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Avatar universal

Serious hives for a week after extreme workout

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?
35 Responses
Avatar universal
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.
Avatar universal
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.
1355118 tn?1298568479
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.
Avatar universal
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.

Avatar universal
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.
Avatar universal
Thanks so much for the response. I've forwarded the information you shared to my doctor and am now awaiting his response.

I'll let you know how it goes.

Thanks again,
Avatar universal
Hi Stratedv,

Just wondering if you have any updates since you  forwarded mike4872 to your doctor. Like yourselves I have been suffering with the exact same symptoms for years and every time I tell the doctors about the hives and mytheory they look at me amazed saying that they never heard of it, so annoying!!! I just wish I knew how to prevent it from happening...
Avatar universal
Thanks for the reminder. I did get a response from my doctor and here's what he said:

"Interesting.  I cannot find this reference when I search the scientific medical lit, but that doesn't mean it is isn't possible.  You'll need to discuss with whomever manages your hives.  But because this is outside our usual wheelhouse, I suggest that before that visit you find out from the responder what was tested and / or whether they just did a trial of high dose vitamins B6 and 12.  Let me know if it makes a difference or if you find any scientific literature on the topic."

I have been exercising regularly for some time now and have not had to deal with the hives as a result. And as we often do, when it's not a pressing concern, I put it on the back burner.

So the real story is that I've gotten a bit lazy on trying to get to the bottom of this and have instead made sure to keep exercising and avoid the problem altogether. So long as I avoid a sudden change in exercise where a part of my body has severe muscle repair and the associated pain, I avoid the hives. I know there will come a time though when I skip exercising for a while and it will happen again. Have you learned anything about it that might help us? If nothing else, It's good to talk with others that have the same issue.
Avatar universal
I havn't been on here for some time so I apologise for that. To give you a little update, I have had various blood tests for auto immune problems, I've had blood counts done etc and they can't find any problems with them systems. The lactic acid thing mentioned earlier is quite intriguing. I have been told though that lactic acid is not the cause for delayed onset muscle soreness, because that is caused my microscopic tears in the muscle fibres. I have stayed pretty much away from any exercise apart from a little bit of football which hasn't caused me much problem to be fair, however I havnt played to my full potential and given it my all because I am conscious of the hives coming up. I am still prescribed an epi-pen in the event of a severe reaction. I am taking a 10mg cetrizine tablet a day but I don't think that is doing anything I think me not exercising is preventing anything happening. I have recently taken up boxing and today I have had my first reaction for a while, I have had muscle fatigue since Friday but today the fatigue had more or less gone but I still got the swelling. It started on my nose face area and I could feel it pulsating, I don't know if you get this feeling. I am going to be speaking to my consultant again to see if I can get stronger tablets because I just can't not exercise. One doctor said to me we may never find the reason why it is happening but when you die a post mortem may show something up! I could not believe that some how I think it may be to late then.
Hope to hear from you soon
Avatar universal
Hi there

I am new to this forum but I can believe I have found similar people who have exactly the same symptoms as me.  Like you if I exercise regularly then I don't have an onset of hives, however, if I exercise and work hard with weights then my muscles really hurt and hives appear a few hours later.  I did a new weight workout two days ago and I'm still suffering today.  When I go to bed the hives don't appear but as soon as I get up again they re-appear.  The hives are definitely not brought on by heat and I really wish people would stop saying that they are.  We know our bodies and when the hives come on - I think doctors are sometimes so quick to give a quick answer without finding out the facts first.
Iam treating my hives at the moment with loratadine which is ok but Asia can only take one 10mg tablet a day, I find the hives come back a little during the day and go again.  I know that the hives will probably persist until the soreness goes away which will hopefully be soon!  
Does anyone have any answers please??
Avatar universal

As you see in all the previous posts, you're not alone. I have been dealing with the same problem you describe for many years without a complete solution. However, I do have a couple strategies: 1) Ease into exercise when you haven't done it for weeks/months. Slowly work up to a full, tough workout over the course of a few weeks so no single workout is such a shock to your body that the hives come. 2) Be prepared to knock them out immediately. Depending on the severity, I take anything from a Loratadine to several Benadryls right away when I see them starting (super-fast - don't wait). Then continue taking the antihistamine on a regular basis (1-2 per day with the Loratadine or every 4 hours with the Benadryl) for anywhere from a couple days to a week and a half, tapering off the dosage until stopping. For me, the dosage and time is really dependent upon the severity of the outbreak and how quickly I started the antihistamine. It took me a while to be able to figure out how bad a reaction was and how aggressively to treat it - with the degree of soreness and overall feeling in my body being the primary indicators. The first approach is much better since #2 can seriously impact your life. But when the hives do come, the second answer is the only way I've found to keep them under control and prevent them from getting really bad. Hope that helps. Let us know if you discover anything else.

Avatar universal
I have been dealing with this since I was about 16 as well and am now 25. It took me a long time to figure out what exactly was even happening with my body. When it first started I tried all the usual things, changing detergents, deodorants, going to different gyms, then I got into the food aspect, changing my diet and eliminating certain known allergens to see if it had any effect.
     It's really hard to do because you have to devote so much of your time and effort into this, you have to completely change your way of life and sometimes avoiding certain foods can be nearly impossible. I've tried removing gluten which seemed to help but I still got the hives, same with dairy, I no longer eat it but still get the hives a day or two after an intense workout which usually involves weight lifting. I've spent countless hours browsing the internet searching for answers and have yet to find anything solid. I've heard everything from people saying you just need to drink a ton of water to people who say just stop taking hot showers..
     I agree many people including doctors are quick to throw out some answer that isn't really thought out and they are not aware of our particular condition which I believe is somewhat rare. I've been to allergists which was no help, he did one of those spot tests on me with samples of a bunch of different allergens like shellfish to see which would cause a reaction. The thing is this was during a time that I was working out and experiencing these reactions so when he did the test my skin rose and puffed up for every single one and he literally just told me I was allergic to everything which obviously is not the case. If he was to take the test during a time when I wasn't working out I'm sure it would yield different results. The only answer I got from him was take antihistamines, which to me is just a cover up and not a solution.
     I have found a couple of cases while reading through the internet where people claimed to have found the cause and are now hive free. One possible "solution" that sticks out to me is taking digestive enzymes. Some people believe that the problem lies in your body not producing enough or the right types of enzymes to break down the food so when your body goes to use food that you've "digested" to repair your muscles it acts as if it's something foreign and shouldn't be there resulting in the hives. One of the cases I read about the guy said he had to take digestive enzymes consistently with every meal for about three months before he noticed a difference.
     Anyway, I'm just as puzzled about this as the rest of you guys and I try not to let it get to me but it can be extremely frustrating at times. Especially when I know I feel the best after a good workout, it's hard to consider the fact that I'll never be able to work out to my potential. I love the stress relief and health benefits a good workout provides and I really hope we can all find a solution to this.
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