Exercise can trigger an allergic response for some people

Some people have a real excuse to skip the gym. In some people, exercise can trigger an allergy attack.

Joe O’Leary went to dinner with his parents at around 8 p.m. one Wednesday in March of 2015. He split a pizza, topped with tomatoes and peppers, with his mom. Then he set out for the gym and hopped on the elliptical. But about a half-hour into the workout, he started feeling weird. “My eyes were watering, I was having trouble breathing,” he says. “In another five minutes I was struggling to breathe my and nose was completely stopped. I looked behind me into the mirror, and my eyes were swollen—every part of my face was swollen.”

O’Leary was rushed to the emergency room and pumped full of steroids and antihistamines. He’d had an allergic reaction, but not just to what he’d eaten for dinner: it was the combination of food and exercise that did him in. Doctors quickly diagnosed him with a condition called exercise-induced anaphylaxis, where a reaction to an allergen only happens in conjunction with exercise. If he combines them with exercise, O’Leary will have an anaphylactic reaction to tomatoes, peppers, soy, and nuts.

RELATED: 10 Most Common Food Allergies

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10 Most Common Food Allergies
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10 Most Common Food Allergies

Milk
Milk only does some bodies good. Many mistake a milk allergy for lactose intolerance since many of the symptoms are similar, but a milk allergy occurs when the body's immune system reacts abnormally to milk proteins, while lactose intolerance involves digestive problems as a result of being incapable of breaking down certain enzymes.

Credit: Flickr/aimeewenske

Eggs
Eggs are great for protein, energy, and filling you up. But to those who are allergic, eating eggs in any recipe can be rather unpleasant. While mostly children less than 5 years old suffer from this allergy and often outgrow it, some carry it into adulthood.

Credit: Flickr/Jon Mountjoy

Peanuts
This salty, nutty treat is often responsible for many serious allergic reactions. When the body identifies peanut proteins as harmful, the immune system releases symptom-causing chemicals into the bloodstream, causing mild to severe allergic reactions.

Credit: Flickr/Mykl Roventine

Soy
Sushi lovers may have soy to blame for allergic reactions rather than the fish. Soy allergies can be introduced to infants through soy-based formula, and in this case are often detected early. Though soy seems like an easily identified allergen, it can pop up in unexpected everyday foods including meat products, baked goods, chocolate, and cereals.

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Wheat
The primary protein the immune system attacks when allergic to wheat is gluten. Wheat allergies are extremely common but are often confused with celiac disease, a condition that essentially prevents the body from absorbing proper nutrients and causes an adverse reaction to gluten. Because wheat is found in breads, pasta, crackers, and even beer, wheat products are tough to avoid.

Credit: Flickr/Emily Carlin

Tree Nuts
According to the American Academy of Allergy, Asthma & Immunology (AAAAI), tree nut allergies affect 1.2 percent of the population. These nuts include everything from almonds to cashews and pecans to macadamias, and if you’re allergic to one of them, you’re most likely allergic to a few of them.

Credit: Flickr/Daniel Panev

Shellfish
One common food allergy that’s easy to identify is the immune system's intolerance of shellfish. Unlike many common food allergies, shellfish allergies are far more common in adults than children.

Credit: Flickr/morbuto

Fish
Finned fish can just as easily cause allergic reactions as shellfish. While the proteins in fish most often incite the immune system's reactions, fish gelatin (in the bones and skin of fish) can be responsible for allergic side effects as well.

Credit: Flickr/Ralph and Jenny

Raw Fruits and Vegetables
Some seasonal allergy sufferers also experience itching and discomfort upon biting into a succulent peach or gnawing on a raw carrot. Because raw fruits and vegetables contain the same proteins as some pollen, it is easy to develop oral allergy symptoms.

Credit: Flickr/muffet

Sesame Seeds
Put down the everything bagel — one seed on your favorite breakfast treat could cause a boatload of allergenic symptoms. The number of sesame seed allergies has grown in the U.S, but it’s not yet required for companies to put sesame seed warnings on food labels.

