Sweat Allergy: Causes, Diagnosis, and Treatment

Author: Dr Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights 

• Sweat allergy is an unusual condition triggered by the body’s sweat.
• It causes intense itching, rashes, and discomfort, especially in hot conditions.
• Common in people with atopic dermatitis or cholinergic urticaria.
• Triggered by exercise, heat, spicy food, or emotional stress.
• Diagnosis involves symptom review, physical exam, and some lab tests 
• Management includes lifestyle changes, antihistamines, moisturisers, and antifungal drugs.

Introduction

You are in your office on a very hot day when your air conditioner suddenly stops working. You start sweating, and as that happens, it feels like your body is on fire. You begin to itch all over. You call the maintenance department, and they promptly restore the air conditioner. As soon as the sweat dries, the itching stops.

The next day, you step out of your air-conditioned car into the scorching sun. You start sweating again, and the itching returns. This has become a recurring problem, and you’ve been wondering what it could be. This condition is known as sweat allergy. It is not very common, but it causes significant discomfort. In this article, I will explain what sweat allergy means and how to manage it.

What is sweat allergy?

Sweat allergy is a condition in which your body has an exaggerated reaction to the components of your sweat, leading to itching. This condition was first described in 1953 by Sulzberger and his associates. It results from the interaction between sweat and the skin.

How does sweat allergy develop?

Sweat is a transparent body fluid naturally produced by the sweat glands [1, 2].  It contains many molecules and chemicals and is responsible for:

• Maintaining body temperature
• Moisturising the skin
• Fighting infections through antimicrobial peptides
• Excreting toxic substances
  
  

This condition is linked to the presence of an antigen called MGL-1304, which is found in sweat. This antigen is produced by Malassezia globosa, a fungus that naturally lives on the skin, along with other bacteria and viruses[3,4,5], These organisms are collectively referred to as the skin microbiota. Malassezia globosa is more concentrated in sweat-sensitive areas of the skin.

In affected individuals, this antigen causes the release of a substance called histamine from a type of white blood cell known as basophils. Beyond the sweat antigen, some researchers suspect that other chemicals produced by the sweat glands may also contribute to the condition [4].

Who is at risk of sweat allergy?

Sweat allergy is often seen in patients with atopic dermatitis or cholinergic urticaria. People with these two conditions tend to have higher levels of the MGL-1304 antigen in their blood.

• Atopic dermatitis is a chronic skin condition often associated with a personal or family history of allergies [5]. Patients may also have asthma or allergic rhinitis (stuffy, runny nose). It is characterised by skin redness, itching, wheals, and peeling. Also known as atopic eczema, it typically begins in childhood but may persist into adulthood. 
  
  
• Cholinergic urticaria is an allergic condition seen mostly in adolescents and young adults, particularly those with a history of allergies[6].  It is triggered by a rise in body temperature due to exercise, fever, or external heat. In addition to itching, patients develop raised skin rashes called wheals. In severe cases, it can lead to allergic shock [7]. This condition is also known as sweat-induced hives.

In an early study by Adachi and associates, 20 patients with cholinergic urticaria were tested using their sweat (autologous sweat), and all had skin reactions. Histamine release was also noted in some of them. 

How does sweat allergy manifest?

The symptoms usually appear when you sweat [1,5,6]. Common triggers include:

• Exercise
• High environmental temperatures
• Spicy foods
• Fever
• Psychological stress
  
  

The primary symptom is itching, especially in areas where sweating is most intense, such as the neck, armpits, and elbow creases. In patients with atopic dermatitis, skin rashes are also common in these areas.

How is sweat allergy diagnosed?

Diagnosis is based on history, physical examination, and laboratory tests.

• History: Patients typically report generalised itching triggered by sweating. There may be a stinging sensation, especially in those with hives. Some may also report rashes. Your doctor will ask if you have other allergies.
  
  
• Examination: Physical signs may include rashes and scratch marks. Your doctor may ask you to exercise briefly in the office to see if sweating triggers your symptoms.
  
  
• Lab tests: Several tests can help confirm the diagnosis, including:
  
  
  • Histamine release test: A blood test to measure histamine released from white blood cells
    
    
  • Autologous Sweat Skin Test:  Small amounts of your sweat are injected into your skin to check for a reaction
    
    
  • Enzyme Linked Immunosorbent Assay(ELISA test): A blood test that detects antibodies to the sweat antigen
    
    
  • Basophil activation test: A blood test to see if white blood cells react to sweat
    
    

Other diagnostic methods are still being researched and developed.

