Mild symptoms may include:

Mild symptoms can be present on their own, without more severe ones occurring. But you should watch carefully in case more severe ones begin to develop.

Mild symptoms may include:
  • right_arrow_orange_icon Widespread flushing of the skin
  • right_arrow_orange_icon Nettle rash (otherwise known as hives or urticaria)
  • right_arrow_orange_icon Swelling of the skin (known as angioedema) anywhere on the body
  • right_arrow_orange_icon Swelling of the lips
  • right_arrow_orange_icon Abdominal pain, nausea and vomiting

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Severe symptoms

There may also be a dramatic fall in blood pressure (anaphylactic shock). The person may become weak and floppy and may have a sense of something terrible happening. This may lead to collapse and unconsciousness.



A severe allergic reaction requires emergency treatment.

You could experience any of the following more severe symptoms:
  • right_arrow_orange_icon Swollen tongue
  • right_arrow_orange_icon Hoarse voice
  • right_arrow_orange_icon Difficulty swallowing
  • right_arrow_orange_icon Difficult or noisy breathing, wheeze, persistent cough
  • right_arrow_orange_icon Feeling faint or weak

What are the various kinds of exercise-induced anaphylaxis?

Food plus exercise

This is called food-dependent, exercise induced anaphylaxis (FDEIA). The symptoms occur when a particular food is eaten before exercise whereas the same food can be eaten without adverse effect when no exertion follows. Wheat is the culprit food for some people, although others including shellfish are sometimes implicated. It is our opinion, supported by the medical experts who reviewed this information, that anyone diagnosed with FDEIA should avoid exertion on the day they eat their trigger food.


Sometimes symptoms occur when the food is eaten just after exercise

People with a history of FDEIA should never exercise alone. They should carry an adrenaline auto-injector (see below – ‘How is anaphylaxis treated?’) and should wear a medical alert bracelet or talisman informing medical services of their condition.


The use of certain anti-inflammatory pain-killers also need to be considered as these may act as an alternative or additional co-factor in triggering a reaction in certain cases. People with a history of exercise-induced anaphylaxis may need to avoid taking aspirin or a non-steroidal anti-inflammatory painkiller (NSAID) such as diclofenac (Voltarol®), ibuprofen (Nurofen®) or naproxen for twelve hours before intended exercise and people with a history of FDEIA may need to avoid taking aspirin or an NSAID on the day they eat their trigger food.


Exercise and exposure to cold

Researchers reported on a 16-year-old Japanese boy who had a four-year history of allergic reactions when he exercised in winter. Tests showed it was the combination of cold and strenuous exercise that triggered the symptoms. Food was not thought to be a factor in this case (Li et al., 2002).


Cereal mites with exercise

A 17-year-old boy suffered anaphylaxis while jogging after eating a Japanese pancake. The pancake mix, which had been stored for several months after the package had been opened, was examined under a microscope, and an abundant number of live mites were discovered. The researchers concluded that it was ingestion of mites associated with exercise that caused the symptoms (Adachi et al., 2013). One of our medical advisers tells us he saw the case of a boy who exercised in the snow after eating a breakfast cereal from a packet which had been open for many months. The boy suffered a severe anaphylactic reaction.


Lipid-transfer protein (LTP) Dependent Exercise-Induced Anaphylaxis

Lipid Transfer Proteins (LTPs) are found in foods which come from plants. Lipid Transfer Protein Syndrome is an allergy affecting people who have become sensitised to LTPs. In this condition patients may find that they react to one or more foods in the following groups: vegetables, fruits, nuts or cereals. In many cases, a reaction only occurs in conjunction with an additional factor such as exercise.


‘Co-factor enhanced food allergy’

Apart from exercise, additional factors have now been identified that can combine with hidden food allergy to cause anaphylaxis. The commonest of these are pain-killing drugs. Aspirin, ibuprofen (Nurofen), diclofenac (Voltarol), naproxen or other non-steroidal anti-inflammatory drugs (NSAIDs), if taken within a few hours of a food allergen such as wheat, can result in an attack of anaphylaxis even though the food or drug is tolerated when taken alone.


Exercise and NSAIDs are referred to as co-factors and the resulting condition is called co-factor enhanced food allergy.


Other examples of co-factors include eating a large amount of the food, stress or anxiety, extreme cold, consumption of alcohol with the food, and the monthly period (premenstrual/menstrual). One or more of these co-factors may combine, in any combination, with a food allergen and result in anaphylaxis.


FDEIA was the first kind of co-factor enhanced food allergy to be identified, and it remains the commonest to be diagnosed.

Getting the best advice

If you suspect you may fall into any of the above categories, ask your GP to refer you to an NHS allergy clinic. Exercise-induced allergy is a complex condition that needs an expert diagnosis and clear advice. A specialist will be able to consider what treatment is necessary.

How is anaphylaxis treated?

Pre-loaded adrenaline auto-injectors (AAIs) are prescribed for people believed to be at risk.



Because severe allergic reactions can occur rapidly, the prescribed adrenaline auto-injector must be readily available at all times. The injection must be given as soon as a severe reaction is suspected to be occurring.



An ambulance must be called immediately following the use of the first device, even if there is immediate improvement or if further devices are available. The emergency service operator must be told the person is suffering from anaphylaxis and needs to be attended by paramedics.

Is exercise-induced anaphylaxis a life-long condition?

Exercise-induced anaphylaxis has only been recognised in the past 30 years or so. It is not yet known how many people, if any, outgrow it. Relevant studies following up a large number of such persons to explain its natural history have not yet been reported. For this reason it is safest at present to regard it as being a life-long condition.

Exercise-induced anaphylaxis during childbirth or surgery

Very rare cases of exercise-induced anaphylaxis have been reported involving women going into labour (Smith, 1985). Although this is unlikely to happen, people who suffer from exercise-induced anaphylaxis need to make medical staff aware of this condition before going through labour or having surgery.

Key points

  • right_arrow_orange_icon Make sure you get medical advice. See your GP and ask for a referral to an allergy clinic
  • right_arrow_orange_icon Once diagnosed, always carry your prescribed treatment
  • right_arrow_orange_icon If any symptoms occur, stop your exercising and rest. Do not drive
  • right_arrow_orange_icon Use your prescribed adrenaline as soon as a severe reaction is suspected to be occurring. An ambulance must be called immediately

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