What is it?

In a select group of persons, exercise can produce a spectrum of allergic symptoms ranging from a skin irritation to a life-threatening anaphylactic reaction. Based on symptoms, the diagnosis can be exercise-induced urticaria or anaphylaxis.

Classified as physical allergies, managing acute episodes can including taking antihistamines, epinephrine and ceasing exercise. Long-term care may require modification of or abstinence from exercise, avoidance of co-precipitating factors (other allergens) and the prophylactic use of medications such as antihistamines and mast cell stabilizers (inhalers, nasal sprays and eye drops).

Exercise-induced anaphylaxis has been described at all levels of physical exertion and during various athletic activities. In susceptible persons, ingestion of certain foods or medications before physical activity may be a predisposing factor. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) have been the most frequently implicated medications. Foods that have been implicated include seafood, celery, wheat and cheese.

Because symptoms may vary greatly, many persons with exercise-induced anaphylaxis are unaware of their condition. Similarly, because it is a relatively rare condition, it often goes undiagnosed.

Source: American Academy of Family Physicians

Michael Banks is the most talented runner living and racing in South Carolina now and is making a strong case for being among the most elite resident runners ever.

Banks, who is 27 and works at the Charleston School of Law, has broken long-standing state records in the 12K and 15K and was just four seconds shy of breaking the half-marathon record in November 2013. And his recent times of 14 minutes, 16 seconds in the 5K and 29:54 in the 10K put him within striking distance of those prestigious state records, as well.

"I think (breaking) all of the state records are do-able for me. Over the next year, I would like to break the 5K, 8K, 10K and half marathon (records)," says Banks, adding that the toughest challenge in chasing records is learning to push himself while racing alone.

If the former Georgetown Hoya runner isn't breaking state records, he's setting new course records and sweeping up enough prize money to make a modest living out of running races.

But following an incident during on a run on an unusually warm, humid day on Dec. 1, 2013, just days after he won the Turkey Day Run in a record-breaking 14:27, word spread in the local running community that Banks was "allergic to his own sweat."

Allergic to sweat?

Banks, who grew up in Massachusetts but has family in Charleston, first started breaking out in hives while running in the summer of 2005. It started around his armpits, then over the next year, progressed to his neck, chest and around his waist where the waistband of his shorts touched his skin.

The allergy seemed related to sweat or sweat-soaked clothing.

Seasonal allergies developed after the hives started and progressed to itchy, watery eyes and a runny nose during the spring. Despite the hives and seasonal allergies, Banks says he never felt like it was a hindrance or serious issue requiring medication.

In the weeks leading up to Turkey Day last fall, Banks suffered from more severe breakouts.

"During my runs my whole body would be covered in a rash and itch like crazy. Usually I would have to take a Benadryl as soon as I finished my run. There were a few runs that I cut short because I was worried about it," says Banks.

ER wake-up call

On Dec. 1, 2013, Banks set out for a 10-mile run and started breaking out and itching.

"My back itched so much about six miles in that I took off my shirt thinking it might be causing irritation. A few minutes later I began experiencing symptoms that were completely new to me. My ears began to feel really warm and I felt like they were starting to close, as if they were swelling shut," says Banks.

When he felt his uvula (the fleshy flap at the back of the throat) and tongue swelling, he became worried he was going into anaphylactic shock and made a bee-line for home. Before getting there, he stopped at his aunt and uncle's house to ask if they had Benadryl. They didn't but decided Michael, who was in a rare panic and having a hard time speaking, needed to go to the emergency room.

On the way, Banks started feeling better and collected himself. At the ER, the nurses asked what was wrong, he adds because "most likely because I was acting pretty normal and nonchalant."

"When I took off my shirt and they saw my rash, there was definitely a 'whoa' factor (and they said) we've got to get some drugs in you ASAP," recalls Banks.

The diagnosis (sort of)

Later that month, Banks went to see Dr. Bruce Ball at Charleston Allergy & Asthma, who diagnosed it as exercise-induced urticaria and anaphylaxis, though last week described it as "very irregular and erratic."

As the name implies, the rare allergic reaction is caused by exercise and ranges from skin irritation to anaphylaxis, a severe, whole-body reaction that can result in shock or even cardiac and respiratory arrest. The condition is different from the much more common exercise-induced asthma.

Ball put Banks on a combination of Allegra and Zantac, urged him to carry an EpiPen (injectable epinephrine) on runs, and on hard training efforts, to run with friends, which is easier said than done with Banks.

So far, that's been good advice. Still, neither Ball nor Banks can't pinpoint what is causing his allergic reactions. A blood test taken last week may bear some answers this week.

Ball suspects that it may be a food that Banks eats in the hours just before a run, but that those foods usually show up as positive allergens in tests. Banks hasn't tested positive for food allergies in tests but suspects a gluten-intolerance because his younger sister has it.

"I've started cutting out gluten, but am waiting to hear the results of all the tests before going gluten-free. A gluten intolerance would certainly explain several things, including my feeling of being anemic the last several weeks," says Banks.

In the meantime, Ball says Banks has to be on high alert during runs for having a threatening combination of symptoms.

"For him, if he's running real hard and gets hot and sweaty and breaks out in hives, he's going to have to assess the other symptoms," says Ball, noting that those symptoms can range from tongue swelling to stomach cramps and nausea.

"Once he has two symptoms involved, he's got to use that EpiPen ... which will give him time to get to an emergency care facility," says Ball, adding that the condition is potentially life-threatening.

No worries

Banks, and even his loved ones, seem to be taking the condition all in stride.

His mother, Lucy Hawk Banks, says she was never worried about Michael's allergy until the episode last fall and that, for now, she's not too concerned.

"It would be nice to get to the bottom of this," says Banks, noting the seemingly growing number of environmental allergies in recent years.

Banks, who along with her husband, was a collegiate runner at Virginia Tech, says Michael is working on figuring out the problem and that, barring any more severe reactions or progress, doesn't see the need for him to pull back on running.

"I haven't scaled back my running despite things that have happened to me over the years. So I'm in no position to tell him or anybody that. If it got to the point where I thought it was detrimental to his health, then yeah, I might say that (scale back)," says Banks.

Banks' girlfriend, Katherine Selheim, says she was worried until the trip to the ER, and that she's just making a more concerted effort to keep tabs on knowing how long he expects to run.

As for Banks, he says the allergy isn't hindering his running and seems to have returned to the level prior to last fall, with mild breakouts.

"The worst part is definitely getting used to running with the EpiPen, but it's an annoyance I'm more than happy to embrace," he says.

Reach David Quick at 937-5516.