My running buddy broke out in hives on a run this week. She ran home thinking she was having a reaction to her sunscreen and planned to get in the shower right away to rinse it off. At home she collapsed from low blood pressure and ended up taking an ambulance ride to the ER, where they diagnosed an anaphylactic reaction. She went to the allergist today and the doctor believes it is rare exercise induced anaphylaxis. Does anyone have any experience with this? I’m hoping the doctor is wrong. But if the diagnoses is correct what does that mean for her? She is supposed to run a marathon on Sunday and she hasn’t decided yet what to do. We have only been talking over texts, so I don’t have a lot of details. Sounds like maybe she doesn’t yet have a lot of info.
If she is running a mary this weekend, then I would expect that she has put in the miles of training to be ready for it. I would expect that the reaction is from something that is not related to running. But I am also spouting advice from the internet, so don’t listen to me.
Todd
I’ve had this happen to me several times (about 1-2 times a year for the last 10 years) and have been repeatedly tested for everything that a variety of allergy specialists can think of to test. There are some very odd causes for allergic reactions out there - body temperature rising too fast, falling too fast, reactions induced by the vibrations caused by running (mine were always running, never any other sport). I carry an epi pen with me most places just in case.
Crazy…Is this the first time that its happened to her?
Can you feel it coming on and does it stop if you stop running? Or do allergy meds help? Have you had to use the epi pen?
This is the first time it has happened to her (she has been running at least 4-5 years) and she doesn’t know if it is ok to run the marathon this weekend. Any info or advice you have is really appreciated.
Worked with an athlete a few years back while coaching rowing who had exercise induced anaphylaxis and it affected a bit more than just the workout itself. He had to modify his diet several hours before and after workouts in order to avoid problems. Apparently, foods he could normally eat would cause anaphylactic reactions if in his system during the workout to about 3 hours after. As a result, he took nothing but water for 2 hours prior to the workout and was very selective what he would eat afterward. Thankfully I never saw him during a reaction but I don’t recall him saying there would always be a great deal of time to act if he did go into one. Moreover, his stopping exercise would not stop the reaction once it began. My suggestion, based on working with him, skip the marathon and get a better sense of what is actually developing while in a somewhat more controlled setting than a race course.
I’ve broken out in hives from running a couple times but it was always when the pollen count was high and i suffer from seasonal allergies. I take allergy medication daily and that helps. If i don’t take the medication I almost always come back form a run with a runny nose.
Suffured with this for a few years as a kid. If I broke a sweat (mainly in the winter) I would break out in hives and I could not breath. It got pretty bad though it was convient when I had a math exam after PE.
Luckily I outgrew it but it was not something to mess with due to the restricted breathing
My non-practitioner-of-medicine opinion would be that she should be fine to run, but it would be prudent to carry some sudafed or something similar during the race to be on the safe side (epi pens are by prescription, eh?).
I know that there are all kinds of weird allergies and auto-immune issues that we know basically nothing about, but “exercise induced anaphylaxis” just smacks of “we don’t know yet” to me. I would look for something obscure and assumed benign to be the culprit before I would consider exercise, particularly since this is not a new activity for her. I broke out in hives with no known cause once while running in my early teen years. Never happened again, so I always assumed the culprit to be something unique to that day: either the tetanus booster I got that day or the high-altitude spraying they were doing to kill gypsy moths. Never had a reaction to subsequent booster shots, so pesticide it is! The wrong chemical in the wrong concentration at the wrong time is all it takes sometimes. Though I do tend to stay indoors if the helicopters are dive-bombing mosquitos nearby, just to be on the safe side.
I actually have this condition. The first time it happened, I also associated it with sunscreen. Not the case, my EIA trigger is food (mainly wheat.) I can only run 3 hours after eating or on an empty stomach, which I prefer. I can tolerate GU’s & Muscle Milk, so on longer runs I rely solely on these for energy. I always carry liquid Benedryl, a phone & an EpiPen. The first two attacks I was not carrying anything. This condition is very disheartening, but I am able to manage my attacks & I try not to let it get me down. I recommend a visit to an allergy clinic. I received my first EpiPen RX from my regular practitioner. My thoughts & prayers are with your buddy.
