Abstract
This survey searched for allergic skin reactions associated with, and possibly resulting from, sporting or recreational activities. The goal was to develop profiles of the types of allergens and responses that might be expected in association with particular sports involvement. The data mainly derive from published reports of allergic-appearing skin responses occurring during and after sports participation. The majority of these are single or short series of cases. Some supplementary data from earlier reviews, and two cases from our own clinical experience, have also been incorporated. Given the scattered availability of published case material in this field, we have included most of the reports that came to our attention. We have indicated where the connection between the clinical response and the putative agent or sporting activity seems tenuous. The data are organised according to type of reaction (type I, immunoglobulin E-mediated, largely hives, angioedema and anaphylaxis; and type IV, cell-mediated, largely contact dermatitis). Some envenomations that may be amplified by allergy have also been included. In water sports, allergic sensitivity to equipment (wetsuits, masks, goggles), water per se and disinfecting agents, and various water-dwelling creatures was found. In team and other outdoor sports, most allergies related to shoes, braces/supports and other equipment, and occasionally to topical medicaments and other miscellaneous contactants. Sports participants encounter a variety of potential sensitisers. Of interest is whether a higher level of physical activity may put them at greater risk of becoming sensitised.
Similar content being viewed by others
References
Kaplan AP. Exercise-induced hives. J Allergy Clin Immunol 1984; 73: 704–7
Mikhailov P, Berova N, Andreev VC. Physical urticaria and sport. Cutis 1977; 20: 381–90
Merry P. World cup urticaria. J R Soc Med 1987; 80: 779
Gallo R, Cacciapuoti M, Cozzani E, et al. Localized aquagenic urticara dependent on saline concentration. Contact Dermatitis 2001; 44: 101
Parks A, Camisa C. Aquagenic angioedema. Cutis 1986; 37: 465–6
Neering H. Contact urticaria from chlorinated swimming pool water. Contact Dermatitis 1977; 3: 279
Porcel S, Leon F, Cumplido J, et al. Contact urticaria caused by heat-sensitive raw fish allergens. Contact Dermatitis 2001; 45: 139–42
van der Mark S. Contact urticaria from horse saliva. Contact Dermatitis 1983; 9: 145
Tippett J. Allergen immunotherapy. Immunol Allergy Clin North Am 1999; 19: 129–48
Rotne H. Very late reactions to allergen-specific immunotherapy caused by physical exercise [letter]. Allergy 2000; 55: 194
Sheffer AL, Austen KF. Exercise-induced anaphylaxis. J Allergy Clin Immunol 1980; 66: 106–11
Horan RF. Exercise-induced anaphylaxis. Immunol Allergy Clin North Am 2001; 21: 769–82
Shadick NA, Liang MG, 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; 104: 123–7
Schwartz HJ. Elevated serum tryptase in exercise-induced anaphylaxis. J Allergy Clin Immunol 1995; 95: 917–9
Sheffer AL, Tong AK, Murphy GF, et al. Exercise-induced anaphylaxis: a serious form of physical allergy associated with mast cell granulation. J Allergy Clin Immunol 1985; 75: 479–84
Kidd III JM, Cohen SH, Sosman AJ, et al. Food-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol 1983; 71: 407–11
Maulitz RM, Pratt DS, Schocket AL. Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol 1979; 63: 433–4
Silverstein SR, Frommer DA, Dobozin B, et al. Celery-dependent exercise-induced anaphylaxis. J Emerg Med 1986; 4: 195–9
van Wijk RG. Drug-dependent exercise-induced anaphylaxis. Allergy 1995; 50: 992–4
Hanakawa Y, Tohyama M, Shirakata Y, et al. Food-dependent exercise-induced anaphylaxis: a case related to the amount of food allergen ingested. Br J Dermatol 1998; 138: 898–900
Longo G, Barbi E, Puppin F. Exercise-induced anaphylaxis to snails. Allergy 2000; 55: 513–4
