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Recently, Dr Sudhir Kumar, a neurologist with Apollo Hospitals, Hyderabad came across a very peculiar case — a young man would develop severe itching all over his body after running, which would last for an hour or so. Opening about the same in a Twitter thread, the expert wrote: “Sid presented with an unusual symptom. He used to develop severe itching all over his body whenever he ran 4 km or more. He had been unsuccessful in his attempt to train for long-distance running,” adding that the 33-year-old had no itching when at rest or any allergy to any food items. In all, he was healthy, however, “due to his inability to run (or do any other high-intensity exercise), he was gaining weight, and had gained 10 kg over the past 2 years.”
But, despite consulting many physicians, a diagnosis could not be reached. As a last resort, the patient visited Dr Kumar who heard his history and realised that the “itching would last for 60-90 minutes and resolve on its own. The diagnosis was obvious by now (I remember seeing a similar case in 1995 during my MD Medicine residency when I was posted in the dermatology unit),” he wrote, adding that “no tests were needed to confirm the diagnosis, as the diagnosis rests on history and exercise-challenge test (where the patient is made to exercise under medical supervision and examined for the appearance of itching symptoms).”
The diagnosis was finally confirmed as “exercise-induced urticaria”. Concluding, Dr Kumar wrote: “Take home message: *exercise-induced urticaria is an uncommon condition; *diagnosis can be made by careful history and exercise challenge test; *management options include low-intensity exercises or antihistaminic dose prior to exercise.”.
Following the same, he received treatment for exercise-induced urticaria, an ‘uncommon condition’.
What is exercise-induced urticaria?
Exercise-induced urticaria is a condition that causes people to develop hives and other allergic reactions during or after a physical activity. The hives might appear like large, raised bumps on the skin, and can occur on any part of the body. They can also look like red spots, blotches, or blisters. Explaining the causes, Dr Rashmi Shetty, Global Dermatology Expert, Founder of Ra Skin & Aesthetics said, “There are various activities that could lead to urticaria, such as increased heat during exercise, rise in blood supply to parts of the body, excessive sweat, or a certain food you consume before the exercise or a specific shower gel or soap that you use.”
Following are the common symptoms:
*Hives
*Itching on the skin
*Flushing (redness) on the skin
*Difficulty breathing or the feeling of choking
*Stomach cramps
*Swelling on face, tongue and hands
*Headache
She advised to immediately stop exercising if you notice hives and other symptoms and contacting a medical practitioner if the symptoms do not go away after 5 to 10 minutes. They may advise a skin-prick test to check for allergies or give some exercise tests to see if the allergic reaction happens again.
There is no way to avoid exercise-induced urticaria, but one can prevent flare-ups by not consuming certain food products or practicing types of exercise that may trigger symptoms. Highlighting the same, Dr Shetty told indianexpress.com, “Preventive measures would depend on the trigger. A few actions to follow, however, would be exercising in a cool room with an air conditioner, keeping yourself well-hydrated or consuming an antihistamine before exercising, after consulting with your doctor.”
A research done by Mayo Clinic in 1997 suggested that exercise-induced urticaria was extremely rare–however cases were increasing with time. They found that women were more likely than men to experience this condition, and most of them had a history of asthma, eczema or allergic reactions to airborne allergens. Additionally, exercise-induced urticaria was more likely to occur if an individual exercises in a very warm, humid or extremely cold environment.
Treatment
According to Dr Shetty, the first step in the treatment is to identify the triggers and avoid it altogether. “Other than that, depending on the severity, a doctor would prescribe a steroid ointment or oral antihistamines. If the case is extremely severe, oral steroids may be prescribed as well,” she said.
“In certain cases, your provider might help identify which exercises to avoid that trigger symptoms. They might also ask you to keep track of what you eat before exercising,” she added.
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