I can feel it at about the point where it starts - an odd flushed feeling, and the skin on my face tightens as the hives appear. It stops getting worse if I stop running but will take hours for the hives to completely disappear. None of the extremely broad range of tests ever revealed anything definitive (some extremely small sensitivity to eggs, wheat, and hazelnuts just at or just below what that allergist considered the threshold for a real allergic reaction, but that’s it). I’ve been advised to take some non-drowsy allergy medicine before running, which I have now started to do. I have had to use the epi-pen twice in 10 years or so - it’s quite easy to use - just put your thumb over the top and stab it into your thigh and the injector automatically emerges and goes into the muscle. I followed it up with a dose of the anti-histamine benadryl (that’s the brand name - chemically it’s diphenhydramine hydrochloride) and slept for a while once the epinephrine high wore off. It’s worth knowing if your friend is allergic to benadryl, as that’s a common thing for first aid responders to administer and the reaction to that (especially if injected) is immediate and significant.
Given how infrequent my symptoms are in the context of running several times a week every week and the lack of any real positive results to any test, the last specialist I went to said that between the anti-allergy meds I take and the epi-pen I sometimes carry I should be in no danger from any activity I choose. Good luck to your friend.
I had a good friend and former teammate who had this. Sudden onset in a long-term, fit young athlete. No appreciable changes or clues as to what precipiated it. It manifested itself as you describe. One day she was fine running regularly, the next day she had rashes and intense itching and was feeling like it was tough to breathe. It literally took months for my friend to get to where she could exercise normally again. I think her doc ultimately thought it was autoimmune in nature but I don’t know the details of that diagnosis (and I’m not a MD). It was one of those things where she did like 20 things (diet changes, went to all non scented/natural soaps and detergents, changed sunscreen brands, took meds etc etc etc) in a short period of time so hard to pin it down.
My non-practitioner-of-medicine opinion would be that she should be fine to run, but it would be prudent to carry some sudafed or something similar during the race to be on the safe side (epi pens are by prescription, eh?).
I know that there are all kinds of weird allergies and auto-immune issues that we know basically nothing about, but “exercise induced anaphylaxis” just smacks of “we don’t know yet” to me.
When the risk is anaphylaxis,it’s not worth finding out without more time to test and do some elimination trials.
Sudafed is a decongestant. Allergies are treated with antihistamines and medications that help stabilize the cells that cause the reaction (mast cell stabilizers)
http://emedicine.medscape.com/article/886641-overview
I had an episode while playing soccer once, but it could have been many other factors. Your friend should take her time and even if she never receives a definitive diagnosis, many things can be eliminated.
I have a condition known as an exercise induced allergy with a food trigger. In other words, exercise without the magic food and I’m fine, eat the wrong thing and workout, and then BAM! First real attack I had (in 2008) played out in a way similar to what you describe. After a pre-race swim had a similar reaction and tried to shower it off to no avail. Before I passed out though, the wife pumped me full of benadryl and it settled down. Then, a year later while training for my first IM, I went for a run after dinner, started to feel odd, itchy, then a full blown allergic reaction, anaphylactic. Just made it back home before my BP bottomed out and I passed out cold - and won a trip to the ER in an ambulance. After a CT, every heart test you can imagine, and the 1000s pricks at the allergist we came up with that diagnosis. Turns out I’m most likely allergic to a dye (which they can’t test for) that is present in only certain foods. This year I got to add one more food to the list (found out the tough way). I still keep an epi pen around just in case, but so far a big dose of benadryl and lying on the floor has avoided any more trips to the ER, and I know what symptoms to look for when an it starts to come on (only one new incident since 2009). It has in no way hampered my fitness or triathlon goals though. Since the first bout, I’ve completed a full iron distance and trained hard under adverse conditions regularly. The trick for me was determining the triggers. Once I get those down, it’s business as usual. I skipped a tri after my first bout (was supposed to race the next day), as I didn’t know what had caused the condition. However, I believe there is also such a thing as exercise induced anaphylaxis without a trigger. If I were her I would skip the marathon until I was sure about my condition. I suspect they will want to give her some type of stress test under controlled conditions with medical staff on hand. I know it stinks to miss an event you have been preparing for, but it’s not worth your life. Turns out I could have done the event I skipped, but I don’t regret missing it for a second. Hope your friend is okay. Will be sure to include her in my prayers.
