Exercise-Induced Pruritus

Discussion in 'Medical Students - MD' started by jllander, Nov 13, 2005.

  1. jllander

    jllander Senior Member
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    Anyone heard of it?
     
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  2. 0T6

    0T6 Member
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    cholinergic pruritus?
    Do you get it after a shower too?
     
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  3. jllander

    jllander Senior Member
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    Nope, only after brisk walking or running.
     
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  4. fourthyearmed

    fourthyearmed Senior Member
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    That happends to me actually. Is it a real disease? I thought it was just my excuse for not exercising.
     
  5. tigress

    tigress queen of the jungle
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    Well I get it too. Actually it can be extremely bad; my thighs will feel like they're burning up and itching. If I scratch (which I usually can't help, because it's awful) I get red dots (petechiae from scratching, probably). Either way the area becomes red, swollen, and very hot to the touch. Cold weather seems to make it significantly worse. I also get something similar, with more swelling, on my hands, particularly in spring and summer, which seems to be obviously an allergic reaction, but to what I don't know. In terms of the exercise, it doesn't happen as much if I'm in good shape. If I'm trying to get back into shape it seems to happen more.

    I once asked an allergist about it and was told that it might be related to my autoimmune condition. But he really didn't know. I never used to think I was particularly predisposed to atopy in particular, but lately I've also developed mild eczema on my arms, so maybe I am. (Except I joke that I caught the atopic dermatitis from my husband :laugh: )

    Other than the obvious (http://www.emedicine.com/DERM/topic442.htm), the only thing I"ve really found is this: http://www.emedicine.com/ped/topic724.htm , which is pretty scary. If what I (and you?) am experiencing is early stages of this sort of thing, it's certainly important to be vigilant. I doubt that's it, though; it seems more annoying than dangerous. Regular cholinergic urticaria is more likely, even though it doesn't really fit for me -- no wheals, really, and it takes a while to develop, often developing only after I stop exercising, actually.

    I'd love to hear if anybody else has any ideas. It does get extremely annoying. The other night I was walking around town for a long time, it was quite chilly out, and at one point my thighs were itching and burning so badly that I had to go behind a pillar to scratch them; a few days ago I actually bruised myself from scratching at it, but when it's happening I don't even notice because it's so excruciatingly uncomfortable.
     
  6. jllander

    jllander Senior Member
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    Thanks for the feedback. I have heard of people allergic to their own sweat, which could explain my symptoms but the only weird thing is that I can be using the elliptical trainer, sweat like a pig, and be totally fine. This itching only comes on when I walk or jog. I found that article on exercise induced anaphylaxis too but I highly doubt that's what this is because it only happens with certain kinds of exercise. <shrug> I'm an medical oddity. Hehehe!
     
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  7. tigress

    tigress queen of the jungle
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    Actually, now that you mention it, it's certainly not as bad when I use the elliptical. I always thought that was because the elliptical is inside as opposed to outside. Maybe it has something to do with what muscles we're using? Like maybe when you use certain muscles they get this reaction? I haven't taken gross anatomy yet so I don't know the answer to that question :p
     
  8. drhobie7

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    I've heard a little about this. It's not uncommon (as you can see by the respondents who share the experience, including myself). My understanding is some people have mast cells that are more readily degranulated by various stimuli, not just IgE. There may be a threshold for mast cell degranulation, which varies by person. Exercise somehow stimulates this degranulation in some people. But what do I know? I'm just a dental student. :)
     
  9. EM Junkie

    EM Junkie SDN Donor
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    I get this all the time, especially on my legs, and especially when I am not in very good shape. I assumed it had to do with increased blood flow to the legs which had previously been somehwhat blood deprived. As far as the biochemical basis, I don't give a squirrel's A55, I am a 4th year!!

    -Scott
     
  10. Gimlet

    Gimlet Cardiac Anesthesiologist
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    Maybe this is oversimplifying the problem, but could it be your thighs rubbing together and causing the itchiness problem? When you're on an elliptical you have to spread your legs wide enough to get your feet on the machine, whereas when you're running, your feet are likely closer together, causing your thighs to rub against each other. What happens when you do other forms of exercise like weightlifting?