When to see a Doctor

Mild cases may not affect your daily life, but you should consult a doctor if:

• Your symptoms interfere with your daily activities
• You experience additional symptoms like rash, breathing difficulty, or fainting
• Over-the-counter medications have not helped
  
  

Early diagnosis and proper treatment can help you manage symptoms and improve your quality of life.

Treatment of sweat allergy

Home remedies

Preventive measures: 

Avoid triggers that cause sweating, such as strenuous exercise, hot environments, and hot baths

• Other tips:
  
  
  • Wear breathable fabrics
  • Use fans or air conditioning
  • Avoid spicy foods
  • Manage stress

Sweat management:

To reduce irritation from sweat:

• Shower at least once daily
• Rinse affected areas with water regularly
• Use cold wipes
• Change sweat-soaked clothes
  
  

Other measures: 

Use of moisturisers/emolients: In people with atopic dermatitis, damaged skin increases the risk of sweat allergy. Improving the skin barrier with moisturisers or emollients is important. Emollients that have a higher oil content than water are preferred. 

Drug treatment

In some cases, drugs may be used to alleviate the symptoms [1]. These drugs include: 

• Steroid creams: Useful especially for patients with atopic dermatitis
  
  
• Antihistamines: The most commonly used drugs. They block the effect of histamine, eg cetrizine
  
  
• Oral antifungals: Drugs like ketoconazole or itraconazole can reduce the number of Malassezia fungi on the skin.  Long-term use is not advised, as it may lead to overgrowth of other organisms like Staphylococcus aureus
  
  
• Sweat desensitisation therapy: This involves gradually exposing patients to artificial sweat or their sweat to build tolerance. This is especially helpful in cholinergic urticaria
  
  
• Targeted therapy: Involves special molecules that bind to the MGL-1304 antigen to prevent histamine release eg monoclonal antibodies
  
  
• Tannic acid spray: Tanninc acid is found in grapes and green tea. Applying tannic acid spray after bathing can help reduce histamine release
  
  
• Tacrolimus: A topical drug (cream) that suppresses immune activity in the skin. It may be helpful for patients with atopic dermatitis or cholinergic urticaria
  
  

Conclusion

Sweat allergy is a rare but distressing condition that can significantly affect quality of life. Proper evaluation is essential to confirm the diagnosis and identify any related conditions. Although the condition is still being studied, several effective treatments are available. If you experience symptoms, it is advisable to visit your doctor for proper evaluation. Over-the-counter medications and lifestyle modifications can also bring relief. Preventing excessive sweating is a key step in reducing flare-ups and improving your comfort.

References

1. Takahagi S, Tanaka A, Hide M. Sweat allergy. Allergology International [Internet]. 2018 Oct 1 [cited 2025 May 2];67(4):435–41. Available from: https://www.sciencedirect.com/science/article/pii/S1323893018300856
2. Murota H, Yamaga K, Ono E, Murayama N, Yokozeki H, Katayama I. Why does sweat lead to the development of itch in atopic dermatitis? Experimental Dermatology [Internet]. 2019 Dec [cited 2025 May 8];28(12):1416–21. Available from: https://onlinelibrary.wiley.com/doi/10.1111/exd.13981
3. Hiragun T, Hide M. Sweat allergy. Curr Probl Dermatol. 2016;51:101–8. https://pubmed.ncbi.nlm.nih.gov/27584969/
4. Hiragun T, Hiragun M, Ishii K, Kan T, Hide M. Sweat allergy: Extrinsic or intrinsic? J Dermatol Sci. 2017 Jul;87(1):3–9.
5. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. The Lancet [Internet]. 2020 Aug 1 [cited 2025 May 2];396(10247):345–60. Available from: https://www.sciencedirect.com/science/article/pii/S0140673620312861
6. Fukunaga A, Oda Y, Imamura S, Mizuno M, Fukumoto T, Washio K. Cholinergic Urticaria: Subtype Classification and Clinical Approach. Am J Clin Dermatol. 2023 Jan;24(1):41-54. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9476404/
7. Borzova E, Grattan CEH. 42 - Urticaria, angioedema, and anaphylaxis. In: Rich RR, Fleisher TA, Shearer WT, Schroeder HW, Frew AJ, Weyand CM, editors. Clinical Immunology (Third Edition) [Internet]. Edinburgh: Mosby; 2008 [cited 2025 Apr 30]. p. 641–56. Available from: https://www.sciencedirect.com/science/article/pii/B9780323044042100429

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published May 9, 2025