My medical mystery

Triathlon Forum
1

I’ve had a few concerning episodes in regards to an allergic reaction of some sort in the past month, and am wondering if anyone has ever had something similar. I do have an appt with an allergist next week.

Late sept, the night before my wife’s ironman chatt (oops) I vomited (felt acid building up all day and finally peaked when I went to sleep) and then broke out in full body hives. Quick trip to walgreen for Benadryl and I was back to normal in a couple of hours. I assumed it was some weird food or freak reaction.

Fast forward to this saturday - raced a local 10-mile race and started feeling a breakout about 7 miles in. Super hot and itchy feet first, then groin, then rest of body. Shortly after finishing, I also experienced facial swelling around my mouth. I looked like an old man with jowls at age 30. Benedryl and nap, back to normal in a few hours, but concerned.

Last night running trails(~6 miles), felt the hot feet again, and cut run short. Body covered in hives again and even more swelling in face. This time upper lip, nose, bit by an eye, maybe a bit in the mouth. Benadryl, bed. Woke up hive free but with swelling in my face still present. Another benadryl dose and it’s coming down through the morning…

So the weird part is that I have no history of any allergy/reaction, and everything I ate was normal/homemade. I can’t think of anything unusual other than stressing the body (running x2, vomiting x1). I’ve been training for a 50-mile next weekend with high mileage, so the body is tired, but neither of these runs are harder than workouts i’ve been doing in the past few months.

Has this happened to anyone in the past? Heard of exercise-induced allergic reaction?

2

I’ve had a few concerning episodes in regards to an allergic reaction of some sort in the past month, and am wondering if anyone has ever had something similar. I do have an appt with an allergist next week.

Late sept, the night before my wife’s ironman chatt (oops) I vomited (felt acid building up all day and finally peaked when I went to sleep) and then broke out in full body hives. Quick trip to walgreen for Benadryl and I was back to normal in a couple of hours. I assumed it was some weird food or freak reaction.

Fast forward to this saturday - raced a local 10-mile race and started feeling a breakout about 7 miles in. Sper hot and itchy feet first, then groin, then rest of body. Shortly after finishing, I also experienced facial swelling around my mouth. I looked like an old man with jowls at age 30. Benedryl and nap, back to normal in a few hours, but concerned.

Last night running trails(~6 miles), felt the hot feet again, and cut run short. Body covered in hives again and even more swelling in face. This time upper lip, nose, bit by an eye, maybe a bit in the mouth. Benadryl, bed. Woke up hive free but with swelling in my face still present. Another benadryl dose and it’s coming down through the morning…

So the weird part is that I have no history of any allergy/reaction, and everything I ate was normal/homemade. I can’t think of anything causal other than stressing the body (running x2, vomiting x1). I’ve been training for a 50-mile next weekend with high mileage, so the body is tired, but neither of these runs are harder than workouts i’ve been doing in the past few months.

Has this happened to anyone in the past? Heard of exercise-induced allergic reaction?

Could you be having a reaction to something outside, rather than something you ate. Not so extreme, but the first time I came down with hay fever, my whole throat went itchy and closed up. I also had a similar reaction to your symptoms when I was given morphine in hospital.

3

This is a doctor thing but I feel it is a key indicator that each time this happens it has been around a run.

Given that I would isolate:
-did you run indoors or out, where, same place both times
-what nutrition did you take in the 2 hours before the run
-what did you wear on the run, same shoes, socks, shorts, top, sweat band, eyewear, bottle you drank from, sunscreen you used etc…I would nuke that stuff in terms of washing it at this point
-what was the pollen count and type that day

I’m really allergic to poison ivy, so have to recall what else I touched when I have an incident and then wash all that stuff. Otherwise it’s a mine field of minor exposures after the primary exposure.

4

Decades ago I had a bizarre rash/hives that seemed to be triggered when my body temp increased. Benadryl would temporarily resolve it, but it came back. Went to an allergist, and he prescribed a mega antihistamine for a week or so. He had no explanation, except a generic “sometimes this happens and we don’t know why.” The idea is that you crush it with a powerful antihistamine, and it goes away and never returns. That is what happened for me.

5

As an adult I developed allergies to some foods that I grew up eating w/o problem, but the reactions to them landed me in the ER with airways swelling shut a few times; amazing how not being able to breathe can affect your future preferences for food choices :frowning: . Those allergies disappeared (confirmed by repeated tests with an allergist) as mysteriously as they appeared.

The severity of those past reactions did, however, condition me to take other unexplained allergic reactions very seriously. They only occurred when running - not biking, swimming, walking, weightlifting or xc skiing. The intermittent nature of the reactions made tracking down the cause difficult. One of the factors that occurred more often was sudden rapid rise in body temperature that occurred during a run when dressed warmly in cool or cold weather. I had a bad outbreak of hives during a winter run that led to a full workup at a local allergy specialist. Very low level reactions to wheat, eggs and hazelnuts showed up (I had that combination in breakfast that morning) were a possible partial explanation, although I had eaten wheat and eggs frequently both before and after without incident on many other runs. The running-specific nature suggested something else according to the allergist - vibrational urticaria.

https://www.nih.gov/news-events/news-releases/nih-scientists-discover-genetic-cause-rare-allergy-vibration

It was the allergist’s conclusion that the hives (my primary symptom here) were not life-threatening in these situations and that non-drowsy antihistamines before or after, coupled with stopping the run and cooling off would be sufficient. Given that, I haven’t bothered with any sort of genetic testing to see if I have the mutation linked to this.

