Young man who would develop severe #itching over body after #running
1. 33-year old Sid presented with an unusual symptom. He used to develop severe itching all over body whenever he ran 4 km or more. He had been unsuccessful in his attempt to train for long distance running.
1. 33-year old Sid presented with an unusual symptom. He used to develop severe itching all over body whenever he ran 4 km or more. He had been unsuccessful in his attempt to train for long distance running.
2. He had no itching when at rest. He had no allergy to any food items. There was no other comorbid illness. In all, he was healthy, however, due to his inability to run (or do any other high-intensity exercise, he was gaining weight, and had gained 10 kg over the past 2 years).
3. Sid was quite troubled by his inability to run (which he badly wanted to do). He had consulted a few local physicians, who could not offer any significant help. At this time, one of his friends (who knew about my passion for running) suggested that he consult me.
#MedTwitter
#MedTwitter
4. Sid consulted me as a last resort.
I listened to his history in detail. He would develop severe itching after running for 30 minutes (about 4 km). Skin over various parts (chest, neck, axilla, arms and groins) would develop multiple raised red rashes suggestive of #urticaria.
I listened to his history in detail. He would develop severe itching after running for 30 minutes (about 4 km). Skin over various parts (chest, neck, axilla, arms and groins) would develop multiple raised red rashes suggestive of #urticaria.
5. Itching would last for 60-90 minutes and resolved on own.
Diagnosis was obvious by now (I remember seeing a similar case in 1995 during my MD Medicine residency, when I was posted in dermatology unit).
Diagnosis was obvious by now (I remember seeing a similar case in 1995 during my MD Medicine residency, when I was posted in dermatology unit).
6. The diagnosis was exercise-induced urticaria. No tests were needed to confirm the diagnosis, as the diagnosis rests on history and exercise-challenge test (where the patient is made to exercise under medical supervision and examined for appearance of itching symptoms).
7. I discussed two options with Sid- "either take anti-histaminic medicine prior to long runs or run at slower pace". He was not keen on taking regular medicines. He started training with walking- and had no itching after walking for 60 min (6 km), gradually increased to 90 min.
8. Sid also attempted a few runs of 60-90 minutes after taking a dose of anti-histaminic and was pleased to note that he did not develop any itching or rashes after the run. Sid was confident that he could now pursue his hobby of running.
#running #fitness #exercise
#running #fitness #exercise
9. Sid returned last week with a big smile on his face. He had successfully completed his first half marathon run in 2 hours 35 minutes.
10. Take home message
*Exercise-induced urticaria is an uncommon condition.
*Diagnosis can be made by careful history and exercise challenge test.
*Management options include low-intensity exercises or antihistaminic dose prior to exercise.
*Exercise-induced urticaria is an uncommon condition.
*Diagnosis can be made by careful history and exercise challenge test.
*Management options include low-intensity exercises or antihistaminic dose prior to exercise.
11a. Further reading
doi.org/10.7759%2Fcure…
doi.org/10.7759%2Fcure…
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