Noakes TD. Running shoe anaphylaxis: a case report [letter]. Br J Sports Med 1983; 17: 213
Miessen WMAJ, de Monchy JGR, Dubois AEJ. Anaphylaxis on skin exposure to grass. Allergy 2001; 56: 799
Beuers U, Baur X, Schraudolph M, et al. Anaphylactic shock after game of squash in atopic woman with latex allergy [letter]. Lancet 1990; 335: 1095
Fiocchi A, Restani P, Ballabio C, et al. Severe anaphylaxis induced by latex as a contaminant of plastic balls in play pits. J Allergy Clin Immunol 2001; 108: 298–300
Aihara M, Miyazawa M, Osuna H, et al. Food-dependent exercise-induced anaphylaxis: influence of concurrent aspirin administration on skin testing and provocation. Br J Dermatol 2002; 146: 466–72
Dohi M, Suko M, Sugiyama H, et al. Three cases of food-dependent exercise-induced anaphylaxis in which aspirin intake exacerbated anaphylactic symptoms. Arerugi 1990; 39: 1598–604
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; 108: 1035–9
Caballero MT, Padial A, San-Martin MS, et al. Mustard hypersensitivity as a cause of anaphylaxis. J Allergy Clin Immunol 1997; 99 Suppl.: S145
Alomar A, Vilaltella I. Contact dermatitis to dibutylthioruea in swimming goggles. Contact Dermatitis 1985; 13: 348–9
Azurdia RM, King CM. Allergic contact dermatitis due to phenol-formaldehyde resin and benzoyl peroxide in swimming goggles. Contact Dermatitis 1998; 38: 234–5
Romaguera C, Grimalt F, Vilaplana J. Contact dermatitis from swimming goggles. Contact Dermatitis 1988; 18: 178–9
Vaswani SK, Collins DD, Pass CJ. Allergic eyelid contact dermatitis from swimming goggles [abstract]. J Allergy Clin Immunol 2001; 107 Suppl.: S214
Fitzgerald DA, Wilkinson SM, Bhaggoe R, et al. Spa pool dermatitis. Contact Dermatitis 1995; 33: 53
Sasseville D, Geoffrion G, Lowry RN. Allergic contact dermatitis from chlorinated swimming pool water. Contact Dermatitis 1999; 41: 347–8
Balestrero S, Cozzani E, Ghigliotti G, et al. Allergic contact dermatitis from a wet suit. J Eur Acad Dermatol Venereol 1999; 13: 228–9
Boehncke W-H, Wessmann D, Zollner TM, et al. Allergic contact dermatitis from diphenylthiourea in a wet suit. Contact Dermatitis 1997; 36: 271
Corazza M, Virgili A. Allergic contact dermatitis due to nickel in a neoprene wetsuit. Contact Dermatitis 1998; 39: 257
Kerre S, Devos L, Verhoeve L, et al. Contact allergy to diethylthiourea in a wet suit. Contact Dermatitis 1996; 35: 176–8
Tuyp E, Mitchell JC. Scuba diver facial dermatitis. Contact Dermatitis 1983; 9: 334–5
Ventura MT, Dagnello M, Matino MG, et al. Contact dermatitis in students practicing sports: incidence of rubber sensitization. Br J Sports Med 2001; 35: 100–2
Munro CS, Shields TG, Lawrence CM. Contact allergy to Tego 103G disinfectant in a deep-sea diver. Contact Dermatitis 1989; 21: 278–9
de Leeuw J, den Hollander P. A patient with a contact allergy to jogging cream. Contact Dermatitis 1987; 17: 260–1
Villarreal Balza de Vallejo O. Contact dermatitis from diphenylthiourea in a knee brace. Contact Dermatitis 1997; 36: 166–7
Romaguera C, Grimalt F, Vilaplana J. Shoe contact dermatitis. Contact Dermatitis 1988; 18: 178
Blair C. The dermatological hazards of bowling: contact dermatitis to resin in a bowlsgrip. Contact Dermatitis 1982; 8: 138–9
Paterson BC, White MI, Cowen PSJ. Further observations on adverse reactions to a bowler’s grip. Contact Dermatitis 1993; 29: 278
Sommer S, Wilkinson SM, Dodman B. Contact dermatitis due to urea-formaldehyde resin in shin-pads. Contact Dermatitis 1999; 40: 159–60
Vincenzi C, Guerra L, Peluso AM, et al. Allergic contact dermatitis due to phenol-formaldehyde resins in a knee-guard. Contact Dermatitis 1992; 27: 54
Haapasaari K-M, Niinimaki A. Vesicular palmar eczema from the neoprene tongue of an ankle support. Contact Dermatitis 2000; 42: 248
Vilaplana J, Romaguera C. Allergic contact dermatitis due to eucalyptol in an anti-inflammatory cream. Contact Dermatitis 2000; 43: 118
Fisher AA. Sports-related cutaneous reactions. Part II: allergic contact dermatitis to sports equipment. Cutis 1999; 63: 202–4
