Pathophysiological mechanisms of exercise-induced anaphylaxis: an EAACI position statement

Allergy. 2015 Oct;70(10):1212-21. doi: 10.1111/all.12677. Epub 2015 Jul 8.


This document is the result of a consensus on the mechanisms of exercise-induced anaphylaxis (EIAn), an unpredictable and potentially fatal syndrome. A multidisciplinary panel of experts including exercise physiologists, allergists, lung physicians, paediatricians and a biostatistician reached the given consensus. Exercise-induced anaphylaxis (EIAn) describes a rare and potentially fatal syndrome in which anaphylaxis occurs in conjunction with exercise. The pathophysiological mechanisms underlying EIAn have not yet been elucidated although a number of hypotheses have been proposed. This review evaluates the validity of each of the popular theories in relation to exercise physiology and immunology. On the basis of this evidence, it is concluded that proposed mechanisms lack validity, and it is recommended that a global research network is developed with a common approach to the diagnosis and treatment of EIAn in order to gain sufficient power for scientific evaluation.

Keywords: allergy; anaphylaxis; exercise; immunology; physiology.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anaphylaxis / etiology*
  • Anaphylaxis / metabolism
  • Anaphylaxis / physiopathology
  • Animals
  • Basophils / immunology
  • Basophils / metabolism
  • Exercise*
  • Gastrointestinal Tract / blood supply
  • Gastrointestinal Tract / metabolism
  • Hemodynamics
  • Histamine Release
  • Humans
  • Mast Cells / immunology
  • Mast Cells / metabolism
  • Osmolar Concentration
  • Permeability
  • Regional Blood Flow
  • Transglutaminases / metabolism


  • Transglutaminases