This happened to me about a year ago. I was 3 miles from home, mu throat started constricting and breathing became very difficult. I couldnt swallow and my whole body broke out in hives. I struggled to get home and my son called 911. At the ER they gave me an epinephrine shot and did a bunch of tests. The doc came up with exercised induced anaphylaxis. Never happened before or since (and I’m 52 now). I now carry an epi pin on trail runs. Probably should carry one everywhere.
Ugh, I feel so bad for your running buddy! I have exercise-induced anaphylaxis too. I would definitely advise skipping the upcoming marathon until you figure out what’s going on. Anaphylaxis is a serious condition. I’ve had 5-6 episodes that required the use of an epi-pen and they were all related to running/standing. For me it has happened indoors, outdoors, on a full stomach, and on an empty stomach. Hopefully you can figure out a trigger for your friend’s allergy (maybe gluten as others have mentioned?), but because there are SO many variables, it takes a while to sort out. And it also takes a while to learn how an allergy attack feels in its initial stages so that you know when to stop. Hopefully there will be no more attacks, but it could be something that your buddy will need to learn to cope with over time. Took me almost 3 years. Best wishes to you and your friend. I hope it was just a freak thing that never happens again, but better safe than sorry.
As a couple others here, I dealt with a similar issue for a few years as a kid before I out grew it. It was scary and frustrating, but as with anything you learn to cope. My issue popped up on a trip to Texas. It initially was a reaction to something, not exercise induced. After many visits to the doctor and being referred to the University of Michigan medical center they concluded it must be diet related and I went on an elimination diet to narrow it down. Apparently the scratch test didn’t show a thing. Well, let’s just say the diet sucked and I didn’t learn much except that milk products might be a slight contributor. Particularly ice cream. Also realized I couldn’t touch a dog without blowing up. Gone was the family pet.
What I did start to realize over time is that exercise set me off. It wan’t uncommon for my hands to swell to the point where I couldn’t use them etc. Usually with some benydrl it would subside within a couple hours. On rare occasions where the reaction was sever I’d end up in the hospital. Tell your friend to listen to their body. I could tell when it was coming on before I ever broke out. I also could “manage” the breakout via a very extended cooldown over 3-4 miles. As the other posted, sudden changes in pace or HR set me off. When I broke out, I’d head for home with the goal being a gradual transition to a walk. Another thing I found was that during sever reactions my vision would go black and white, or almost just shadows. This is when you wanted to stop. The options were stopping, which usually led to passing out, or shutting the eyes and having someone walk you down until you could get them open again. After having this happen once while I was alone and using the weeds brushing my legs on the side of the road to get home, I didn’t get to run alone any more.
20 years later, my parents got horses. I go out to pet them and BAM! Hives up and down my neck like no other… Guess what I did while I was in Texas as a kid? Rode a horse! Your pal should think about ANYTHING that they might have done, encountered, ate that was outside the normal routine. I’d been on a horse before, but for some reason it must have just set me off.
Be careful with medicating. My Dr’s had me so doped up on antihistamines that I was a walking zombie. The school officials thought I had a serious drug issue and I’d end up sleeping all day in class and getting home and couldn’t remember what happened in the day.
Over time I outgrew things and now it’s only horses and a very minor reaction to dogs if I’m around them long enough. Best of luck to your friend.
Thank you everyone for all of your information and advice. I really didn’t know such a thing existed so it is crazy to hear how many people have had similar experiences. My friend ran the marathon today. She took antihistamines before the start and ran with 2 epi pens. I ran with her and she showed me how to use the epi pen, just in case. We ran at a training pace rather than a race pace.(Worked great for me since I was just using the race as a training run anyway) No episode so that was good. She didn’t eat 2-3 hours prior to the race, in case it was a food triggered thing, so she did run out of gas the last couple of miles. But other than that it was a good race. Thanks again for all the help! She will need to put some time into figuring this thing out and all of this information is helpful.
And when one of mine does come on, I’ve learned that by any means I need to get horizontal as quickly as possible! It makes a difference when your BP is dropping out, and can mean the difference between whether or not one loses consciousness!