Credit: Flickr/jeffreyw

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Exercise-induced anaphylaxis was first described in 1979, and probably affects around 50 in every 100,000 people. While awareness of the condition among allergists has gone up, researchers and doctors still don’t know exactly why it occurs, says Maria Castells, an allergist at Brigham and Women’s Hospital.

For between 30 to 50 percent of people, the reaction comes from combining certain types of food and exercise. For others, strenuous activity triggers a reaction to drugs like aspirin. Some women only experience the phenomenon when they’re at the point in their menstrual cycle with high levels of the hormone estrogen, because it can bind to the cells involved with an allergic reaction. “There are a variety of things that it might be,” Castells says. “And for a proportion it’s nothing, really, just the exercise itself.”

The amount of exercise needed to trigger a reaction varies from person to person, Castells says. It generally takes more to cause anaphylaxis in someone who is relatively fit than someone who isn’t in great shape. Almost all types of exercise, like running, dancing, or biking, have been reported to cause anaphylaxis—though there haven’t yet been any reports of anyone having a reaction after swimming, Castells says.

It's still not exactly clear what causes the connection between exercise and anaphylaxis. There are a number of working theories about the mechanism involved, tied to the physiological changes that happen in the body during exercise. Increased blood flow might push sensitive immune cells around the body, for instance. Or perhaps certain proteins in the gut change their behavior during exercise, interacting with food in ways that could cause an allergic reaction. And since exercise increases the absorption of material from the gastrointestinal tract, it's possible that there are simply more allergens able to make their way into the body during a workout.

It’s difficult to test those theories, though, because the condition is difficult to recreate in a laboratory setting. “So there’s no mouse model and no human model of the ideas,” Castells says. There are a number of groups trying to develop a model, but they need more time.

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Best workout for your zodiac sign
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Best workout for your zodiac sign

Aries: martial arts

Fiery Aries is independent, highly active, and she loves to win. Her ruling planet is Mars—the Roman god of war. Since she has a warrior spirit, this workout (think karate, aikido, tae kwon do, jujitsu, and kick-boxing) suits Aries perfectly—giving her strength, flexibility, speed, and the ability to defend herself.

Other workouts to try: competitive sports and interval training.

Taurus: weight lifting

Taurus is the original gym rat. Since her sign rules the physical body and the senses, she knows how important it is to keep her body fit and feeling good. She has inherent inertia, meaning once she’s motion, she stays in motion. Since she can be a little bit stubborn, Taurus has to make the choice to get going—but after she does, nothing can stop her. For these reasons, a good weight-training program is excellent for her. She can always adapt it to suit her ever-evolving progress.

Other workouts to try: anything endurance-related, like long-distance running or jogging, cycling, and triathlons.

Gemini: group exercise classes

Social butterfly Gemini is high-energy and she loves to be around people. She can get distracted quickly, so the structure and variety of a group exercise class helps to keep her focused. If she can find an instructor who teaches her about fitness during the class, all the better—after all, Gemini loves to learn. The activity boosts her mood while helping her clear her mind and tone her body. (Win-win-win!)

Other workouts to try: walking with friends and five-minute routines.

Cancer: yoga

The Cancer babe is ruled by the moon, AKA her emotions. She loves the mind-body connection that yoga offers her. It helps her to find her inner stability and balance her emotions, all while giving her a full-body workout. Plus, the meditative practice lets her feel perfectly in sync.

Other workouts to try: water aerobics and swimming.

Leo: play

Leo doesn’t always have the patience for the gym, but she knows that she needs to keep her heart and her body in tip-top shape. Her best solution? Play. Whether it’s with the dog, children, or on a sports team, Leo loves to have fun and act like a kid again. Any activity that feels like amusement instead of work will keep her motivated and healthy.

Other workouts to try: dancing, trampoline jumping, hula hooping, and ice skating.

