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Last Updated on October 17, 2023


Imagine the excitement of a great workout or a refreshing run in the park, but instead of exhilaration, you’re met with itching, redness, and hives all over your body. This is the bewildering experience of individuals suffering from exercise-induced urticaria (EIU). In this comprehensive guide, we will explore the fascinating world of this kind of urticaria, from understanding its causes and mechanisms to discussing strategies for management and coping.

Understanding Urticaria: A Brief Overview

Before delving into the specifics of urticaria caused by exercise, it’s essential to grasp the basics of urticaria. Urticaria, more commonly known as hives, is a skin condition characterized by the sudden development of raised, itchy, and often red welts on the skin. These welts, also called wheals, can vary in size and shape and typically come and go within a few hours.

Urticaria has several types based on its duration:

  • Acute Urticaria: This lasts less than six weeks and is usually a result of allergic reactions.
  • Chronic Urticaria: Persists for six weeks or more, and its cause is often more challenging to identify.

Exercise-induced urticaria falls under the category of physical urticarias, which includes various forms of hives triggered by physical stimuli, such as heat, cold, pressure, and, as the name suggests, exercise.

What is Exercise-Induced Urticaria

EIU is a condition where physical activity, such as exercise, leads to the onset of urticaria symptoms. It can be a perplexing and frustrating experience for the people suffering from it because engaging in physical activity is typically associated with health and well-being.

The Science Behind Exercise-Induced Urticaria

The exact cause of urticaria induced by exercise is not fully understood. However, several theories do explain the mechanisms behind this condition. It’s essential to note that it may result from a combination of factors, and the triggers can vary from person to person.

  • Histamine Release: One of the leading theories suggests that EIU causes the release of histamine, a chemical that plays a role in allergic reactions. During exercise, the body’s core temperature increases, releasing histamine from mast cells. This histamine release can result in the characteristic hives and itching in urticaria.
  • Increased Blood Flow: Physical activity increases blood flow to the skin, resulting in high pressure on small blood vessels. This pressure may contribute to the development of hives in individuals predisposed to exercise-induced urticaria.
  • Cholinergic Urticaria: Some cases of EIU are associated with cholinergic urticaria, a specific subtype of urticaria. Cholinergic urticaria is a result of high body temperature, sweating, or emotional stress, which can occur during exercise.

While these theories offer some insight into the mechanisms of exercise-induced urticaria, the condition remains complex and may have multiple contributing factors.

Exercise-Induced Urticaria Symptoms and Diagnosis

This type of urticaria presents a distinct set of symptoms that typically occur during or shortly after physical activity. The primary symptoms include:

  • Itchy, raised hives or welts: These can appear on any part of the body and often have a reddish or pinkish color.
  • Skin redness: The skin may become red or flushed.
  • Swelling: In more severe cases, individuals may experience facial or lip swelling, known as angioedema.
  • Shortness of breath or wheezing: In rare instances, exercise-induced urticaria symptoms may also include respiratory distress.

Diagnosing EIU can be a bit challenging due to the dynamic nature of the condition. Healthcare providers typically rely on a combination of clinical evaluation, a detailed medical history, and specific tests, such as an exercise challenge test. During this test, the patient has to engage in physical activity while the doctor monitors their symptoms and vital signs.

Triggers and Risk Factors

Understanding the triggers and risk factors associated with exercise-induced urticaria is crucial for prevention and management. Some common triggers and risk factors include:

  • Temperature: Extremes in temperature, both hot and cold, can trigger symptoms. Exercise in hot weather or cold environments may be problematic for some individuals.
  • Intensity and Duration: Vigorous or prolonged exercise is more likely to trigger symptoms. Shorter, low-intensity workouts can be effective.
  • Clothing: Tight-fitting clothing that causes friction on the skin can exacerbate symptoms.
  • Food Allergies: In some cases, EIU relates to food allergies. Consuming certain foods before exercise may increase the risk of symptoms.
  • Infections or Illness: Being unwell can make individuals more susceptible to Urticaria by exercise.
  • Underlying Conditions: People with other allergic conditions or a family history of urticaria may be at a higher risk.

