Exercise Induced Urticaria VS Cholinergic Urticaria
Post by: caiyixian on October 14, 2010, 10:57:27 AM
Hello all! I would just like to get some opinions on my condition. I’ve suffered from eczema since I was 7, and now it has been 15 years. It was quite bad (IgE close to 6000 the last time I checked), but i was still able to exercise and function somewhat normally. I just finished serving my military service around 5 months ago, which lasted for 2 years. I realised that my eczema was getting worse, probably due to the stress you face as a soldier and the not so hygienic surroundings, and occasionally I started having hive-like rashes (back then I didn’t know what I had were hives) on my body after physical activities. Back then I just attributed it to my eczema and tried to ignore it, as we weren’t allowed image capturing devices so I could not take pictures to show my dermatologist, and she always attributed it to some virus attack or something.
Now I’m in college, my skin is mostly fine as I’ve had steroid injections, and I’m going through sublingual immunotheraphy at the moment. However, in the past few days I’ve done long-distance running, massive amounts of hives appear all over my body. I’ve attached pictures, would those rashes I have be defined as exercise-induced urticaria, or is it just eczema? I’m really confused because all my life I’ve attributed that kind of rashes to my eczema. Antihistamines and steroid jabs don’t seem to work, as I took antihistamines an hour before I went running and had the jab two weeks ago. Hope I can get some kind of idea if I really have exercise induced urticaria. Thank you!
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Exercise Induced Urticaria?
Post by: HivesGuy on October 14, 2010, 11:41:06 AM
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Hello caiyixian,
Thanks for the great post and welcome to the forum.
I am very sorry to hear about your eczema and hives struggles over the past few years. I know it can be extraordinarily frustrating dealing with these kinds of medical issues. I think we can all relate to your experiences on many levels.
I also think your treatments are interesting, and I would love to hear if they help over time (or not). Especially the sulingual immunotherapy.
As far as your question about whether this is exercised induced hives (also called Cholinergic Urticaria)–let me first say that I am not a doctor or anything, and so I would highly recommend you see a good dermatologist that is familiar with this condition to get a proper diagnosis. BUT–just asking my opinion, yes, it sounds and looks very much like it could be cholinergic urticaria.
This site has a lot of information (both on the home page and this forum), and you can read the symptoms and our experiences to see if they match yours. Generally speaking, it often feels very itchy and like a stinging sensation that also itches very intensely. This can happen any time the body becomes hot–whether it be exercise, spicy foods, strong emotions, or anything that would generally cause a sweat to break out.
In most situations, these type of hives disappear within a few minutes (or at the longest a few hours). It is very rare for this to persist more than a day or so. My hives (which look a lot like your pictures when I have a severe attack), generally clear up within about 5-10 minutes once I have cooled down. So if you only get this when hot or anxious, and it disappears once you are cooled down, I would suspect Cholinergic Urticaria very strongly.
Also, this type of hives is often associated with other severe allergies such as asthma or eczema. So it wouldn’t be unusual for you to have both eczema and Cholinergic Urticaria.
If you have any more questions, please let us know. You can also find lots of great info on the site and forum by browsing around. Thanks again for the great post, and welcome to the forum.
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Title: Hives and anxiety bad mix
Post by: robbie on January 20, 2011, 06:03:37 PM
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Hey folks, i stumbled upon this site in hopes to get some sense kicked into me. I had terrible hives as a youth (im almost 40 now) and they started in Gr 7 roughly lasting until about 16yrs old. I gave up all sports etc becasue of embarrassment.
I dont really remember them going away, they just did. Well fast forward up to 3 yrs ago and they started back out of nowhere. I was swimming 4days per week, running a couple days and cycling everywhere. One morning I got up, went for a ride 25km then went for a short run after and noticed they were back. I even started to notice them after a good swim workout! Needless to say I was pretty upset to see them, and frankly quite surprised. Well i just kept riding etc, then slowly I stopped communting to work as I would start the day with hives and hated it (i own a gym and teach fitness so I was worried to say Im allergic to fitness >:()
Regardless, i just kept going on my own rides, never with friends…I would ride 1-3hrs daily in summer, come home covered in hives and just go on with my day as theyd be gone in an hour.
WELL here comes the kicker…I am aware I worry a lot, so I googled this finally this summer to look for a cure and EVERY web site points to Exercise Induced Anaphlaxia…well my brain is HOOKED on this now. Everytime I get hives now I panic! I have completely quit training as if I so as much lift a weight or run 5min I feel itchy and worry…Essentially, before I read about the dangers I was fine, just itchy and burning…now I am frightened by it.
I am trrying to find others who simply ignore this and train, get hives and live through it…i feel I need fitness badly, but now Ive become frighteded to death of it. I have nights that I am in tears feeling defeated by this. Ive become depressed about it, i limit my social life and I can go on. I have never had any swelling in my throat etc, but now I am hyper focused. Anyway, I am simply looking for some folks who train daily or regularly that get hives and besides the itch they are harmless.
