Allergies and Delayed Pressure Urticaria

My last race of the 2011 season was very disappointing.  Although my preparations were not ideal because of our move to France and my extensive travel, I still expected to do better.  Nevertheless, although I’m by no means a fast runner, my 2:18 half marathon time shows there was a clear problem on the run.  Although my swim was pretty good with a 29 min time (the course was a bit short) and my bike was respectable (3:08 for a very hilly course), the run was simply a shocker.

During a trip to Japan in August 2011, I suddenly (or so I thought) developed allergies.  One morning, I woke up with a massively swollen lip and wondered what happened.  A few days later, when the matter repeated itself I begun to worry and figured it was related to stress.  With a little time to kill, I chose to relax, get a massage and take it easy for the day.  Upon waking up that next morning, not only did my lip continue to swell up, but my back where I have been massaged was very swollen and painful…  Not a fun situation.

The problem seemed to worsen rapidly and my mind spun a million miles an hour trying to find the root cause.  The first instincts of course were around food.  As a huge Sushi lover I imagined that it was related to a food indigestion and stopped eating shellfish, and other related food.  Though this seemed to work for a few days it must have only been coincidence because a few days later similar symptoms reoccured with added hives pretty much all over my body.

I promptly cancelled my client meeting and began to panic when I woke up with this swollen lip...

After a short stop in the US, I grabbed some Benadryl and started taking it daily which helped with some of the hives and prevented the famous swollen lip.  However, it also seemed that if I was placing pressure on my skin, a few hours later welts would appear under the skin at the location where the pressure had been placed.  This was not an ideal situation for someone trying to ride a bike for a few hours at a time.

By the time I was starting my race in Aix-En-Provence, I was on a one-a-day, self-medicated benadryl treatment which seemed to keep the hives at bay.

The morning of the race, I felt like I had lots of time and made a rather large mistake of eating eggs for breakfast.  Several folks I have shared this with later on called me crazy, stupid and a bunch of other similar terms and they are right on all accounts.  Whatever the exact cause of it was, my stomach seemed to shut down half-way through the bike and cramps started to settle in.  By the time I reached T2, my stomach was in so much pain that I couldn’t run and was reduced to a walk for the first few miles.  After a stop to the bathroom I was able to start jogging again but after a few more miles, my tank was empty due to my inability to inject any food or liquids and it was just too late.  I suffered tremendously and pretty much walked the entire last lap.

The experience left a bit of a sour taste in my mouth with a 6h and change performance which I considered to be well below what I was capable of doing and quite a disappointment for a race I’d build up to for so long.

Following the race, I went on a quest to figure out what was wrong with me.  I was convinced that I had some allergy and possibly digestive issues and that I had to deal with them if I hoped to have a good 2012 season.  Off to an allergist I went to start a battery of tests.  I was tested for all the common things such as pollen, major food items, dust, and other things and many of them came back negative.  Of particular surprise, the tests showed no sensitivity to pollens and any food items…I was therefore free to resume eating my sushi, my morning eggs and anything I so desired.

For a while I thought I might be allergic to shellfish and that I would be deprived of my favorite sushi

Overall, I was diagnosed with two things.  The first was an allergy to mites as well as streptococcus and staphylococcus.  I have no idea what all this stuff meant and I still don’t, however, I know that it generally means that I’m allergic to dust and that my body tends to have frequent colds and strep throats.  The second issue that I have is a rare disease (or expression of a disease) called Delayed Pressure Urticaria (DPU).  This DPU is a very painful set of welts that pressure can cause on the skin and occur 6-12 hours after the pressure.  So if you carry a backpack in the morning, your shoulders are on fire mid-afternoon…If you squat with a bar on your back, your skin will swell where the bar was, if you get a massage, your skin will swell, if you ride a bike a while…well…you get the idea.

So the good news is that allergies are common and quite well treated these days.  For the mites allergy, I am now on a daily treatment of Telfast 180mg (Allegra in the US) and it keeps most hives at bay and I haven’t had another episode of swollen lip in months.  The bad news is that supposedly, the DPU is not something that can be cured and that most people simply have to learn to manage it…we’ll see about that at a later time.  Some people report that it can go away…others haven’t figured out the magic cure yet and this is not a common-enough disease that pharma companies spend much time on it.