    Just a thought...I've never heard of this problem before this thread. I hope you don't have to put up with too many jokes about your "burning loins." ;)
     
  11. Pinesinger

    Pinesinger Born-again Yankee
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    I had this problem for about a month, it was attributed to an antibiotic I was taking at the time. I broke out in very large red urticaria on my legs, especially thighs, lower arms, and face. It only happened when I exercised, and was worse when I was outside. After about a month it stopped and hasn't happened since, that was my first year of school, I'm now an MSIII. My doctor recommended Zyrtec to try to control some of the histamine, and actually suggested I carry an Epipen because she was concerned about this being a precursor to angioedema and anaphylaxis.

    Jllander, i see you're in Winston-Salem, maybe it's something in the air here?
     
  12. jllander

    jllander Senior Member
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    Well, I considered my thighs rubbing together, but when I started jogging today, it was on my calves and lower back. So I doubt it's just friction. I also considered an allergy from being in a new place (I'm originally from CA, I've only been in NC for 4 months). However, this happened in California as well. It probably has something to do with my histamines but I'm only one week into immunology, so I don't know the biochemical basis of them ..... yet. Thanks for the great ideas everyone!!
     
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  13. skiz knot

    skiz knot Legendary Dr. X
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    Is any one else here impressed by her use of medical jargon? :thumbup:




    Ummm, you seem to want people to "diagnose" your condition, but you don't tell us what your "autoimmune condition" is. Potentially important info, don't ya think? :rolleyes:
     
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  14. nala

    nala Member
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    My legs and arms often itch really badly - I always just thought that when my pores open up any lotion I would have put on in the past day irritates my skin. Can that be?
     
  15. tigress

    tigress queen of the jungle
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    Nah, I don't want anybody to diagnose me. I'm just contributing to the conversation (I wasn't the OP, remember). It's interesting that so many people experience this.

    [The allergist I saw said that many people with autoimmune conditions also have some unexplained rashes or urticaria. I don't think it matters much what the condition is, but I also don't know much about dermatology/allergy/etc. yet. But since you seem to want to know, I have juvenile rheumatoid arthritis, but it's not very active now.]
     
  16. thackl

    thackl 1K Member
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    Same exact thing happened to me once in Highschool. I forget which antibiotic I was on..... popped up when I worked out (b-ball season) and stopped a few weeks after.
     
  17. DropkickMurphy

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    I have the same symptoms, and was diagnosed as having dermatographism. I've found good relief with a combination of Zyrtec and Singulair. Benadryl and epi (in severe cases) works to halt the attacks.
     
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  18. bonovox

    bonovox Coexist, or else...
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    It is definitely a rare condition. This summer, I had two episodes of exercise-induced anaphylaxis, one which landed me in the ER and the other which coulda killed me had my car not slammed into a pole when I got knocked out.

    I've had episodes of exercise induced urticaria in the past, and both of these anaphylatic episoded were preceded by urticaria that gradually coalesced into a big red swollen me.

    All of these episodes occurred while walking or running on a treadmill.

    They do not know much about the cause of EIA, other than it's a type I hypsersensitivity reaction which somehow involves a lower threshold for mast cell degranulation. I spoke to an allergist and he told me this much.

    The key differential to be considered is cholinergic urticaria, which is much more reproducible than EIA (the test for EIA, which isn't that great, involves running on a treadmill). Cholinergic urticaria occurs during passive body warming, like getting hives while taking a hot shower. They also can inject your skin with methacholine and see if you get hives from that.

    Now, in my case, the two anaphylactic episodes were preceded by eating large meals less than 2 hours before going to the gym. So, for me, I can prevent these episodes by simply not going to the gym 4-6 hours post-prandial. Certain medications taken before exercising may also be an initiating factor.

    Unfortunately, there's not much beyond this you can do to prevent it. Anti-histamine prophylaxis is somewhat helpful according to the literature (although, the second time that brought me to the ER, I had taken claritin prophylactically before going to the gym). Make sure to carry an Epi-Pen with you at all times when you go exercising, and also zyrtec or benadryl. When you start breaking out in hives, don't start your car or do anything that could land you in trouble should you pass out. If you start feeling faint, Epi-Pen yourself.

