Dear Dr. Sugar,
I work out regularly, but I have had a sort of reaction during my last two intense cardio workouts. My face turns bright red; I wheeze slightly, cough, and my eyes and nose itch. I have to stop and rest, but the symptoms go away after about 30 minutes. The symptoms seem to be similar to a food allergy, however I work out first thing in the morning and only have coffee before starting. What could be the cause of this reaction and how can I avoid it?
— Not Seeking a Workout Excuse, I Swear
Thank you for asking such an interesting question! Your symptoms that are brought on by exercise are actually quite concerning (especially the respiratory symptoms — cough and wheezing). I am glad that you stop and rest when these symptoms appear, as they could be a sign of possible allergic reaction to exercise. Yes, that's right, although rare, some people have an allergic response to exercise or physical exertion and their symptoms can range from a hives-like rash to a life-threatening anaphylactic reaction.
Allergic symptoms from physical exertion are called "exercise-induced anaphylaxis," according to Medscape. The most common symptoms present with this condition are itching, hives, angioedema (swelling of the eyes, lips, throat, hands, or feet), flushing, shortness of breath, difficulty swallowing, chest tightness, passing out (syncope), profuse sweating, headache, gastrointestinal symptoms (nausea, vomiting, abdominal pain), and choking, throat constriction, or hoarseness of the voice. Symptoms may occur at any stage of exercise, and stopping the exercise typically resolves the symptoms. However, Medscape does note that some people continue to have serious symptoms even after they stop exercising.
Learn more about an exercise-induced allergic reaction after the break!
According to the American Academy of Family Physicians, jogging and running are the most common activities to incite exercise-induced anaphylaxis. It also reports that activities such as volleyball, skiing, dancing, and even yard work can incite the condition. Medscape also reports that exercise-induced anaphylaxis attacks are not always elicited by the same type or intensity of physical exertion, and that cotriggers such as food, alcohol, temperature, drugs (especially aspirin or other nonsteroidal anti-inflammatory drugs), humidity, seasonal, or hormonal changes may influence an attack. The foods most commonly associated with food-dependent, exercise-induced anaphylaxis are wheat, shellfish, tomatoes, peanuts, and corn.
Diagnosis of this condition should be done by a medical professional and is generally based on history, blood work, allergy testing, and, sometimes, an exercise-challenge test. Long-term management should be tailored specifically to the person with the condition since the severity, frequency, and intensity of exercise needed to trigger the allergic anaphylactic reaction (with all possible cotriggers) varies from person to person. Medications may or may not be recommended to prevent attacks; however, self-administration of epinephrine (via an Epi-Pen) may be recommended if an attack arises during exercise.
There are other conditions that share similar symptoms with exercise-induced anaphylaxis. Thus, my usual disclaimer always applies: any formal diagnosis and treatment should be performed by your own personal medical professional. Given the concerning nature of some of your symptoms, I recommend that you see your physician as soon as possible.
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