Managing Exercise-Induced Urticaria

Managing EIU involves a combination of strategies to reduce the risk of symptoms and alleviate discomfort when they occur. Here are some approaches

Start Slow and Gradual

The key to success is gradual progression. Don’t push your limits or rush into an intense exercise regimen. Instead, start with low-intensity workouts and allow your body to adapt.

Week 1-2: The Foundations

Walking: Begin with daily walks. Start with a 15-minute stroll and gradually increase the duration.

Week 3-4: Building Stamina

Low-Intensity Aerobics: Introduce low-impact aerobics like swimming or cycling for 20-30 minutes, 2-3 times a week.

Choose the Right Time

Timing your workouts can make a significant difference for individuals with EIU. Opt for cooler times of the day, such as early morning or late evening, when the temperature is milder.

Medications and Treatment Options

  • Antihistamines: These medications can help block the effects of histamine and reduce symptoms. They are a preventive measure.
  • Epinephrine: In severe cases, epinephrine (an EpiPen) to treat anaphylactic reactions that can occur with exercise-induced urticaria.
  • Leukotriene Modifiers: These medications are to help control symptoms.
  • Immunotherapy: Allergen-specific immunotherapy for individuals with EIU triggered by specific allergies.

Lifestyle Modifications

  • Identify Triggers: Keeping a detailed diary of exercise routines and any associated symptoms can help identify specific triggers.
  • Manage Stress: Stress management techniques may be helpful, as emotional stress can trigger symptoms.

Stay Hydrated

Proper hydration is essential for everyone. However, it’s especially crucial for those with exercise-induced urticaria. Dehydration can exacerbate symptoms. Drink water before, during, and after exercise to stay well-hydrated.

Monitor Symptoms

Keeping a diary of your exercise routines and symptoms can be invaluable. Note down the type of exercise, duration, and any reactions you experience. This can help you identify patterns and triggers, allowing you to adjust your routine accordingly.

Be Mindful of Food Triggers

Certain foods may trigger EIU in some individuals. Pay attention to your diet and avoid known food triggers before exercising. Consulting with a dietitian can be beneficial.

Alternative Therapies

Acupuncture: Some individuals report relief from urticaria symptoms through acupuncture.

Herbal Remedies: Certain herbs and supplements, like quercetin and bromelain, are believed to have anti-inflammatory properties.

Homeopathy: Some people turn to homeopathic remedies to manage symptoms. Consult a qualified homeopath for guidance.

Living with Exercise-Induced Urticaria: Tips and Coping Strategies

Living with EIU can be challenging, but with the right strategies, individuals can continue to enjoy an active lifestyle:

  • Know Your Limits: Understanding what types of exercise and intensity levels trigger your symptoms can help you make informed choices.
  • Exercise with a Buddy: It’s always a good idea to have someone with you during workouts, especially if you’re prone to severe symptoms.
  • Carry Medications: If prescribed, carry antihistamines or an epinephrine auto-injector as a precaution.
  • Stay Informed: Keep up-to-date with the latest research and treatment options for urticaria.
  • Don’t Give Up: While it may take time to find the right balance, don’t let urticaria deter you from staying active.

When to Seek Medical Help

Exercise-induced urticaria is usually manageable with the right strategies, but there are situations when immediate medical attention is crucial:

  • Anaphylactic Reactions: If you experience severe symptoms like difficulty breathing, swelling of the face or throat, or a drop in blood pressure, use an epinephrine auto-injector if prescribed and seek emergency medical help.
  • Sudden Onset of Symptoms: If you suddenly develop symptoms during exercise and have not been diagnosed with exercise-induced urticaria, seek medical attention.


Exercise-induced urticaria can be a perplexing and frustrating condition, but with the right approach and guidance, individuals can continue to lead active and fulfilling lives. If you suspect you have EIU or have been diagnosed with it, consult a healthcare provider to create a personalized management plan. While it may require some adjustments and precautions, this condition shouldn’t stop you from enjoying the many benefits of physical activity. By staying informed, knowing your triggers, and adopting appropriate strategies, exercise can still be a joyful and rewarding part of your life.


MetroBoston Clinical Partners is a well established and experienced research center in the greater Boston area. Under the leadership of qualified physicians and medical professionals, we coordinate a range of clinical research trials in Dermatology and Internal Medicine.

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