Sorry to sound like a suck, but this is ruining my life.
Thanks
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Title: Re: Hives and anxiety bad mix
Post by: HivesGuy on January 21, 2011, 11:58:24 AM
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Hello Robbie,
Excellent post and welcome to the forum. Wow, I can certainly understand your frustration with the hives. Especially since you are involved in fitness with your career/business. I know that must be frustrating dealing with it.
Exercise induced anaphylaxia is similar to Cholinergic Urticaria, but there are differences. With exercise induced anaphylaxis, you generally start swelling when you exercise, and may have some hives, etc. With Cholinergic Urticaria, it is more of a prickly stinging sensation that also itches. You can have one or the other, or even both at the same time (as it is quite common for people with Cholinergic Urticaria to have other hives or allergy issues).
If you do have exercise induced swelling, then I would strongly recommend you talk to a doctor about getting an epi-pen. Also, I would advise you to never exercise or do any physical activity. It is really dangerous and if you ever do swell, then you risk sudden death or severe health risks.
If you have only Cholinergic Urticaria, then you may be able to exercise, but it really depends on the severity of your case. Especially if you have ever had swelling before, then I would avoid exercise. If not, then you could maybe try it (but again, I strongly urge you to speak to a dermatologist first). You should also make sure to have an epi-pen, and an adult with you at all times should you ever consider it.
I know it is hard to live with, but it went away for you in the past, and there is probably a really good chance it may go away again. I would really hang in there, and try to find ways to manage your business and life until you recover.
Best of luck
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Title: Re: Hives and anxiety bad mix
Post by: robbie on January 22, 2011, 12:11:53 AM
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Well, so far Ive been lucky i guess. I was riding 2-3hr rides almost daily, getting tons of hives (all tiny) and just ignoring them. It wasnt until I read about the anaphylaxia that I became to care about it at all to be honest. I guess ignorance is bliss…i workout, i get hives and nothing has happened (knock on wood) now I read about death etc and I suddenly start panicking at the first sign.
I think lots of it’s in my head
Bought dust mite free bedding covers etc today.
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Title: Re: Hives and anxiety bad mix
Post by: HivesGuy on January 22, 2011, 05:35:27 AM
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Yeah,
The thing about it is that there are some people on here who have had this for years and years (some even decades) and have never had a swelling reaction or faced death. They just get hives and go about their business.
Others, however, do sometimes have to watch out for it. So you never know if you will swell or not, and I think it is always a good idea to take precautions. You could always stop and cool down and take breaks when you get hot, and like I said, carry an epi-pen.
Also, if you work with a doctor to find a good antihistamine combination that works for you, you may also be able to avoid a lot of the hives itching, and that may make life easier for you. I know it is frustrating, but try not to get too down about it or worry to much. That’s what I try to do.
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Title: Exercise Induced Urticaria VS Cholinergic Urticaria
Post by: vanillalatte on April 28, 2011, 06:38:01 PM
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Hi all!
I’ve been researching my own allergies,and I recently came across this thread. It seems that many on this forum are experienced with cholinergic urticaria, and was wondering if anyone could offer any insight into my situation.
I am turning 16 this year, and recently began getting hives after exercise, fluctuations (hot AND cold) in body temperature, and exposure to heat. At first, it was only minor, red, itchy bumps on my thighs, but my condition has now escalated to full body hives. My situation seems to be opposite of many posters on this thread in that my hives appear when I sweat, and not before. From my research online, the other possibility appears to be an allergy to sweat, or exercise urticaria. However, I also get hives if I’m standing outside during the winter and it is freezing cold. Could it be a combination of both- as in exercise-induced cholinergic urticaria?
I have been taking Benadryl to alleviate some of the itchiness and the burning/prickling feeling I get, but it does not seem to prevent or decrease the itching. I have yet to try Zyrtec/Reactine, but am hesitant to do so before seeing a medical professional.
Can anyone offer any insight into my situation in regard to exercise urticaria VS cholinergic urticaria?
Thank you very much.
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: nowash on April 28, 2011, 11:51:16 PM
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Hi vanillalatte, welcome to the forums.
The thing with sweat and ChU is that according to the latest review article on PubMed there is the theory that there are different subtypes of ChU. One subtype is described as being caused by keratin plugs on the sweat glands which prevent sweat from escaping. This I assume fits with the forum members who feel they have to break through a sweat; their hives would come first before the keratin plugs were cleared. Another subtype is classified as where the patient is just reactive to their sweat. They don’t know if it is an allergy to sweat proteins per se or if it could be just inflammatory mediators. Nonetheless this subtype does not require keratin plugs and I would assume hives would appear with sweat and not before. How well do you sweat?
