Details of the patient: aged 57 years, scientist by profession, 5’10 inches height, 70 kgs weight, athletic build, not obese; diabetic since 4 years on Glucoformin G1 half tab in the morning and half in the evening; hypertensive since 15 years on Amlong 5 mgs one OD; for cholesterol, taking Atorvastatin for the past 8 months.
Basic info: Vegetarian- lacto, non-ovo; avoids garlic; patient informs that he is not allergic to pencillins; coffee drinker; non-smoker, non-alcoholic; uses Hamam and Pears toilet soaps for bathing; prefers cotton clothing; clothes washed in a washing machine with Surf detergent; uses sunflower oil for cooking for over a decade; does not use any body spray deodorant; no family history of skin allergies and asthma; does not expose in sun for work;
Medical History: On 12th May, 2010, at 2100 hrs the patient suffered the first episode of sever itching of back, shoulders, inner side of thighs, calf muscles and chest with raised skin patches, red in colour of various shapes (circle, oval and irregular) measuring from 5 mm to 15 mm. As itching became intolerable he reported to a local physician who prescribed Cetirizine Tab + Ranitidine Tab for 3 days. The patient responded well and the next morning there was no trace of nettle rashes. He took the medicines for 3 days and there was relief. Again on 19th May, 2010, he had the second episode of moderate intensity, took Cetzine and Ranitidine, itching receded and skin became clear in the next morning. From then on he was on Cetzine one OD in the night for nearly a month. He changed his residence from Besant Nagar to Pallavaram on 17 July and from that date the problem became chronic. Physician changed him to Atarax, for which he responded for two days only . Then switched over to Laevocetirizine for which he responded similarly for two days only. On Aug 5, the patient felt terrible itching at 6 pm, with swollen upper lip, nettle rash all over the body and immediately reported to a General Medical Practitioner (Patient’s relative), who administered Betnesol Inj intramuscular and Avil inj intramuscular. Within one hour all the symptoms vanished and the patient was advised to consult a dermatologist immediately, the next day. He reported to Retd. Prof and HOD, Dermatology, suspected allergy due to mosquito bite/arthropod assault and prescribed Erythrocin, Alercet, Versafe Tabs, Betnovate Cream and Casil Soap and asked the patient to report after a week. But pruritus became intolerable within two days and the dermatologist added Wysolone 1 TD to be tapered to 1 BD after a week and 1OD for the third week. The intensity of suffering reduced, but relief was temporary. On 4th September, Laevomizole was given for de-worming with a repeat dose on 11th Sept. On 12th September night, again the worst happened, with swollen lower lip, terrible itching and nettle rashes appeared on the back of neck, shoulders, back, inner side of thighs and on the abdomen. The local physician administered Betnesol Inj and Avil injection and there was complete relief for a week, during which the patient was advised to take Dec 100 (Diethyl Carbamazine) tabs for 3 weeks to rule out filarial attacks as the episodes occurred in the nights between 2230 hours and o230 hrs. From 14th September on, Diabetologist prescribed Montek-L in the morning and Cetirizine in the in the nights. Till 14th September, there was partial relief, intensity of itching reduced, nettle rashes did not spread much. Low intensity itching persisted.
On 12th October, in the night at 2340 hrs sudden flare up of uncontrollable itching started and raised patches appeared all over the body. Immediately the patient took a tablet of Cetirizine available with him, but spent a sleepless night scratching the skin till the morning. On 13th morning, rashes receded in the exposed parts but itching continued in tolerable intensity. Raised reddish skin patches and itching continues.
As has been suggested by the Dermatologist and Diabetologist, a diary of food and beverages consumed was maintained, but no specific cause of allergy could be pinned.
Tests done so far: Blood Tests for TC,DC,ESR, Lipid Profile etc.
Eosinophil count was 13% on
Eosinophil count was 5% on 11/10/2010
Could not come to any conclusive treatment to alleviate suffering!!!!