Living with Exercise Induced Anaphylaxis
You’ve heard of allergic reactions due to Food Allergies, but have you heard of an allergic reaction due to Exercise?
Neither had I until it happened to me. As strange as it may seem, I developed an allergy to Exercise.
As an extremely active individual, who exercises 5-6 times a week, whether it’s training in team sports such as football, basketball or personal training like running, swimming or gym workouts, I exercise almost every day. As a child I was heavily involved with every school sport and sports days were my favourite day of the year. Outside of school I attended active extracurricular activities nearly every day and I played soccer and Gaelic competitively for my region. Throughout university I kept up my fitness and love of sports by joining the firsts football team, basketball team and running club. We would train twice a week and I would train myself the days I didn’t have an activity.
As you can see, I live a very active lifestyle, so you can imagine my shock when I first developed Exercise Induced Anaphylaxis.
It was an ordinary day in January, with lectures in the morning and training with my University football team in the evening, so I had planned out my day and my meals as I do every morning and headed off to my lectures for the day. I got home around 4p.m. and began making my dinner which consisted of a vegetable bean curry with brown rice. I ate my dinner, prepared my football bag (and my medical bag) and got a lift with my friend to training. So far, I had no symptoms at all.
About 20 minutes into the warm-up, I felt my eyes begin to water and get itchy and tingly and I remember turning to one of my friends asking her if she could see anything in my eye, to which she replied that it was just a little bit bloodshot but it looked fine. I thought this could have been due to the grass causing hay fever symptoms and just hoped that it would pass.
About 30 minutes into training I could feel my eyes swelling more and my face became red and a little swollen, but I just thought this was due to the sprints and running drills we had just done. I was out of breath and tired from the runs and I just thought these physical symptoms were due the strenuous exercise.
Following this, we started to play a game and about 5 minutes into the game I felt I couldn’t concentrate properly on what I was supposed to be doing. My face became more swollen and puffier as time went on, I could feel my hands swelling under my gloves and an itchy rash was appearing on my skin.
I didn’t understand what was happening or why this was happening but I stopped training at this stage as my skin had become incredibly itchy and my face had swollen so much that I was unrecognisable as I remember the shock on the girls faces when they looked at me! I sat down at the side of the pitch and took an antihistamine from my medical bag in my football bag.
As the reaction increasingly got worse, I called my sister who lived near, and she waited for me at my house. I got a lift straight home where my sister was waiting for me and she sat with me until it calmed down. Fortunately, about 10 minutes after I had taken the antihistamine, I could feel it settling down and I knew the reaction wasn’t getting any worse. Visually the reaction looked more severe than any food reaction I’ve had before as my face and eyes were extremely swollen and a red rash had developed on my skin, however I didn’t experience any internal symptoms such as a tight chest, difficulty breathing or an itchy throat. My airways were clear, and I had no symptoms of stomach cramps, diarrhoea or vomiting. Due to the fact I had no internal symptoms and that I had felt relief after taking the antihistamine, I didn’t administer my epi-pen. Around 2 hours later, I began feeling much better however my face remained swollen for the evening and the next day.
The evening of the reaction and the next few days, I tried to write down everything I ate or came into contact with on the day of the reaction. As far as I was aware I didn’t eat or come into contact with any nuts or peanuts throughout the day but I wondered if there were traces of nuts on something I had touched and then accidently touched my face. I wasn’t sure what exactly had caused the reaction, if it was due to cross contamination through one of my cooking pots that my house mates might have used to make their food before me, or if there were traces of nuts in my friend’s car on the way to training. As my allergy to nuts is my most severe, if I realised I had ingested nuts through food by accident I would have given myself the epi-pen straight away.
These reactions during exercise happened on and off a number of times over the next few months, so I began researching and reading up on similar cases around the world and I realised there was a condition called Exercise Induced Anaphylaxis.