Burches E, Morales C, Pelaez A. Contact dermatitis from cuttlefish. Contact Dermatitis 1992; 26: 277
Jeebhay MF, Robins TG, Lehrer SB, et al. Occupational sea-food allergy: a review. Occup Environ Med 2001; 58: 553–62
Virgili A, Ligrone L, Bacilieri S, et al. Protein contact dermatitis in a fisherman using maggots of a flesh fly as a bait. Contact Dermatitis 2001; 44: 246–63
Warren LJ, Marren P. Textile dermatitis and dyed maggot exposure. Contact Dermatitis 1997; 36: 106
Kirkup ME, Sansom JE. Contact sensitivity to tetrahydroxypropyl ethylenediamine in a sunscreen, without cross-sensitivity to ethylenediamine. Contact Dermatitis 2000; 43: 121–2
Freeman MJ, Bergfeld WF. Skin diseases of football and wrestling participants. Cutis 1970; 20: 333–41
Okazawa H, Aihara M, Nagatani T, et al. Allergic contact dermatitis due to ethyl alcohol. Contact Dermatitis 1998; 38: 233
Foussereau J. An allergen in a judo club? Contact Dermatitis 1985; 13: 283
Goncalo S, Goncalo M, Matos J, et al. Contact dermatitis from a billiard cue. Contact Dermatitis 1992; 26: 263
Gonzalez E. Schistosomiasis, cercarial dermatitis, and marine dermatitis. Dermatol Clin 1989; 7: 291–300
Chapman A, Ekelund C, Tominaga J. Rash and pruritus after a camping trip. Pediatr Infect Dis J 1993; 12: 966–9
Edmonds C. Bathers’ itch. In: Flagstaff AZ, editor. Dangerous marine creatures. Flagstaff (AZ): Best Publishing Company, 1995: 174–6
Edmonds C. Bathing suit dermatitis. In: Flagstaff AZ, editor. Dangerous marine creatures. Flagstaff (AZ): Best Publishing Company, 1995: 177–8
Freudenthal AR, Joseph PR. Seabather’s eruption. N Engl J Med 1993; 329: 542–4
Kumar S, Hlady WG, Malecki JM. Risk factors for seabather’s eruption: a prospective cohort study. Public Health Rep 1997; 112: 59–62
Tomchik RS, Russell MT, Szmant AM, et al. Clinical perspectives on seabather’s eruption, also known as ‘sea lice’. JAMA 1993; 269: 1669–72
Ubillos SS, Vuong D, Sinnott JT, et al. Seabather’s eruption. South Med J 1995; 88: 1163–5
Burnett JW, Kumar S, Maleck JM, et al. The antibody response in seabather’s eruption. Toxicon 1995; 33: 99–104
Burnett JW, Calton GJ, Burnett HW, et al. Local and systemic reactions from jellyfish stings. Clin Dermatol 1987; 5: 14–28
Burnett JW, Calton GJ, Burnett HW. Jellyfish envenomation syndromes. J Am Acad Dermatol 1986; 14: 100–6
Burnett JW, Auerbach P. Stinging marine creatures. Alert Diver: The Magazine of Divers Alert Network 2000; Mar/Apr: 20–21
Kokelj F, Stinco G, Avian M, et al. Cell-mediated sensitization to jellyfish antigens confirmed by positive patch test to Olindias sambaquiensis preparations. J Am Acad Dermatol 1995; 33: 307–9
Peca G, Rafanelli S, Galassi G, et al. Contact reactions to the jellyfish Carybdea marsupialis: observation of 40 cases. Contact Dermatitis 1997; 36: 124–6
Edmonds C. Fire coral. In: Flagstaff AZ, editor. Dangerous marine creatures. Flagstaff (AZ): Best Publishing Company, 1995: 117–8
Addy JH. Red Sea coral dermatitis. Int J Dermatol 1991; 30: 271–3
Nutter AF. Contact urticaria to rubber. Br J Dermatol 1979; 101: 597–8
Acknowledgements
The authors were supported during the preparation of this manuscript by funds from the Department of Pediatrics, Michigan State University, Kalamazoo Center for Medical Studies, Ml, USA. We acknowledge with thanks the services of the Bronson Methodist Hospital medical library (James Shiley) in obtaining many of the papers reviewed, and Liga Greenfield (Pharmacia Corp.) for help with part of the literature search. The authors have no conflicts of interest directly relevant to the content of this review.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brooks, C.D., Kujawska, A. & Patel, D. Cutaneous Allergic Reactions Induced by Sporting Activities. Sports Med 33, 699–708 (2003). https://doi.org/10.2165/00007256-200333090-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-200333090-00005