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Some people experience intense itching during and after exercise. They may also develop flat, red bumps on the skin, which are also called hives. These may look like blotches or blisters that can appear anywhere in the body. These are characteristic of a condition called exercise-induced urticaria.

Exercise-induced urticaria is a distinct form of allergy induced by physical activity.

It is not common, but it can occur during various athletic activities such as jogging, dancing, bicycling, and tennis. Sometimes, symptoms also occur during lower levels of physical activity such as walking or doing yard work. Aside from itching and hives, symptoms may include redness or flushing of the skin, swelling of the face, tongue, and hands, headache, nausea, vomiting, stomach cramps, diarrhea, choking, and difficulty breathing. These symptoms often subside when physical activity is stopped, but in some people, a life-threatening anaphylaxis (severe allergic reaction) may occur.

What causes exercise-induced urticaria is not clear. However, studies show that during exercise, mast cells may be activated and histamine may be released. These, and other mediators, are often involved in allergic reactions. In some patients, eating certain foods before exercise can cause symptoms to appear. It has been observed that some patients tolerate these foods when they do not exercise, and others exercise without symptoms if they do not eat certain foods, suggesting the possible relationship between the combination of certain food and physical activity with allergic reactions. Other factors that may trigger exercise-induced anaphylaxis include alcohol and non-steroidal anti-inflammatory drugs (NSAIDs).

Do You Have to Give Up Exercise?

You do not have to give up exercising, but you should slow down or stop exercising as soon as your symptoms start. Call your doctor immediately if the hives do not go away in a few minutes, or if you have other symptoms. These symptoms do not always appear in the same type or intensity of exercise you do. It is best if you can exercise with a partner who knows about your condition.

Eating certain foods before exercise may increase the likelihood of allergic symptoms to occur. Try to keep track of the foods you eat before exercising for a few weeks to see if there is a pattern associated with your symptoms. If so, stop eating these foods for a while and observe if the symptoms stop. Your doctor may also advise you not to exercise within a few hours after you eat.

In some cases, medicines may help prevent symptoms. These include antihistamines such as hydroxyzine, mast cell stabilizers such as cromolyn (Intal), and leukotriene modifying agents such as montelukast (Singulair), zileuton (Zyflo), and zafirlukast (Accolate). Corticosteroids such as prednisone may also help reduce allergic reactions, but long-term use is no recommended because of potential side effects.

In severe, life-threatening cases, when difficulty in breathing or vascular collapse occurs, you may need to receive epinephrine injections. Beta-agonists such as albuterol may also be given to relieve chest tightness and airway obstruction.

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