Exercise Induced Anaphylaxis
Exercise Induced Anaphylaxis is Anaphylaxis which is caused by physical activity. A combination of exercise and other contributing factors such as food, weather conditions, or medications can cause exercise-induced reactions. It is a rare condition which occurs in about 2% of the population and it is more common in females. The pathophysiology (science and understanding) of Exercise-Induced Anaphylaxis (EAI) is not yet fully understood but there are several theories. Research shows increased levels of histamine and tryptase, chemicals involved in the allergic response, are present in patients with EIA after exercise. Release of these mast cell mediators (histamine and tryptase) may result in vascular leakage, inflammatory cell recruitment and occurrence of anaphylaxis. Morphological changes, changes in structure and form, of mast cells in the skin of EIA patients have been observed following exercise. During exercise there is a redistribution of blood flow from the gut to skin or skeletal muscle where mast cells would be more responsive to the trigger food. Mast cells are best known for their role in allergic reactions which release histamine (same as above) that cause itching, hives, and anaphylactic shock. The intensity of the exercise and the amount of food ingested can provoke different symptoms in different people. Also, individuals don’t always experience symptoms every time they exercise, it can occur at random.
The main symptoms are similar to what you would expect with a food allergic reaction; hives, itching and redness of the skin, swelling of face and hands and a rash on the skin. Other symptoms include; nausea, dizziness, cramps, diarrhoea, coughing, wheezing or difficulty breathing.
How I Controlled Exercise Induced Anaphylaxis
As there are many contributing factors that can cause exercise-induced reactions, I decided to keep a diary recording my food intake, the weather conditions and what medications I took each day to see if I could find a link between what I was eating before training and my exercise induced reactions. After a few weeks of monitoring these factors, I narrowed it down to wheat and legumes. If I had a wheat-based product (brown rice, wheat wrap) or legumes (beans, lentils) before training I would have a reaction when exercising. So, once I figured out the trigger food, I could avoid it on the days I had training and therefore I didn’t experience a reaction when exercising.
I informed my doctor about what had been happening and he advised me to get a skin prick test and a blood test to determine if I had an allergy to wheat and legumes. However, the results showed that I was not allergic to wheat but had a mild reaction to some of the foods in the legume family such as peas and soybeans. The foods I had been eating from the legume family were broad beans, blackeye beans and lentils which only caused a reaction if I exercised after eating them, but without exercise I was fine. I still try to eat wheat-based products and legumes on the days I don’t have training, or I eat them after exercise as advised by my doctor. I don’t believe in cutting the foods fully out of my diet if I can still eat them safely when not exercising.
I didn’t have any exercise induced reactions for 8 months after the diagnosis as I was careful to avoid the trigger foods before exercise. However, my most recent reaction happened about 4 hours after I had dinner, which consisted of vegetarian lasagne, spinach and broad beans, and I went for a late evening run. The same things happened, my eyes began to get tingly, followed by the rest of my face and when I eventually stopped to check my face in my mobile camera, I realised my whole face had become swollen. I called my Mum and she collected me straight away and had antihistamines in the medical bag in the car for me. Ten minutes after taking the antihistamine I began to feel better however my face and eyes were swollen for the rest of the day and following day. When trying to pinpoint what trigger food caused it, I realised the broad beans are part of the legume family so this must have been the trigger food which affected me 4 hours after ingestion. I am now extremely careful about eating before exercise and make sure to have my dinner after exercise.
For me, my exercise induced reactions are due to eating a particular food before exercising. There can be a range of common trigger foods such as Peanuts, shellfish, tomatoes, corn, wheat or any other foods. Usually more vigorous exercise causes exercise-induced reactions, however it can happen during any physical activity such as running for the bus or dancing on a night out- which is a bit of a scary thought!
When I experience exercise induced reactions, it usually takes me 10-15 minutes to realise it’s happening as it’s a gradual reaction that starts with slow facial swelling and redness which are also common symptoms when exercising. When this happens, I feel extremely self-conscious and uncomfortable around people and don’t really want anyone to see me. I have 100 thoughts running through my mind – what did I eat? Did I take all the necessary precautions? Will I use my Epi-pen? Will I go to hospital? It’s not that bad is it? Guilt also sets in for the people around me, I’ve interrupted the training and ruined the rest of the plans for the day.
I then have to remind myself that I can’t always control these reactions and that the people around me are supportive and care for my wellbeing.
Advice for those with Exercise Induced Reactions
Always Always Always have your medication bag with you when exercising or on the side of the pitch or track. In this bag you should have your 2x epi-pens, antihistamine tablets and your inhalers, along with any other medication you have been prescribed by your doctor to carry with you every day.
Also make sure you, your friends and team mates know exactly where your medication is and how to administer the epi-pen.
If you have any concerns regarding your allergies or believe you may have symptoms that are caused by allergies, you should speak with your doctor.