Sandhya Raghavan
... Read More
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Cookie Policy.
Written By: Sandhya Raghavan | Published : October 21, 2017 9:27 AM IST
"I am allergic to exercise!" How's this for an excuse to skip the gym? As funny as it sounds, being allergic to exercise is no laughing matter. Exercise-induced anaphylaxis is a legitimate problem that occurs as a reaction to physical exertion and one could pretty much die from it! Which means you could suddenly start showing symptoms of severe allergic reaction while running on the treadmill or performing push-ups. These symptoms include classic signs of anaphylaxis and have to be addressed almost immediately, otherwise, things could turn fatal. Not funny anymore, is it?
So if you start palpitating after running at a speed of 10 mph for five whole minutes on the treadmill, does it mean you have exercise-related anaphylaxis too? Not quite. Palpitations are different from wheezing caused by the constriction of airways. It's considered an anaphylactic reaction when you see symptoms like wheezing, developing hives, swelling, nausea, stomach cramping, itching or flushing.
What triggers the allergy?
The range of triggers is quite broad, but it mostly results from any particular type of physical activity. It could be something as mild a stroll by the river or as labour-intensive as a session on the elliptical. Funnily, the same exercise may not always result in an anaphylactic reaction. But the exercise itself is not to blame. There are a few associated factors that increase the chances of an attack. Studies say that eating certain foods, ingesting drugs, or working out under certain environmental conditions trigger an episode of exercise-related anaphylaxis.
What foods can trigger exercise-related anaphylaxis?
The allergic reaction is triggered when the person ingests a certain kind of food. This condition is called food dependent exercise-induced anaphylaxis. Exercise alone doesn't cause the reaction. Common food types that predisposes the person towards the reaction include wheat, shellfish, grapes, nuts, peaches, eggs, oranges, apples, hazelnuts, cheese, cabbage, chestnuts, tomatoes, peanuts, fish, pork, beef, chicken, turkey, mushrooms, barley, onions, alcohol and cow's milk. Of the entire list, shellfish and wheat have been the biggest culprits.
In some patients, taking drugs like aspirin can trigger the problem. Working out in cold, humid or warm environment can also be the culprit. Other factors such as being on one's menstrual periods, having a dental amalgam, ingesting dust mites etc. have also been named as triggers.
(Read: Natural ingredients that prevent allergic attacks)
Who is more vulnerable?
It is usually seen in people with a family history of the exercise-related anaphylaxis. It is a rare disorder but can strike at any phase in a person's life from age 4 to 74. It is seen very often in children. Of the total cases of all anaphylaxis, exercise-induced one represents only 5 to 15 percent of the cases.
How is it diagnosed?
Diagnosis of exercise-induced anaphylaxis is based on the patient's clinical history and physical examination. If an association with exercise and allergic reaction is seen, it then determined if it is food dependent or not. Patients are checked to see if the allergic reaction is due to food or other factors like temperature or allergens. This step is crucial to prevent any future episodes of attacks. The clinician also determines whether it is a genuine anaphylaxis case or some other disorder that is mimicking its symptoms like idiopathic anaphylaxis, cholinergic urticaria, cold urticaria, mastocytosis or exercise-induced asthma.
How is it treated?
In the case of an emergency, it has to be dealt with like a normal anaphylactic episode -- with drugs. Main drugs used to prevent a case of anaphylactic shock includes epinephrine, antihistamines and systemic corticosteroids. Patients are advised to carry an epi pen in the likely event of an attack.
Protective interventions include administration of drugs like cetirizine and montelukast. Use of pretreatment agents is also explored to thwart any episode of exercise-related anaphylaxis. Those who have a wheat-induced anaphylaxis, sodium cromoglycate is given as a preventive agent beforehand.
Should people with this condition not exercise at all?
Nice try! But no, you can exercise all you want to but certain precautions should be taken. The condition should be managed like other cases of anaphylaxis, and the commonest way is to avoid the potential allergen. So patients are discouraged from performing outdoor exercises if it is too cold, hot or humid. They are also prevented from exercising during pollen seasons. Aspirin and other NSAIDs that are the associated triggers banned before, during or after exercise. It is also recommended that people with the potential to get an attack should not exercise four to six hours after food. Since there is a risk of such attacks happening after the exercise, care should be taken after exercising as well.
References:
Barg, W., Medrala, W., & Wolanczyk-Medrala, A. (2011). Exercise-Induced Anaphylaxis: An Update on Diagnosis and Treatment. Current Allergy and Asthma Reports, 11(1), 45 51. https://doi.org/10.1007/s11882-010-0150-y
Povesi Dascola, C., & Caffarelli, C. (2012). Exercise-induced anaphylaxis: A clinical view. Italian Journal of Pediatrics, 38, 43. https://doi.org/10.1186/1824-7288-38-43
Kim, C. W., Figueroa, A., Park, C. H., Kwak, Y. S., Kim, K. B., Seo, D. Y., & Lee, H. R. (2013). Combined effects of food and exercise on anaphylaxis. Nutrition Research and Practice, 7(5), 347 351. https://doi.org/10.4162/nrp.2013.7.5.347
Image source: Shutterstock
