Case study ( 2810 views as of February 18, 2019 )
Siri is a 28-year-old elementary school teacher who has been struggling with a rash that comes and goes over the last two weeks. It came on "out of the blue" after attending a music recital, and was intensely itchy. It looked like red blotches with raised, fleshy plaques that would last for an hour or so, then settle down. Siri tried over-the-counter anti-histamines, which would seem to help for a few hours, but made her very tired, and made her mouth feel very dry.
Siri has had no swelling to her lips, tongue, or the back of her throat, and no trouble with breathing. She hasn't had any recent cold or infectious symptoms. She has no significant allergy history, other than occasional itchy eyes in the springtime. She is not aware of any food allergies or intolerances, but has been wondering if she's developing some kind of a food allergy. She hasn't taken any new medications or supplements.
Siri would benefit from seeing her primary care provider to confirm the nature of the rash, but this sounds like "hives" or "urticaria". Hives are often associated with allergies, but may also occur in the context of viral infections, or reactions to medications. Some people develop hives in the context of exercise, temperature changes, stress, or for no clearly identifiable reason. Given two weeks of symptoms, referral to a skin care specialist, allergist, nutritionist or other allied care provider may assist in identifying a reversible cause for Siri's rash. An emergency department visit may provide some options for symptoms control, and education regarding dangerous allergic symptoms to watch for. A pharmacist will be of assistance in understanding symptom control choices, and any prescription medications Siri may be given.Author: Dr. Adam Lund