Some use it as a jokingly meant excuse for not moving enough, but British Sarah Manning Norton has a real allergy to physical activity.
“Exercise Allergy”
I can imagine you’re not taken seriously when you say you’re allergic to physical exertion. It’s something a less sporty student says to the gym teacher before being picked last for dodgeball.
47-year-old Sarah Manning Norton can’t just go for a bike ride or jump on a trampoline with her kids. She first went into an anaphylactic shock when she participated in Jane Fonda’s aerobics on TV at the age of 17. An anaphylactic shock is an allergic reaction where the body goes into shock due to dilation of blood vessels and the release of an excess of histamine. This can cause the airways to narrow, depriving you of oxygen.
She stopped the aerobics to answer a phone call and lay on the floor. Then she felt her chest tighten as if she were having an asthma attack. Hives broke out, a well-known symptom of anaphylactic shock, which Sarah attributed to the itchy carpet she was lying on.
She became dizzy and her ears started ringing, so she called for her mother. Her mother quickly realized it must be some kind of allergic reaction and drove straight to her aunt’s house to get “anti-histamine-like” medicine. Once back, Sarah received the medication and then lost consciousness. However, she woke up again and doesn’t really know what medicine she had been given.
Up to that point, Sarah played tennis and hockey and trained regularly. She had experienced symptoms during training before but just powered through. Apparently, she realized it was an allergic reaction back then because she would take Benadryl, an antihistamine, in those cases. However, she didn’t know it was a reaction to the training. She didn’t know such a thing existed.
Until her mother called her during her studies. She had seen a news item about exercise-induced anaphylaxis. It recounted stories of people collapsing during training because they didn’t know they suffered from this condition.
Exercise-Induced Anaphylaxis
Exercise-induced anaphylaxis is a rare condition that occurs during or immediately after exercise [1]. It is a rare condition about which not much is known. Recognized initial symptoms include [2]:
- Itchy skin
- Hives
- Abdominal cramps
- Diarrhea
- Nausea
If the activity continues, more severe symptoms may occur:
- Angioedema (swelling in the face and throat)
- Laryngeal edema
- Very low blood pressure
- (eventually) heart failure
Stopping the activity usually provides immediate relief of symptoms.
Various types of activities have been associated with this severe allergic reaction to exercise. Running, tennis, and cycling, for example. But also lower-intensity activities like walking and gardening can trigger a reaction. A long-term follow-up study from 1999 identified running as the activity most associated with exercise-induced anaphylaxis [3]. Another study also observed this reaction with various activities such as soccer, raking leaves, shoveling snow, and horseback riding [4].
Combination of Diet and Exercise Leads to Faster Allergic Reaction
Allergic reactions to exercise can occur on their own, but often happen when there’s a second exacerbating factor. One of the most common of these factors is food. Particularly, eating prior to physical activity increases the risk in people with this condition. A specific form of exercise-induced anaphylaxis is food-dependent exercise-induced anaphylaxis. In this form, the reaction can only occur if a specific type of food is eaten before exercise. Either the food or exercise alone cannot lead to a reaction in these cases [5].
The types of foods often implicated in these cases are wheat, shellfish, tomatoes, peanuts, and corn [6]. However, there is a wide range of foods associated with this type of allergy. Various fruits, seeds, milk, soy, lettuce, beans, rice, and various meats. Almost everything. In one case, there was a specific combination of wheat with a type of Japanese sour fruit prior to training, which caused problems (umeboshi) [7].
There is also a non-specific food-dependent form of this exercise allergy. In this form, any type of food eaten before physical activity leads to a reaction [8].
Sarah now knows it’s best to avoid any type of food before training. If she does eat something, carbohydrate-rich foods seem to be her safest option while protein turns out to be dangerous. The reverse would be more inconvenient, I think.
Not Always an Excuse
An exercise allergy can be hereditary as evidenced by a family in which 7 men in three generations have this allergy [9,10]. So far, there seems to be no cure for the problem, only prevention of symptoms. For example, avoiding certain types of food, but also conditions like high temperature or humidity. It’s also important to have an epipen to administer adrenaline in emergencies and to inform family, trainers, and colleagues about this.
Sarah still trains and it’s been 20 years since she had an attack, but she still carries an epipen. Prolonged and high exertion is still dangerous for her, but she takes as many precautions as possible.
I myself was not aware of the existence of this condition. As mentioned, it’s a rare condition, which is evident from the fact that I couldn’t find a Dutch name for it. It’s quite possible that many more people have the condition but don’t suffer from it because, for example, they never eat certain foods before training. For example, I’ve never eaten Japanese sour fruit before training.
In any case, it’s important that more people are aware of the existence of this condition so that perhaps previously vague and unexplained symptoms can be explained.
References
- Sheffer AL, Austen KF. Exercise-induced anaphylaxis. J Allergy Clin Immunol. 1984 May. 73(5 Pt 2):699-703.
- Sheffer AL, Austen KF. Exercise-induced anaphylaxis. J Allergy Clin Immunol. 1980 Aug. 66(2):106-11.
- Shadick NA, Liang MH, Partridge AJ, et al. The natural history of exercise-induced anaphylaxis: survey results from a 10-year follow-up study. J Allergy Clin Immunol. 1999 Jul. 104(1):123-7.
- Aihara Y, Takahashi Y, Kotoyori T, et al. Frequency of food-dependent, exercise-induced anaphylaxis in Japanese junior-high-school students. J Allergy Clin Immunol. 2001 Dec. 108(6):1035-9.
- Maulitz RM, Pratt DS, Schocket AL. Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol. 1979 Jun. 63(6):433-4.
- Romano A, Di Fonso M, Giuffreda F, et al. Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol. 2001 Jul. 125(3):264-72.
- Aihara Y, Kotoyori T, Takahashi Y, Osuna H, Ohnuma S, Ikezawa Z. The necessity for dual food intake to provoke food-dependent exercise-induced anaphylaxis (FEIAn): a case report of FEIAn with simultaneous intake of wheat and umeboshi. J Allergy Clin Immunol. 2001 Jun. 107(6):1100-5.
- Soyer OU, Sekerel BE. Food dependent exercise induced anaphylaxis or exercise induced anaphylaxis?. Allergol Immunopathol (Madr). 2008 Jul-Aug. 36(4):242-3
- Longley S, Panush RS. Familial exercise-induced anaphylaxis. Ann Allergy. 1987 Apr. 58(4):257-9.
- Grant JA, Farnam J, Lord RA, Thueson DO, Lett-Brown MA, Wallfisch H. Familial exercise-induced anaphylaxis. Ann Allergy. 1985 Jan. 54(1):35-8.