Also you sure you don’t have cold urticaria as well? I mean I notice when I go from hot to cold quickly my hives feel worse, but it has to be from hot to cold and not just lukewarm to cold. I think I read that Cold urticaria patients can react to the cooling effect of their own sweat. If you’re saying that you can get hives just from being cold with no exercise or warmth or sweating beforehand, then I would suspect cold urticaria.
As for the difference between exercise-induced urticaria and cholinergic urticaria, it is a difference of warmth. Doctors use passive heating with a warm environment to distinguish which condition you have. Although I suppose it isn’t impossible to have both cholinergic and exercise induced urticaria at the same time.
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: vanillalatte on April 29, 2011, 08:42:42 PM
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Thank you for your warm welcome and taking the time to read my post!
To answer the question about sweat, I’ve noticed that I can exercise fine until I begin to sweat, and that’s why the hives appear. I can only sweat a little before the hives and itch occur, but after that, I completely stop sweating, and don’t sweat even if I continue to exercise. I am a dancer, and I find that after my outbreaks, I can still continue dancing. However, this is not the case when I run or workout..maybe it has to do with the amount of exertion? Before I had Cholinergic Urticaria, I sweat really easily, and would often turn really red in the face. Even now with Cholinergic Urticaria, i get really red in the face, and when I cool down, I can feel the heat leaving my cheeks.
I really don’t know whether I have Cholinergic Urticaria AND cold urticaria…it seems to happen to me whenever my body temperature fluctuates. I am really worried for this upcoming summer, because it will be my first with this condition. I do see your point with the cold urticaria though..I will be sure to pay more attention to when my outbreak happens next time to see if it is the sweat cooling.
Do you mind explaining what you mean by difference of warmth and passive heating? I’m getting really confused as to whether I have multiple forms of allergies, because I seem to experience symptoms and situations from exercise urticaria, cholinergic urticaria, and cold urticaria. It is especially unbearable during P.E class, as I’m still in high school. My teacher is unaware of my situation, and it is difficult for me to do any form of fitness without feeling prickly and itchy all over. As for Cholinergic Urticaria not involving exercise, I sometimes get outbreaks when entering a stuffy room, which confuses me, as it has nothing to do with exercise.
Also, I currently take Benadryl, and have experimented with taking it at different times when I expect an outbreak. I’ve tried taking it 1-3h before, right before, during, and after, and it doesnt seem to do much except make me drowsy to the point where I cannot focus at school. Is there an optimal time to take any antihistamines for them to work most effectively, other than during sleep? Taking it before bed also wouldn’t work as Benadryl only lasts for six hours..
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: nowash on April 30, 2011, 06:21:51 AM
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So what I mean by a difference of warmth is that the key to knowing which condition you have is whether or not you react to passive heating. When a doctor sees that you get hives which appear without exercise from a warm environment, say a warm room or hot bath, your diagnosis would most likely be cholinergic urticaria. The doctor would also confirm if you get hives from exercise as well. However, if you get hives only from exercise and not a warm environment your diagnosis will most likely be exercise-induced urticaria. Passive heating would be heat absorbed through the environment; exercise-induced urticaria patients do not react to passive heating.
There are other clues to look for to determine whether you have ChU or not. Most people with ChU get hives from strong emotions such as embarrassment, anxiety, or nervousness. Some cannot eat spicy foods without breaking out. Some cannot eat hot food. All these are symptoms are common of ChU but not exercise-induced urticaria.
Let me ask you a few questions: When you get the hives, you can see sweat on the surface of your skin, is this correct? Or perhaps do the hives appear before sweat has reached the surface of your skin? Do you get hives when embarassed, anxious, or nervous? You mentioned exertion; you said you could continue the same activity after an outbreak caused by something like dancing, but not when you strongly exerted yourself in things like exercise. Can you remember anytime you had a refractory period, a length in time in which you could not break out anymore? A lot of ChU sufferers work out to use this phenomenon to stay “cured”.
As for the Benadryl, the right time would be probably be 30 minutes to an hour before a breakout; you need to give it time to be absorbed, but you cannot wait too long or it will be metabolized in your body. However, have you tried a 24 hour antihistamine, such as Claritin, Zyrtec, or Allegra? These have less of the drowsiness associated with antihistamines since they do not cross into the brain as easily.
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: vanillalatte on May 03, 2011, 05:13:01 PM
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Actually, I’ve found that i don’t get hives from embarassment or spicy food. I think it’s mostly exercise urticaria, but the only thing that’s indicating otherwise is my outbreaks when I enter stuffy rooms. I used to get hives from hot baths, but it no longer happens to me anymore, which is weird. Today I went out in the sun and had an outbreak of hives as well.
