Discussions By Condition: I cannot get a diagnosis.

What does my mother have?

Posted In: I cannot get a diagnosis. 1 Replies
  • Posted By: Anonymous
  • July 12, 2009
  • 07:23 PM

My mother has had hives since Feburary, which has lead to dark skin. She has seen the doctor about this numerus times. He said it could have something to do with her autoumune system. He prescribed her Hydroxyzine HCI pills for the hives. Most recently her face has swelled up. She has itchy red eyes, ear aches, slight cold chills, and hurt chest hurts. Her breathing and everything else is fine. She was wondering if it could be Hay Fever, the common flu or possibly the H1N1. She has never had allergies before. What could this be?

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  • Okay, the distinction needs to be made promptly by her doctors whether it is chronic urticaria or urticarial vasculitis, the latter of which results in hyperpigmentation. Urticarial vasculitis can either represent the primary disease or secondary to underlying pathology, so some screening needs to be performed relative to paraneoplastic, obstructive lung disease etc. and they need to start doing this promptly. If the screening is clear, then you're looking at the primary form. What's important, if such determination is made, is to further discriminate which form she is afflicted with, ie normocomplementemic or hypocomplementemic, the former being more benign than the latter. In sum, this is not a condition that her doctors should merely be watching, but actively making certain an underlying pathology such as the examples mentioned is not present, and further defining the variant of urticarial vasculitis if it turns out to be the primary form of the disease. Urticaria which persists for the period described and that results in hyperpigmentation, is always an indication to look further. A punch biopsy would be very helpful in ruling out urticarial vasculitis and should be top on the list. IgG and IgE fractionation would also be important among other tests needed. The hydroxyzine is one of the traditional antihistamines and may or may not produce a beneficial effect. One of the more recent forms, such as Zyrtec or Allegra may perform better with less side-effects, ie dry mouth etc. Also, in some patients, the combined use of an H2 receptor antagonist like Tagamet is often used to produce better results. If it turns out to be urticarial vasculitis then corticosteroid therapy would be advised. Realize that no form of the disease is necessarily fatal, but the need to quickly assess any potential underlying secondary cause is crucial, as well as bringing relief to your mother's symptoms otherwise. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
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