Upon researching allergies, I found that one can develop allergies suddenly at any point in life.  Though it was frustrating for some time, I’ve learned to live with them and I am now following a course of allergy shots in order to try to reduce my dependency on medicine.  As a result, I’ve now reduced my daily intake of medicine to 45mg per day and things appear to be improving still.

In addition to allergy shots, I also recommend to athletes allergic to mites an investment in anti-mites pillow case covers.  Taking those with you while you travel for business and races will improve your rest and preparations.

But back to Delayed Pressure Urticaria…

The first major instance of Delayed Pressure Urticaria that I remember was related to that massage I got while in Japan.  Immediately after the massage, all went well until the middle of the night when I woke up itching severely along my spinal cord where the therapist had spent a lot of time on.  By morning when I got up, the itching continued and as I looked in the mirror, I noticed some severe swelling accompanied by itching.

A few days later, while traveling, I found that my shoulder was very swollen where the strap of a laptop bag had been putting pressure on.  This type of swelling was very deep, underneath the skin and painful.  Still a few days later, after a bike ride, the area where I sit on the bike became very swollen, painful and itchy in the same manner as the previous incident.

The trend was worrisome.  After applying pressure on a part of the skin, the skin became very swollen, itchy and painful, often accompanied by GI issues, headaches and general tiredness and discomfort.  As I researched these symptoms, it was clear that they were related to Delayed Pressure Urticaria, often simply referred to as DPU.  I note that researching things on the internet can be quite alarming.  Tales of people’s symptoms getting worse until they were literally immobile, stories of people unable to workout and gaining large amounts of weight and other ramblings quite demoralized me.

Lest we not allow ourselves to be demoralized by the internet, I sought the advice of my allergist who sadly confirmed that indeed DPU was not curable but merely “manageable” by avoiding pressure.  As a businessman, the idea that sitting for prolonged amounts of time would result in painful after effects was not entirely appealing and as a triathlete, the inability to ride a bike wasn’t really matching my plan.  Of course, as a father, the idea that I was unable to carry my child on my shoulder was simply unacceptable.

As my search for answers externally in talking to doctors or looking in the internet led to a complete lack of hope, the only possibility was to find answers internally.  I don’t know if it’s linked to getting older or to being an athlete but I have found that the root cause of most problems can be obtained internally and that the body is remarkable at letting you know what is wrong.  As such, I went on my search…

To start ruling out likely candidates, I went for a battery of tests on allergies.  When the tests came back, the news was clear, I was not allergic to pollen nor to food…I could continue to eat my favorite sushi.  As I looked at the symptoms, there were not entirely predictable which bothered me.  With my mite allergy, I could usually pinpoint it easily to closed environments (airplanes, hotel rooms, etc…), but with this it was much more difficult.  Sometimes I would go on a bike ride and suffer from DPU the next day, but other days I was not, or it wasn’t as severe, therefore something “external” must be going on.

The other aspect of DPU that bothered me were the GI issues.  Almost every instance of DPU was accompanied by GI distress.  Though my research confirmed that, I always found it difficult to believe that an allergy would cause these type of issues and came to the hypothesis that it was what I was eating that caused a reaction impacting both my GI tract and my DPU.  Over weeks and months, I tried to identify what I ate and if it could be linked to my symptoms.  I really tried to keep track of it to identify the cause but it was quite difficult due to travel, exotic foods I would eat in foreign countries and the like.

After 6 months of trial and errors however, I believe I have finally found the suspect: Eggs.  Although my tests came back negative for an Egg allergy, it seemed to be egg-related foods that triggered my DPU.  Anything made with an egg from omelets, to pancakes, cakes, cookies, brownies, steak tartare, mayonnaise, etc… will cause DPU.  Discovering that egg was the culprit took a lot of effort because eggs are pretty much everywhere, particularly in France.  Many sauces contain eggs, all cakes, some pastas, even some mashed potatoes or other meals are made with eggs.  To be frank, there may also have been some denial on my part as well since I truly love eggs and have been eating eggs in the morning for breakfast for as long as I remember.

Avoiding foods containing eggs has been the secret to beating DPU and resuming a normal life

Nevertheless, now that I avoid eggs in my diet, I have been able to resume all my athletic activities without fear of DPU.  I can bike, squat, carry my kids on my shoulder, everything is fine.  And on the few days when I see something that I must have, I bite the bullet and suffer a bit 6-12 hours later.  This particular allergy is not violent so I don’t have to worry about going into a strong reaction that would send me to the hospital.  So if I accidentally intake small amounts of egg protein, or even use sports drinks that were made in a factory that processes eggs (Such as the Ironman PERFORM sports drink by Powerbar at all Ironman competitions), I am completely fine and able to perform my normal activities.

