How easy train can set off a deadly response

A trip to the beauty of Cheshire should be the perfect summer outing.

But shortly after embarking on a fairly challenging journey around Alderley Edge with her husband, Lauren Layfield felt her feet begin to ‘itch like crazy’.

Within minutes, the sensation was so unbearable that radio presenter Capital, 34, had to stop where he was, on a field, tearing his jeans and clawing helplessly at his stabbing limbs.

The problem isn’t the usual rustic hazards, like nettle stings or insect bites — the intense itching is triggered by excessive walking.

The cause, a little-known condition known as exercise-induced urticaria (or cholinergic urticaria), is very common. About one person in 2,000 is affected, i.e. 33,000 or more Britons. While anyone can develop it, you most likely also have eczema, asthma, or other allergies.

Even light exercise can cause bumps to appear and the skin is blotchy, red, and very itchy. Symptoms usually subside within 15 to 30 minutes of stopping exercise.

“It was so horrific, I had to get undressed because my feet felt like they were on fire,” recalls Lauren, who also reports on BBC1’s The One Show and lives in London with husband Luke Beddows, 34, a comedy writer.

Shortly after embarking on a fairly challenging journey around Alderley Edge with her husband, Lauren Layfield felt her feet begin to 'itch like crazy'.  Within minutes, the sensation was so unbearable that radio presenter Capital, 34, had to stop where he was, on a field, tearing his jeans and clawing helplessly at his stabbing limbs.

Shortly after embarking on a fairly challenging journey around Alderley Edge with her husband, Lauren Layfield felt her feet begin to ‘itch like crazy’. Within minutes, the sensation was so unbearable that radio presenter Capital, 34, had to stop where he was, on a field, tearing his jeans and clawing helplessly at his stabbing limbs.

‘I scratched like crazy. I had to sit there until the itching subsided and then creep back into the car at a snail’s pace to stop it from happening again.’

This wasn’t Lauren’s first attack, but it was the most severe.

He started experiencing symptoms in his late teens. ‘If I went camping with friends or out for a walk, I would see the tops of my feet start to itch and the skin would look red and blotchy,’ she says.

“It didn’t matter what I wore, it just happened. I was at Lincoln University at the time, studying drama. As a student, I didn’t exercise much, but I started to make the connection that when I did some form of exercise, the itching and redness of my skin will occur.’

As with any allergic reaction, the trigger — exercise — causes histamine and other chemical messengers to be released.

This causes blood vessels to dilate (resulting in redness or redness of the skin), and leak (causing swelling and itching).

‘Cells in our skin called mast cells contain histamine and, in people with cholinergic urticaria, exercise can make them “hyperactive,” explains Dr Sophie Farooque, allergy consultant at Imperial College Healthcare NHS Trust, and author of Understanding Allergy.

Other factors such as heat, UV rays of the sun and sweat can also play a role. In some cases, it’s a combination of exercise and certain foods that causes the reaction – which is called exercise-induced anaphylaxis that is dependent on food.

‘Some people with certain food allergies may only experience a reaction when they exercise,’ explains Dr Farooque. ‘Exercise can be very light, such as walking or running to catch a train, and people can react up to four hours after eating or sometimes longer.’

Foods that are often implicated in anaphylaxis due to exercise-dependent diet are wheat and shellfish.

He started experiencing symptoms in his late teens.  'If I went camping with friends or out for a walk, I would see the tops of my feet start to itch and the skin would look red and blotchy,' she says.  File photo used above

He started experiencing symptoms in his late teens. ‘If I went camping with friends or out for a walk, I would see the tops of my feet start to itch and the skin would look red and blotchy,’ she says. File photo used above

But because reactions can occur hours after exercise and eating, it’s hard to pinpoint which food is to blame.

Doctors believe this happens because when we exercise, our cardiovascular system redistributes blood to working muscles, sending less of it to other areas, such as the intestines.

‘This slows down digestion and food stays in the intestines longer, allowing for greater absorption of food from an allergic person and this triggers a reaction,’ says Dr Farooque.

Over time, Lauren’s condition worsened and the itching spread to her stomach, chest and neck while exercising.

At 26, unable to even run to the bus to get to work (at BBC Media City in Manchester) for fear of an attack, Lauren decided to see a doctor.

‘The itching is really annoying,’ she said. ‘My skin is red and blotchy, but it’s the need to scratch that drives me absolutely crazy.

‘This happens every day. It really started to affect my life. I don’t do any sports, except a little weightlifting in the gym.

And I stopped wearing certain clothes like skinny jeans because it made it worse. Every day I always think, “how am I going to plan my day to avoid this turmoil from happening?” ‘

Her doctor was confused and referred Lauren to an allergy specialist, who diagnosed her on the spot.

‘I laughed when I was told,’ he recalls. ‘I knew my skin was reacting to physical activity but I never realized it was the real thing.

‘That sounds ridiculous. But I’m also relieved that I didn’t just imagine it.’

To confirm the diagnosis, Lauren had a blood test and ran around the hospital parking lot, and up and down stairs to see what had happened to her skin.

After ten minutes, not only was his body covered in blotches, but his pupils were also dilated—an early sign of anaphylaxis, a severe allergic reaction that causes the immune system to release a flood of chemicals that can cause a sudden drop in blood pressure and blockage. airways, making breathing difficult.

People with cholinergic urticaria who continue physical activity without taking antihistamines are at risk for this potentially fatal complication. ‘I realized for the first time that this condition is potentially quite dangerous if not managed properly,’ says Lauren. “It’s scary.”

Controlling cholinergic urticaria includes taking antihistamines regularly, or at least an hour before exercise to prevent a reaction, says Dr Farooque — and if a rash develops, those affected should stop exercising immediately. For some people, stopping exercise or exercising in the cooler parts of the day is enough to reduce or stop symptoms.

Lauren is now on a strong antihistamine and carries an EpiPen in case of a severe allergic reaction. He didn’t have to use it yet.

On this regimen, Lauren was able to manage her condition, although she avoided running, exercising, or walking too fast for fear of an attack. There were many things Lauren wanted to do but couldn’t because of her condition.

“I’m often asked to run the London Marathon and other races for charity and I’d like to say yes, but I can’t take that risk,” he said.

‘I’m just grateful I’ve found a way to control the terrible itching and realized what I have to do to stay safe.’

Mini muscle maybe

Small muscles that play a big role. This week: The suprahyoid muscle

The suprahyoid muscle is a group of four muscles under the tongue that pulls the Adam’s apple up and forward during swallowing — closing the airway to prevent food and drink from entering it — and opening the muscle at the top of the esophagus to allow food and drink into the stomach.

The muscles become weak with age (called presbyphagia), causing difficulty swallowing that can put older people at risk for pneumonia. To keep them toned, speech and language therapist Elizabeth Boaden recommends the ‘chin tuck against resistance’ exercise. This involves placing a 12cm diameter soft ball under your chin, holding it there and repeatedly pressing the chin down and releasing it.

Elizabeth Boaden has created a series of courses on swallowing difficulties in myAko.online.

You can also ask your GP about a referral to a speech and language therapist.

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