A 44-year-old man with a two-year history of episodes of exercise-related urticaria and facial angioedema was admitted to our department because of vascular collapse during an athletic activity. The diagnosis of exercise-induced anaphylaxis was established after excluding other causes of shock. This clinical syndrome was described recently; it consists of urticaria, local angioedema and/or cardiorespiratory failure following exercise. Factors possibly associated with or predisposing to attacks include personal and family histories of atopy, food ingestion and weather conditions. Not every effort evokes these reactions, indicating the presence of other, still unknown variables and therefore complicating the diagnosis because provocation tests often have false-negative results. With reference to this case, the clinical syndrome, its pathophysiology and its treatment are discussed.