Serious hives for a week after extreme workout

[stradev]

I'm in my early 40s and have been dealing with recurring hives since high school. I've finally found what appears to be the cause, but I'm not sure what to do next. When I heavily use muscles that haven't really been exercised in a few weeks or more, I get very sharp pain in those muscles the next day or two. That's when I know the hives are going to come. Unlike most exercise-induced hives I've read about, the hives don't come when I exercise, but a day or two later - always after the sharp muscle pain. The first few times I got them they got so bad I ended up in the emergency room where they gave me epinephrin, etc. and they went away. The strange thing though, is that they came back again and again over the course of a week to a week and a half. Now that I can recognize them coming right away, I usually knock them out right away with a double dose of Benadryl, which I then have to take every 4 hours - tapering the dosage off over the course of the week. They still come back over the week, but they never get out of hand if I keep up with the antihistamine. So I can live with it if I have to, but the Benadryl does make me less productive and I'd really like to figure out how to eliminate them for good. I went to an allergist several years back and he wasn't particularly helpful. So for now, my best solution seems to be to exercise regularly enough to avoid the "new exercise program" pain that always seems to trigger the hives and then to have a good supply of Benadryl ready when they do come. I experience this week-long bout maybe 2-3 times a year now. Any ideas?

[mike4872]

I too had similar symptoms. Rash that sent me to the ER. After getting a heavy dose of prednisone rash was gone. A week later it returned. I slowed the reaction with Benedryl. I was suffering from severe aches in my calf muscles and thighs. After exhaustive testing, my Rheumatologist found that I have an enzyme deficiency called ( MTHFR ). I am currently taking a prescription strength B6 and B12 vitamin daily for the rest of my life. So far I have seen an improvement. Legs don't hurt as much.

[stradev]

Hi. I'm back checking in on this discussion since I just had another bout of the hives. I am more certain than ever about what causes them. I took a number of months off from exercise and on Saturday, just started up again with weights. I should have eased back into it, but instead I worked out hard and ended up with muscle soreness the next day. About 24 hours after working out, I could tell the hives would be coming (because of the soreness I felt). I've been paying close attention to the triggers and I can say with high confidence that the only thing common in all cases is this muscle soreness. So I'm very interested in what you describe as "allergic reaction to formed lactic acid".

I am certain that my hives are not caused by body heat, sweating or the weather since I've done more aerobic exercises lately where I sweat profusely (I.e. playing racquetball) and got no hives. It is clear that the hives are caused by something associated with muscle soreness - potentially the presence of high levels of lactic acid (or some other chemical involved in the muscle healing process) creating an allergic reaction. The symptoms will come and go over the next 7-10 days and only remain under control with high doses of benadryl (starting with 100 mg at a time, every ~4 hours for a total of up to 500 mg in a day, then tapering down to lower doses over the -10 day period).

I've found that I can prevent occurrence of the hives two ways: 1) Never exercise hard enough to cause muscle soreness, or 2) Exercise regularly enough to prevent significant muscle soreness. I've found that once I get past the hives, if I work out regularly and keep the muscles in good enough shape to avoid strong pain the next day, the hives won't come.

Despite this conclusion, I'd still love to find another way to avoid the hives in case I ever do take a break from working out, then want to re-start.

Thanks.

[Dr Rajput]

Hi, welcome to the forum, you seem to have type of Cholinergic urticaria is a subcategory of physical urticaria that is a skin rash brought on by a hypersensitive reaction to body heat. Symptoms follow any stimulus to sweat such as exercise (sometimes called exercise-induced urticaria), heat from the sun (which could also indicate solar urticaria), saunas, hot showers (reaction to water can also indicate water urticaria), spicy foods which may cause an increase in body temperature or even stress due to blushing or anger. Another important reason for delayed occurrence of hives can be due to allergic reaction to formed lactic acid after extreme workout.

Cholinergic urticaria can be very difficult to treat. Most treatment plans for cholinergic urticaria involve being aware of one's triggers. Drug treatment is typically in the form of antihistamines,H2-receptor antagonists such as cimetidine.

As the disease may be physiological in origin, psychological treatments such as stress management can sometimes lessen severity and occurrence. Take care and regards.

[Hook84]

I can't believe I have found this especially your symptoms. I have been suffering the exact same symptoms as yourself. I do exercise / running / football / weight training and when I pull a muscle or get the delayed onset muscle syndrome caused by exercise then this is when I get the hives rash which can be very severe. It normally happens approximately 12 - 24 hours afterwards. For example If I finish a gym workout at 9pm and I do my normal routine go to bed etc. I then get up in the morning and my muscles are stiff I will instantly know that the hives will start to come up and the more a move around (walking) the more the rash comes up. It comes up considerably more in cold weather but is not cold urticaria as I can be outside in -3 conditions and not get the rash, but If I have a pulled / damaged muscle then that's a different game altogether. I have been to see my Immunologist recently who has given me an Epi-Pen to take in the event of the rash taking over If I have an attack. Can I ask what other symptoms you get as I have spoken to my dermatologist who has told me that my symptoms are very rare and that he has never had this type of symptoms. When I get the rash I become very agitated and become very irritable it also causes me to go start shaking only slightly and I become very tired and exhausted. It feels like my whole body is pulsating and I get lethargic.

My dermatologist has said to me that in all the time he has studied hives / urticaria type rashes he has never come across the delayed onset hives rash caused by muscle fatigue, so we are two of a kind. He has contacts in America who he has spoken to and up to now he hasn't got any more information for me.

I am currently waiting for my recent blood tests that have been done by my immunologist and then I will have an action plan put together as to what I can take to stop the reaction. At present I am not doing any exercise due to it. I t may be that I have to do very light exercises. Maybe swimming. Keep in touch and I will let my Dr know that I have found someone else who has the same Symptoms.

[stradev]

Update: I've had two more bouts recently. In each of these cases, I pulled a muscle and the hives originated at the site of the pull - between 18-36 hours after working out. So it's quite clear they are related to muscle damage. I read that when a muscle is damaged, an enzyme called CK or Creatine Kinase is released. I'm wondering if I could be allergic to that and I'm having a histamine reaction to the enzyme... or perhaps it's simply a reaction to the muscle damage.