperatures, common allergens (such as pollen and dust mites), and for females—their menstrual cycle.[]
Working with patients
Diagnosis can be challenging. Allergists should work with patients to investigate symptoms, possible food triggers, and eventually diagnose EIA if applicable. This may include blood work to check for elevated tryptase levels during a reaction, says the Cleveland Clinic.[] Other options include a scratch test or, less commonly, a food challenge or exercise challenge. As the latter two options present risks by intentionally triggering an episode, some physicians may choose to forgo these methods.
After receiving an EIA diagnosis, patients should be advised on how to best prevent future episodes, and what to do when one occurs. For patients with trigger foods, they may still be able to enjoy these foods, but they should wait 4 to 6 hours after ingesting the known food trigger before engaging in exercise.[]
Rather than avoiding exercise altogether, patients should be encouraged to find new ways to maintain an active lifestyle while managing their EIA.[] This could include participating in lower-intensity exercise, as well as always carrying medication to treat an episode should one occur unexpectedly.
What this means for you
For patients presenting with severe allergic reactions, investigate whether any physical activity was involved in the episode, as well as any foods consumed prior to the activity. Blood work and allergy testing can be used to diagnose EIA and individual patients’ triggers. Advise patients to know their own symptoms and triggers, and to adapt their diet and exercise routines accordingly.