6

Hives can be a symptom of overactive thyroid. Have them check your TSH levels.

7

A hot burning/tingling sensation in my foot usually means my gout is about to come back. Gout is caused by high triglycerides which is a body chemistry thing. So I don’t think you have gout but your thinking something external is causing this may be incorrect. So having a complete blood work up might yield some clues or a diagnosis

8

https://www.mayoclinicproceedings.org/article/S0025-6196(11)63475-7/fulltext

Exercise induced urticaria……?

For the last several years I have developed severe itching and hives on my abdomen and legs after exercise, but only when I train in the cold. I have no issues all summer long but when the winter returns it comes right back. This last week the temperature dropped into the 40s and sure enough, the hives and itching were back.

I haven’t had this my whole life, only the last few years. No idea why it started.

I spoke with an allergist about this. Antihistamines were recommended. Some people advise carrying and Epi Pen. I’ve had this without any sequelae for at least a half dozen years so we decided this wasn’t necessary for me.

Not saying that this is what you have but it’s a thought.

9

Do you have a history of tick borne illnesses? I developed an allergy to meat, (alpha-gal) but it’s not the meat, it is the meat reacting to a previous tick bite. My allergy comes on about 4-5 hours after ingesting mammalian meat. It took an allergist five years to make the connection as everything they tested me for came up negative……it was the interaction with the tick bite. Just something else to consider. Good luck with that, be safe, and don’t give up until you have an answer.

10

Clearly an issue for a doctor, so I am curious to hear their perspective.

Throwing this out there- did you recently get a covid booster shot or a flu shot? I only ask because I have a family member who had some unusual swelling in their face and hands several weeks after the booster ( 3rd shot), they are still dealing with this ( flares up then recedes) but their pcp seemed to think there was a link because they were otherwise young and healthy with no history of allergies.

11

Thanks all for the brainstorming - I’ll bring some of these ideas with me to the allergist next week.

re: some questions above:

  • Covid vaccine back in May, got the flu shot 10/7. So flu shot after the first (non-running or facial swelling) reaction, but before the more serious reactions this past week.

  • I do have a few lone star tick bites this summer(live in TN). No meat before this sat morning reaction, but had pork for lunch this past tuesday. Worth mentioning to the doc if all allergies pop up negative.

  • Nothing was new on saturday race day or tuesday in terms of clothing or other kit.

  • Race day breakfast was a picky bar, coffee, and a Maurten Caf gel before the start. nothing I haven’t had dozens of times. Tuesday food harder to pick out. Don’t recall exactly what was for lunch other than leftover pork chop and frozen veggies. Snacks could have been a bar, Halloween candy, yogurt, etc. truly don’t remember.

  • Could be seasonal allergy aggravated by running? But this is my second fall here in TN, and never had any reactions before.

  • Both runs were not particularly cold. high 40s saturday, 50s tuesday PM. Before TN, lived in Chicago and MN. never issues with cold.

I’m hoping the allergy tests show something, and if not, blood work it is.

12

https://www.mayoclinicproceedings.org/article/S0025-6196(11)63475-7/fulltext

Exercise induced urticaria……?

For the last several years I have developed severe itching and hives on my abdomen and legs after exercise, but only when I train in the cold. I have no issues all summer long but when the winter returns it comes right back. This last week the temperature dropped into the 40s and sure enough, the hives and itching were back.

I haven’t had this my whole life, only the last few years. No idea why it started.

I spoke with an allergist about this. Antihistamines were recommended. Some people advise carrying and Epi Pen. I’ve had this without any sequelae for at least a half dozen years so we decided this wasn’t necessary for me.

Not saying that this is what you have but it’s a thought.

Hey OP, I’m a physician (but not an allergist-immunologist). Obligatory - my advice is non-professional and does not replace the need to discuss this issue with your health care team.

So - I quoted the above reply because you can have heat, cold, and exercise-induced urticaria or allergy symptoms. When I rotated through allergy in residency, the field was very interesting but very confusing; there’s quite a bit of ‘art and science’ of matching your symptoms and allergy testing. I would strongly recommend meeting with an allergist asap and avoiding any potential triggers in the meantime. Anytime “vomiting” and “allergy” is connected, you worry about the potential for anaphylaxis.

For me, I developed something like an exercise-induced or heat-induced urticaria; it’s 100% under control with de-sensitization (may have some risks!) and daily 2nd gen anti-histamine (Zyrtec).

Hope this helps, be well.

13

Ever since I’ve gotten “older”, pork makes me feel not so great. I wouldn’t be surprised if it was either the exercise allergy or the pork. A food diary is a great way to figure it out!