And now to answer your questions, yes, whenever I exercise, I feel the sweat on my underarms, so I know I have no problems sweating. However, the instant I sweat, I start getting the prickling and pain, and then eventually hives. Once all the hives come out (usually full body hives), around 15 minutes later, I feel rushes of heat leave my face, and the itching stops. My hives also tend to disappear within 2 hours. No, I dont seem to get hives from strong emotions or spicy food. As for the refractory period, I believe it has happened before, as I have often had to continue doing P.E class after a break-out. The hives remain, but the itching and pricking stops. I am hesitant to push past the pain, because I have once experienced faintness. My vision became blurry, and I felt faint.
I bought some Allegra today, and will try it out and keep this thread updated. Do you recommend that any anti-histamines be used on a daily basis? I’m from Canada, which is a relatively temperate climate. However, I will be going to China this summer, and I am really scared that the difference in heat, humidity, and temperatures will literally kill me. Do you have any recommendations for this as well?
Thanks!
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: Slick1020 on May 06, 2011, 03:08:17 PM
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When I deploy the Air Force gives me around 90 claritin tablets to cover my 6 month deployment. They assume you are taking the pills as needed and if you need more you must ask for more in theater. But to answer your question, yes I do take my Allegra twice a day. I think its a good idea to take the meds you are prescribed until you can start sweating without the meds or your symptoms go away.
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: vanillalatte on May 08, 2011, 01:11:44 PM
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Thanks for your reply. Do you take Allegra consistently twice a day? I am hesitant to do so, because of the chances of becoming immune.
Just an update on Allegra, it seems to be working somewhat better than Benadryl. The itching and prickling feelings have disappeared, but the hives are still there. There doesn’t seem to be a decrease in the number of body hives, but at least the itching is gone! I will keep on trying and keep this thread updated in a few days. =)
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: Slick1020 on May 08, 2011, 11:38:02 PM
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Yes, I take it twice a day. And I don’t think you can become immune to allegra because its not an antibiotic. A doctor may have to increase your dosage if you must take the meds everyday of your life which I doubt. That’s only because your body begins to recognize the medicine as natural to the body.
When I exercise I still get the hives on allegra but I’m hoping my body will stop having a reaction after a week of working out consistently.
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: vanillalatte on May 14, 2011, 08:08:16 PM
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Just a quick update on Allegra: It seems to be working pretty well at keeping the prickling away, but still hasnt decreased the hives at all. Hopefully it’s not a placebo. We’ll see how it goes. Can anyone tell me how effective Allegra 12h is compared to Allegra 24h? The price is double for the 24h one, but I won’t actually need relief for the whole day, so I was wondering if anyone knew anything about this.
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: Slick1020 on May 15, 2011, 11:28:34 AM
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Hives won’t go away until you start working out. Probably after the 3rd to 4th day you won’t see the hives anymore.
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria- Are they the same?
Post by: nowash on May 15, 2011, 12:49:09 PM
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Vanillalatte, I think the 12 hour and 24 hour only differ by amount of medicine and different structure of the pill, to make it last different lengths. I don’t think there’s an actual strength or effectiveness difference, just a duration difference. It probably costs twice as much since there’s twice as much medicine in it.
Antihistamines might not always get rid of the wheals since things other than histamine that mast cells release can cause them. The leukotrienes have been shown to cause wheals when injected into the skin; Singulair, an antileukotriene, has helped some people on the forum, including me.
Also, about the sweat under your arms; I could be wrong, but I was under the impression that most people with ChU have no problem with sweating there, since we usually are always sweating there and this clears out any keratotic plugs (if that’s the case). I’m more curious about the forearm and whether you sweat well there or not. The underarm sweating however lets you know that you probably don’t have anhidrosis due to an immune system attack on your sweat glands.
I don’t have many tips for a hot and humid climate. Living in one, it’s hard to give any advice that I know will work well that’s not self-limiting, like stay inside or keep bottle of ice water around. Most doctors will recommend antihistamines on a daily basis. Some even recommend to double the usual dose. I’ve read case studies where ChU patients had to take multiple antihistamines with double or triple the dose on each just to function! Perhaps you could see if you’re the type that gets better with sweat therapy?
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Title: Re: Exercise Urticaria VS Cholinergic Urticaria– Are they the same?
Post by: vanillalatte on May 16, 2011, 06:15:08 PM
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Hi Nowash,
I worked out for the first time this week for about 40minutes today after taking Allegra an hour earlier, and I was able to sweat under my arms as usual. This time, however, I could feel sweat on my nose, and some sweat on my back. I also did not have any hives, which I was really surprised about, since I havent done any physical activity this past week, and have not taken any antihistamines either. I will continue to try out the sweat therapy method. At this point, I’m pretty sure I have cholinergic urticaria and not exercise urticaria, although I dont have any problems with spicy foods or emotional changes.
Thank you so much for taking the time to reply to my posts.