Virgo: Pilates

The structure and exactitude of Pilates suits detail-oriented Virgo perfectly. Joseph Pilates (a Virgo rising!) designed this fitness method to strengthen and align the body, which suits Virgo just fine—efficiency is a must for her. The Virgo babe is highly intelligent, practical, and methodical. She loves this systematic workout because it gets results and helps her feel really good in her body.

Other workouts to try: yoga, weight lifting, and IntenSati.

Libra: dance

Graceful Libra is ruled by the planet Venus, the Roman goddess of love, beauty, and relationships. She’s intelligent and yearns to feel balanced and healthy in her body. As dancing is lively, varied, social, and fun, it’s the perfect workout for the Libran sensibility. She would often rather forget that she is working out, so she especially loves that she can get caught up in the rhythm of the music. Dancing makes her feel totally alive, vibrant, and connected—score!

Other workouts to try: group exercise classes, tennis, any activity done with a partner, Pilates, and yoga.

Scorpio: Spinning

Sultry Scorpio is intense and driven. She loves the feeling of working it, and Spinning lets her dig in to realize the full force of her power. (A fun and intense workout in a dark room? So Scorpio.) Plus, she can ride the waves of enthusiasm generated by a brilliant instructor. All-out exertion is good for her, as she wants to completely let go. As an added bonus, Scorpio rules the pelvis, and cycling is said to be well-suited to women seeking pelvic floor exercises.

Other workouts to try: pole dancing, belly dancing, yoga—especially Ashtanga or Kundalini—and (of course) sex.

Sagittarius: jogging outdoors

Sagittarius is outdoors-loving and intelligent. She loves to challenge herself and explore the world, and jogging outside in nature keeps her in forward motion. The activity helps her use up her boundless energy, strengthen her body, and see new things. Don’t turn to the treadmill, however—there’s nothing a Sagitarrius hates more than to feel stuck. Bonus points: The endorphin high she gets from extended cardio activity matches her naturally optimistic attitude.

Other workouts to try: archery, hiking, horseback riding, skiing, and walking.

Capricorn: rock climbing

Capricorn the goat represents the climb to the top of the mountain—and that can translate literally into the perfect workout for these ambitious souls. Capricorn wants to be able to see the task ahead of her, and completing it feels super-satisfying. She’s not afraid of hard work, and she is always looking for a new achievement. Even better, each climb helps her build her physical strength and her self confidence.

Other workouts to try: hiking, weight training programs.

Aquarius: circus workouts

Aquarius is not afraid of being a little bit weird—she’s an outlier and a creative innovator. Above all else, she hates to be bored at the gym. Circus workouts or adult gymnastics suit her magical and transcendent personality just fine. She has a lot of stamina and perseverance, so she’s not afraid of diving into something demanding. Circus workouts help her build her strength and define her individuality while potentially also allowing her to work as part of a team, which she loves.

Other workouts to try: aerial yoga or silk dancing classes, trampoline, diving, ropes course, and wind surfing.

Pisces: swimming

Mystical Pisces loves to be in the water—so swimming puts her right in her element. She has a meditative spirit, and enjoys the calming rhythm of doing laps. It helps her feel transcendent, which she loves, and the excellent full-body workout heightens her self awareness and keeps her centered. Also important? The Pisces babe is very sensual and can sometimes become overwhelmed by her senses, so being in the water helps her tune in to herself by blocking out distracting sights and sounds.

Other workouts to try: yoga, scuba diving or snorkeling, surfing, walking, and tai chi.

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Luckily, Castells says, diagnosis is straightforward. And once people are diagnosed, their symptoms can be managed the same way any allergy is managed—by avoiding allergens (the foods and drugs, ideally, as opposed to the exercise trigger) and carrying EpiPens. “A lot has been done to advance the clinical piece of it, so it’s a better known syndrome,” she says.

O’Leary didn’t get a ton of information after his diagnosis, but his allergist was able to give him the basics. To cope, O'Leary cut all of his allergens out of his diet completely. Even though he could avoid a reaction by waiting to exercise after eating tomatoes or nuts, he prefers to just avoid them all together. He would rather sacrifice ketchup than risk having an unexpected attack.

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