Finally, thanks to my lovely dietitian wife, we’ve found ways to continue to eat the things I love by being careful or creative.  As an example, it’s perfectly possible to make pancakes without eggs and they taste delicious!

I don’t know if eggs is the same culprit for all those who suffer from DPU but hopefully this insight may help some people identify what triggers their own reaction and learn to manage the disease.  Despite what I had previously found from my research, I have learned to live perfectly well with this disease and I’m confident that anyone who has fallen victim of this condition can as well.

I now know that in addition to probably a training issue, my performance at Aix 70.3 was probably due in part to my egg allergy and I look forward to testing myself again soon in Mallorca 70.3.  Until then, happy training to all!

Special Note: For all those living with DPU, I am particularly interested to hear your own stories and if you have come to similar, different or complimentary conclusions.  As an additional reference point, I have a suspicion that ultimately, the culprit is the liver and I am continuing my research on the topic.  I’ll of course write about any significant discoveries.

7 thoughts on “Allergies and Delayed Pressure Urticaria

  • I have the same allergy DPU and I found out that eggs were cause of my allergy. However, I’m not able to do any physical activity without a reaction.

  • Great insight. I also had a severe hive break out after a massage and I believe I have DPU. My GP prescribed me with Prednisolone and honestly, I do not like to be on corticosteroid due to its side effects. My dermatologist told me I have highly sensitive skin. You mentioned that you take Telfast 180mg on a daily basis to prevent any hives from flaring up. Do you know if there are any side effects to ingesting antihistamines for a prolonged period of time?

  • Hi Cecilia – Yes, I agree that it’s definitely not ideal to be using Prednisolone. I keep some as an emergency only in my bag but other than that I avoid it. Telfast/Allegra has been able to keep all my symptoms at bay for the most part but for me, it is also in combination with avoiding eggs and products made with too much eggs. I have not experienced any side effects from Allegra but some doctors would advise you to take them before bed rather than in the day because it can cause mild drowsiness. Whatever it is, I certainly think that any effect from Allegra would be minor compares to effects from corticosteroid. Good luck!

  • I have had excellent success with Bentonite Clay. It was recommended to me by a woman who works with natural medicine. I had never heard of it but I was more then willing to try it. It draws out the toxins from your body. I use the liquid version, just doing one tablespoon a day in juice or water.

  • I also seem to have DPU. I am currently in my third bout of hives; it’s been about 11 days right now. I also get angioedema (swelling of lips and sometimes eyes) in the morning, though not every day during the hives outbreak. I have had three extended periods of time with the urticaria (hives) and two of these bouts with hives erupted after or during an airplane flight. So I am wondering if that has to do with the pressure of remaining seated for long periods of time. I don’t think it is caused by stress as I feel fine about flying and both trips were very relaxing vacations, with no worries or responsibilities. I have tried many meds as suggested by my doctors, including hydroxyzine, montelukast, famotodine (Pepcid), Zyrtec, Benadryl and Allegra. All make me drowsy save for the Allegra and the Pepcid so that is what I am using during the day to manage my symptoms. One bout of hives lasted about 8 weeks so I am very apprehensive right now.

    Could anyone share about the allergy shots? i am considering this course of treatment.

  • Eggs!!! Pure genius! I’ve avoided eggs as they caused me to have intestinal discomfort and frequent bowel movements. Never have I linked the DPU to eggs! I’ve only avoided eating eggs as a whole food, I will now remove them from my diet completely and see!! THANK YOU!!

  • I too have dpu and I also have adrenal insufficiency with hypothyroid and ibs I live on corticosteroids and zyertec another anti-inflammatory cuz they think I have fibro now but I have not been able to link what is causing the severe hives and swollen knots I have discovered I am allergic to aluminum but I have pretty much gone completely organic and aluminum phosphate free but still if I get a massage I swell and hive out or if I carry grocerys on my arms I will swell but I will also get hives in areas that don’t get any pressure this makes living pretty difficult and all this started 4 years ago and my endo is the only one that discovered the majority of my problems

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