Rare Allergy Triggered by K-Pop Dancing and Crab Consumption

Medscape

20-05-2025

A 30-year-old man presented to the hospital with acute shortness of breath and generalised urticaria. He had no known preexisting conditions or allergies. The patient reported that his symptoms began shortly after eating crabs and engaging in vigorous physical activity while dancing to K-pop.
Further investigation revealed that he danced to fast-paced songs.
The case reported by Tianci Tang, of the School of Public Health, Zhejiang Chinese Medicine University, Hangzhou, China, and colleagues highlighted a rare medical condition.
The Patient and His History
The patient reported acute shortness of breath and generalised urticaria that had started 2 hours before admission. Four hours earlier, he had eaten crab and danced. After 2 hours of dancing, a large wheal appeared on the patient's chest.
Shortly thereafter, he experienced redness and swelling of the neck, followed by breathing difficulties. The patient denied any history of allergies. His medical, medication, family, social, drug, and travel histories were unremarkable.
Upon further questioning, the patient revealed that he had been dancing to the K-pop and BABYMONSTER's 'Batter Up,' indicating that the exercise had been intense and involved significant physical exertion.
Findings and Diagnosis
On admission, the patient's oxygen saturation in room air was 98%, and his heart rate was 112 beats/min. His respiratory rate, body temperature, and blood pressure were within normal limits. The patient was alert and fully oriented.
Examination revealed pharyngeal redness and congestion, involuntary trembling, regular abdominal softness, no pressure pain, and swelling in both lower limbs. Auscultation and percussion findings were unremarkable.
Shortly after admission, the patient developed an uncontrollable, violent cough, followed by vomiting. He was treated with 40 mg methylprednisolone sodium succinate in a physiologic salt 100 mg intravenous drip and 1 g vitamin C in a 500 mL intravenous drip of glucose.
Laboratory tests revealed normal cardiac, liver, and renal function.
On the basis of the World Health Organization criteria for allergic reactions, the patient was diagnosed with an exercise-induced food allergy.
During the night of admission, the patient's serum creatine kinase concentration rose to over 6000 IU/L. The patient was subsequently diagnosed with rhabdomyolysis after undergoing renal function tests. However, the patient's vital signs remained stable.
The treatment included adjusted medication doses, four bags of sodium chloride injection (500 mL/bag size) for hydration, and sodium bicarbonate injection.
After treatment, the patient's skin symptoms temporarily improved. However, 3 hours later, a skin cyclone reappeared at the end of the toes and glans penis; therefore, a single intravenous injection of furosemide (2 mL, 20 mg) was administered. The patient's allergic symptoms resolved completely 6-7 hours after admission.
Discussion
'Allergy combined with rhabdomyolysis is a multifactorial disease; to our knowledge, no prior reports exist of allergy as a direct cause of rhabdomyolysis. The patient in our case recovered completely after anti-allergy treatment, urine alkalinisation, and hydration,' the authors concluded.
However, diverse symptoms remain rare and are challenging to manage.
The prevalence of exercise-induced food allergies in Germany is approximately 0.02%. Reliable data on the frequency of concurrent rhabdomyolysis are unavailable.