This is simplified information about exercise induced anaphylaxis – there are more resources available at the bottom of the page for further reading for those who are interested in knowing more.

What is it?

Exercise Induced Anaphylaxis (EIA) is a condition in which moderate to extreme exercise causes anaphylaxis in the patient (and in extreme cases even mild exercise cause symptoms). Many of these cases are further described as Food-Dependent Exercise Induced Anaphylaxis (FD-EIA), where a patient has eaten an allergen and then exercised, causing symptoms.

What are the symptoms of exercise induced anaphylaxis?

Symptoms of EIA may start at any stage of exercise or just after it, but in most patients, they begin within 30 minutes after initiating exercise. The condition has been described in some studies occurring up to 4 hours later.

Symptoms may include:

  • Extreme fatigue
  • Warmth or Flushing
  • Pruritus (severe itching) or Urticaria (hives)
  • Angioedema (swelling of the body, hands, feet or face)
  • Wheezing
  • Upper Respiratory Obstruction and Collapse

  • Why do symptoms only occur with exercise?

    In many cases a weakly positive skin prick for the causative allergen is found. Patients can consume the allergen safely as long as they are not exercising or exercise without eating the allergen and remain safe, it is only the combination which causes anaphylaxis.

    Hypothesis for why this happens include:

  • Increased gastrointestinal permeability (where the cells of the intestines allow larger molecules, in this case allergens, to pass through to the gut)
  • Blood flow redistribution (where blood is diverted away from other organs to the muscles used in exercise).
  • Alterations in Blood Plasma.
  • Changes in Osmolarity and pH of the blood.

    Food Dependent Exercise Induced Anaphylaxis

    In comparison FD-EIA, ingestion of the causative food usually precedes exercise by several minutes or even hours. There are some cases where FD-EIA may also occur if the food is ingested soon after the completion of exercise. The triggering factor is important, so that the condition can be properly managed.

    Animal allergy, dust mite allergy, pollens and certain drugs have also been known to be part of the trigger for this form of anaphylaxis.

    What foods are involved in exercise induced anaphylaxis?

    Cereals are the most common trigger food involved with EIA, the most prominent being wheat and buckwheat.

    Cases of EIA with shellfish, kiwi and grape have also been recorded as well as tree nuts, soya, potato and fish.

    Please visit the Food Index of this site if you are interested in the cross reactivity of a specific food, there are lots of resources dedicated to cross reactivity.

    Wheat Dependent Exercise Induced Anaphylaxis

    This is a condition within FD-EIA which is well studied as it has been suggested by some studies that over 50% of FD-EIA cases are triggered by wheat allergens (see reference section).

    How is EIA diagnosed?

    For FD-EIA, diagnosis can start with skin prick tests (or blood tests) for possible allergens. The result may only be a mild positive.

    WD-EIA can be diagnosed the same way, but with IgE for omega-5-gliadin (the major wheat allergen) specifically tested for.

    How can EIA be managed?

    Antihistamines should never be used as an alternative to epipens for those suffering from anaphylaxis. It is recommended in the UK that in these cases that two epipens are prescribed in case of unit failure or a biphasic reaction.

    Avoidance of exercise after your trigger allergen is consumed or avoidance of your trigger allergens if you intend to exercise. Management of the condition varies from case to case depending on the severity, but should be discussed with your healthcare provider.

    A higher chance of EIA has been linked to:

  • A warm environment
  • Cold environment
  • High humidity
  • Aspirin intake
  • Menstrual cycle

  • Knowing which allergens bring the condition on, plus any of the additional factors as above, can all help in managing the condition.

    Exercise Induced Anaphylaxis should not be confused with cholinergic urticaria, which is chronic hives, which usually starts with an elevated body temperature.


    Healthline - Killer Workouts: Exercise-Induced Anaphylaxis

    Anaphylaxis Campaign - Exercise Induced Anaphylaxis

    You can't run, you can't hide: Living with Exercise-Induced Anaphylaxis

    Dermnet NZ - Exercise Induced Anaphylaxis

    Food Allergy Canada - Exercise-induced anaphylaxis: Feeling the wrong kind of burn

    Science Direct - Exercise Induced Anaphylaxis

    Allergen Encyclopeda - Wheat

    Articles and Journals

    A rare case of food-dependent exercise-induced anaphylaxis by potato snacks, 2024

    A rare case of wheat-dependent exercise-induced anaphylaxis induced by exercise 5 hours after wheat ingestion, 2024

    Food-dependent exercise-induced allergic reactions in Lipid Transfer Protein (LTP) hypersensitive subjects: new data and a critical reappraisal, 2024

    Food-dependent exercise-induced anaphylaxis caused by leek and several allergens of the allium family, 2024

    Wheat-dependent exercise induced anaphylaxis: A rare but potentially fatal syndrome. Case Report, 2023

    Food-Dependent Exercise-Induced Anaphylaxis: A Distinct Form of Food Allergy—An Updated Review of Diagnostic Approaches and Treatments, 2023

    Case report—wheat-dependent exercise-induced anaphylaxis in a patient with chronic spontaneous urticaria: A diagnostic challenge, 2023

    Epidemiology, outcomes, and disproportionate burden of food-dependent exercise-induced anaphylaxis from the Hong Kong Multidisciplinary Anaphylaxis Management Initiative, 2023

    Wheat-dependent exercise-induced anaphylaxis: subtypes, diagnosis, and management, 2023

    Food-dependent exercise-induced anaphylaxis to orange, with possible underlying thaumatin-like protein allergy, 2023

    Wheat-dependent exercise-induced anaphylaxis caused by percutaneous sensitisation to hydrolysed wheat protein in cosmetics, 2022

    Food-Induced Anaphylaxis among Children Weighing less than 15 kg: A Single-Center Case Series of the Pediatric Emergency Department, 2021

    Exercise-induced anaphylaxis unrelated to food ingestion and with hyperleukotrieneuria during challenge testing, 2021

    Exercise induced anaphylaxis in kiwi allergic patient: case report, 2021

    Omega-5 and Gamma Gliadin are the Major Allergens in Adult-Onset IgE-Mediated Wheat Allergy: Results from Thai Cohort with Oral Food Challenge, 2021

    Identification of allergens for food-dependent exercise-induced anaphylaxis to shrimp, 2021

    Food-dependent exercise-induced anaphylaxis to soybean: Gly m 5 and Gly m 6 as causative allergen components, 2020

    Diagnosis of exercise-induced anaphylaxis: current insights, 2016

    Pathophysiological mechanisms of exercise-induced anaphylaxis: an EAACI position statement, 2015

    Exercise-Induced Anaphylaxis: An Update on Diagnosis and Treatment, 2011

    Food-dependent Exercise-induced Anaphylaxis – A Review of 5 Cases, 2009

    Exercise and aspirin increase levels of circulating gliadin peptides in patients with wheat-dependent exercise-induced anaphylaxis, 2005

    Exercise-induced anaphylaxis to grape, 2001

    The natural history of exercise-induced anaphylaxis: Survey results from a 10-year follow-up study, 1999

    A novel wheat gliadin as a cause of exercise-induced anaphylaxis, 1999

    Food-dependent, exercise-induced anaphylaxis: A study on 11 Japanese cases, 1991

    Let me know if you found any of these interesting or useful. If you spot an article or research that you think is interesting you can message me or tag me on Facebook or Twitter - links at the bottom of the page.

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