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Exercise-Induced Allergic Reactions

By Peter J. Delves, PhD, Professor of Immunology, Division of Infection & Immunity, Faculty of Medical Sciences, University College London, London, UK

Exercise-induced allergic reactions occur during or after exercise.

  • Exercise can trigger or worsen asthma or, rarely, a severe allergic (anaphylactic) reaction.

  • Doctors usually base the diagnosis on symptoms and their relationship to exercise.

  • Drugs used to treat asthma can usually prevent symptoms from developing during exercise, but becoming more physically fit and gradually increasing the intensity and duration of exercise also helps.

Exercise can trigger the following:

  • Asthma: Exercise often triggers an asthma attack in people who have asthma, but some people have asthma only when they exercise. Exercise may trigger or worsen asthma because breathing fast cools and dries the airways, and as the airways warm again, they narrow. Exercise-induced asthma is more likely to occur when the air is cold and dry. The chest feels tight. People may wheeze, cough, and have difficulty breathing.

  • Anaphylactic reactions: Rarely, vigorous exercise triggers a widespread, potentially severe allergic (anaphylactic) reaction. In some people, this reaction occurs only if they eat a specific food (especially wheat and shrimp) before exercising. Breathing becomes difficult or blood pressure falls, leading to dizziness and collapse. An anaphylactic reaction can be life threatening.

Typically, symptoms triggered by exercise—asthma or an anaphylactic reaction—occur after 5 to 10 minutes of vigorous exercise. Often, symptoms begin after exercise has stopped.


  • A doctor's evaluation

  • An exercise challenge test

The diagnosis of exercise-induced allergic reactions is based on the symptoms and their relationship to exercise.

An exercise challenge test can also help doctors make the diagnosis. For this test, lung function is measured before and after exercise on a treadmill or stationary bicycle.


  • Drugs used to treat asthma

  • Avoidance of possible triggers

For people with exercise-induced asthma, the goal of treatment is to be able to exercise without symptoms. Becoming more physically fit may make symptoms less likely to develop during exercise. Inhaling a beta-adrenergic drug (such as those used to treat asthma—see Table: Drugs Commonly Used to Treat Asthma) about 15 minutes before starting to exercise often helps prevent reactions. Cromolyn, usually taken through an inhaler, may be helpful.

For people with asthma, taking the drugs usually used to control asthma often prevents symptoms from developing during exercise. For some people with asthma, taking drugs to treat asthma and gradually increasing the intensity and duration of exercise enables them to tolerate exercise.

People who have had an exercise-induced anaphylactic reaction should avoid the form of exercise that triggered the attack. If eating a specific food before exercise triggers symptoms, they should not eat the food before exercise.

A self-injecting syringe of epinephrine should always be carried for prompt emergency treatment. Exercising with other people is recommended.