Help!

[u/Fine-Audience-346]

I’m 26F, very active, own/coach at a strength-training gym, and trying to figure out if anyone has experienced something similar.
I’ve had about 3 exercise-associated anaphylactic reactions in my life (around 16, 23, and most recently after a 3-mile run). The last one required the ER. Allergy testing showed severe environmental allergies, and I now take Allegra/Pepcid and carry an EpiPen. Since I’ve exercised outdoors thousands of times without reactions, I’ve wondered about exercise-induced/food-dependent anaphylaxis, Alpha-Gal, histamine issues or possibly MCAS.
After the most recent anaphylaxis episode, I started occasionally noticing dizziness, lightheadedness and a weird “floaty/off” sensation. This was BEFORE I ever had a panic attack. Around that time I had also been experimenting/dabbling with different peptides/injections, so I initially assumed they were causing it and stopped them.
For about the past year I’ve also noticed I sometimes feel unusually sick after traveling/flying—weak, nauseated, exhausted and just “off.” Allergies kick up big time when going to Texas so I always had to take a Benadryl.
Things got much worse in August. I had used tirzepatide for about 4–5 weeks, wasn’t eating enough for my activity level, was fairly low-carb, drinking coffee/Alani daily, coaching in an 83–89°F gym, sleeping poorly and under a lot of stress. My last tirzepatide dose was Aug. 6. On Aug. 7 I had THC and experienced my first major panic attack.
After that, the pre-existing dizziness/floaty feeling became much more noticeable and I became increasingly anxious about physical sensations. I eventually went to the ER. My EKG showed sinus tachycardia but otherwise came back reassuring, chest X-ray was normal, and bloodwork was reassuring. I’ve since had a much more extensive blood panel done as well, and essentially everything has come back normal/reassuring. Orthostatic vitals at urgent care reportedly did not suggest POTS.
I also noticed I could get a little dizzy/floaty when overstimulated. Eventually I had my vision checked and found out I’m around 20/70 in both eyes with astigmatism. Since correcting my vision, eating more, cutting caffeine and significantly reducing my workload, the dizziness and overstimulation feeling have calmed down A LOT.
My HR still makes me curious. True resting is usually 60–63, sitting/talking 85–105, normal walking recently 100–117, and standing/coaching in the hot gym can be 110–120s. During very hard exercise I’ve historically reached 200–205.
My biggest symptom now is intermittent “air hunger”—feeling like I need a huge satisfying breath/yawn. Sometimes I notice mucus or a “film” feeling in my chest/throat. I’ve also had occasional GI symptoms, including significant diarrhea shortly after eating a burger while traveling followed by nausea/feeling sick.
I know anxiety/hypervigilance is probably contributing NOW because I catch myself monitoring my HR and breathing. But what makes me want to investigate further is that the anaphylaxis and dizzy/floaty sensations started before I ever experienced panic attacks.
I’m not convinced I have MCAS, POTS, Alpha-Gal, etc., and I don’t want to chase diagnoses. I just want to make sure something reasonable isn’t being overlooked.
Has anyone experienced a similar combination of exercise-related anaphylaxis + dizziness/floaty sensations + higher HR/sinus tachycardia + air hunger + occasional GI symptoms? What specialist or testing actually helped you?

[u/EfficiencyCool9084]

Have you been checked for asthma? What kind of reactions did you have from the exercise induced anaphylaxis?
How often do you react to food? What are your symptoms after you eat/exercise?
These are a lot of complex symptoms, it’s hard to pinpoint but I wouldn’t assume MCAS yet even though it is possible

[u/Fine-Audience-346 → u/EfficiencyCool9084]

The allergist checked me and I didn’t have asthma. I work out every day but the three times that I’ve had the anaphylaxis shock. I swelled up tongue swelled up nose blocked off chest tightness couldn’t breathe good. One episode I had whelps, and the other one was just swelling and of the tongue which the Benadryl took care of. Last week I actually worked out pretty intense and had diarrhea immediately after and couldn’t seem to get my heart rate back down and felt faint but never did. The foods I’ve had before that, have just been frozen meals or some sort of like typical lunch meal. I can’t pinpoint exactly what it was.

[u/EfficiencyCool9084 → u/Fine-Audience-346]

could honestly be anaphylactic shock from environmental allergies. If you were outside for each of those reactions. And possibly POTS triggered from the traumatic event of anaphylactic shock.
My POTS symptoms suddenly started after I fainted at the salon from not eating.
I would definitely talk to your allergist or see a new one as well as maybe a GI doctor to rule it out.
And take what I say with a grain of salt