Thursday, May 23, 2013

Am I really Allergic to Exercise?



While it sometimes can sound like a bad excuse, some people can really be allergic to working out or exercise in general.

Skin reactions, like hives, and respiratory problems, like asthma, are common complaints among those who work out in the gym or outdoors, and their complaints could sometimes be warranted.

Many of the exercise induced conditions are due to histamine, which is a chemical in the body that usually is released to augment the immune system, and when histamines are released in the body at the wrong time, this can wreak havoc on how you feel.

However, determining whether these problems are due to an allergic disease involves going to see an allergist and getting a complete workup. Below are a few of the more common conditions, and if you have ever experienced any of the following, or other exercise induced illnesses, do your body a favor and schedule an appointment with us before your next workout.

Cholinergic Urticaria (CU)

A very common and frustrating disease, cholinergic urticaria (CU) is a condition where a person breaks out in hives just before (or after) they begin to sweat due to exercise or heat.  The exact cause of this condition is not completely understood, but it tends to occur most commonly in young men, but can also occur in women.  Because sweating is the trigger, it occurs most frequently under the arms and around the chest and neck, but it can happen anywhere on your body.  Classic CU consists of small hives that cover the whole body, and they are extremely itchy, and can even be burning or painful; however, large, plaque-like hives have also been described. The disease is set off by the allergy cells (mast cells) releasing histamine, which causes the hives, and in sufficient quantities, can lead to full blown anaphylaxis with wheeze, abdominal pain, and fainting. What makes this type of urticaria (hives) different from most, is it’s relative lack of response to traditional antihistamines.  However, there are other steps you can take to help mitigate the symptoms, and we can help you feel better.


Exercise induced anaphylaxis (EIA)

Dramatic, sudden and potentially life-threatening, Exercise Induced Anaphylaxis (EIA), is by far the most alarming allergic reaction seen in people exercising. Thankfully, the condition is rare, but it is also almost certainly underreported.  Symptoms include hives, asthma, angioedema (swelling of lips and tongue), a drop in blood pressure, and even death.  Some cases of EIA are triggered by something in the environment including high pollen counts or eating certain types of food (particularly grains and seafood) just prior to working out. Immediate treatment with epinephrine will usually reverse the attack. Luckily, many of these patients have a spontaneous resolution of the symptoms. Anyone with a history of EIA needs a prompt evaluation by an allergist.


Exercise induced bronchoconstriction (EIB)

Exercise induced bronchoconstriction (EIB) is a very common respiratory complaint at the gym, and is usually the mildest.  It is so common that some studies suggest that up to 30% of all high school athletes, and as many as 50% of Olympic winter athletes have some form of EIB.  Basically, if you’ve ever run or worked out strenuously and then developed difficulty breathing and wheezing, you may have EIB.  It happens when the airway gets too cold and dry during exercise (this is why its so prevalent among winter athletes). Once the airway rewarms and moistens up, a signal is sent to the allergy cells to blow up and release their histamine.  This causes the lungs to tighten up, causing that wheeze and shortness of breath. The majority of people with asthma have EIB, but the majority of EIB sufferers do NOT have asthma. Treatment is simple, and usually stops the whole process before it starts.


All of these conditions can be diagnosed and treated by a board certified allergist. If exercise or work out regularly, and feel some of these conditions, any of our board certified allergists could treat you. Before you cancel your gym membership, set up a same day appointment with one of our New York allergists. Your body will feel better, and anyway, you probably can’t get out of that 2 year contract.