    I had maybe 5 episodes of exercise induced urticaria over the past 6 years prior to my two anaphylactic episodes. So, don't feel like you got nothing to worry about just because you only get hives. GET AN EPI-PEN!

    Good luck and stay safe.
     
  19. DrWuStar

    DrWuStar YUM
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    i have a cold urticaria... more or less an allergy to cold. my allergist said these things are rare, but not unheard of. can happen with cold, heat, exercise, or pressure. i have allergies to a lot of other, more normal, allergens as well, so i take an antihistamine (allegra-D) all year round. it keeps the itches under control. before they figured it out though it was really unbearable. i was SOOOOOO itchy and broken out in hives all the time. if you want to get diagnosed and a prescription for antihistamines, i would suggest going to an allergist because i think this is pretty uncommon, so your PCP might think you are just crazy. mine did.
     
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  20. DrWuStar

    DrWuStar YUM
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    i have a cold urticaria... more or less an allergy to cold. my allergist said these things are rare, but not unheard of. can happen with cold, heat, exercise, or pressure. i have allergies to a lot of other, more normal, allergens as well, so i take an antihistamine (allegra-D) all year round. it keeps the itches under control. before they figured it out though it was really unbearable. i was SOOOOOO itchy and broken out in hives all the time.

    if you want to get diagnosed and a prescription for antihistamines, i would suggest going to an allergist because i think this is pretty uncommon, so your PCP might think you are just crazy. mine did.
     
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  21. noncestvrai

    noncestvrai Member
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    Just to be clear, this isn't "jock itch" right... :D

    If it was the case, take the cheapest topical antifungal available...they are all the same...

    noncestvrai
     
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  22. fun8stuff

    fun8stuff *hiding from patients*
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    you don't think this could have anything to do with the clothing you wear when you use an elliptical and are going for a walk/jog? Long pants vs. shorts?
     
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  23. YouDontKnowJack

    YouDontKnowJack I no something you don't
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    i think this is normal.

    when i was out of shape, and suddenly ran a lot one day, i got the leg itch. and there was no clothing over it.

    after i got back in shape, it went away.

    the itch is more of a staticky feeling. just slap your skin for a while, and don't use dirty nails to scratch. didn't they teach you this in micro?
     
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  24. epidural man

    epidural man ASA Member
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    Strange but is is only mentioned once in the literature.

    Duffull, S. B., and E. J. Begg. "Terfenadine ineffective in the prophylaxis of exercise-induced pruritus." Journal of allergy and clinical immunology 89.4 (1992): 916-917.


    I get it - intense itching over my legs, butt, back, arms - when I exercise in a colder environment - mostly with running. It hurts actually. If I stop running, it slowly gets better. No rash, just increased flushing in the itchy areas.

    I think it is genetic because my bro and sis get it too.

    Again, it is strange the medical community is silent on this as I think a lot of people get it - it is described by people all over the net saying they get it - yet most medical sites seem clueless (blaming food, or calling it Exercise induced urticaria or anaphylaxis).
     
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  25. evilbooyaa

    Staff Member Moderator 7+ Year Member

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    8 year necrobump?! WHYYYYYYYYYYYYYYYYY YOU DO THIS
     
  26. crash38

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    My girlfriend has this issue...a very uncomfortable itchy feeling that happens with exercise. There's no rash, but there is redness in the affected areas. It goes away shortly after she stops, and isn't a problem at all when she has been consistently exercising (only when starting up after falling off track).


    exercised-induced urticaria/anaphylaxis?

    why would exercise cause this?
     
  27. norealname

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    This is chronic cholinergic urticaria. I too suffer from that condition. Luckily, a little bit of claritine helps, especially if I'm out in the sun or something. It gets quite unbearable sometimes though, especially with hot showers or vigorous exercise.
     
  28. dismorfik

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    Pop some antihistamines.... Zyrtec in the morning, Benadryl at night.
     
  29. purphant

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    Same here. Happens with brisk walking or running. My brother gets it too. I use it as an excuse to just not exercise lol
     
  30. readin

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    i actually asked my PMD about this. he says that it's a fairly common complaint
     

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