Exercise-induced anaphylaxis (EIA) is a unique physical allergy characterised by a spectrum of symptoms occurring during physical activity that ranges from mild cutaneous signs to severe systemic manifestations such as hypotension, syncope and even death. Although EIA is a rare condition, it is becoming increasingly recognised, as more people participate in physical activity and sport. The specific aetiology of EIA is unclear; however results from skin biopsies reveal a lowering of the mast-cell degranulation threshold, which causes the release of histamine and other mediators. Five types of EIA can be distinguished and have been described in the literature. Because of the fact that there are specific precipitating factors in EIA, physicians in collaboration with their patients should develop individual long-term management strategies for controlling EIA. Management of acute episodes of EIA typically includes cessation of exercise, administration of epinephrine and antihistamines, vascular support and airway maintenance.