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Episode of angioedema,hives,thyroid with no deficiency,steroids and histamine

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I'm 31 years old and since I was 19 I have had episodes of angiodema and hives lasting from 5 years, to 6 months, etc.. on and off. I've been tested for Thyroid along the way with no signs of deficiency.. I"m back on an episode now and It's been 5 months. I have to be on steroids and 50mg histamine in order to have some sort of control of both the angiodema and hives and yet, they still show. I wish someone some where could tell me what causes this. I have had an immune and allergy specialist in XXXXXXX hills for the last 5 years and no one can tell me what causes this....

Posted Fri, 13 Apr 2012 in Asthma and Allergy
 
 
Answered by Dr. Naveen Kumar 1 hour later
Hi

Thanks for the query

Angioedema is an allergic condition characterized by swelling just below the surface of the skin, usually around the lips and eyes. During an allergic reaction lots of chemical mediators of inflammation are released, histamine is one of them, which causes blood vessels to swell. The cause is unknown, but certain food and environmental conditions can trigger an attack of angioedema.

Angioedema is similar to that of hives, but hives produce itchy red lesions on the surface of your skin. Angioedema is a much deeper swelling, occasionally leading to breathing difficulty. Sometimes it's not possible to pinpoint the cause of hives and angioedema, especially when these conditions become chronic or recur. Both hives and angioedema are usually caused by an allergic reaction, to food, medication, pollen or insect stings.

Angioedema are of two types, hereditary angioedema which is genetic and acquired angioedema. It is difficult to cure this condition because of the modifications in the genes of our body. But, it can be controlled if the preventive measures are followed; such as avoiding those things which can trigger an attack of allergy and angioedema. Some doctor suggest skin patch test (allergen test) to find the triggering allergens which can be avoided.

Hope this answer is helpful. Should you have any additional queries, I will be available to address them.

Regards

Dr. Naveen Kumar N.
Above answer was peer-reviewed by
 
Follow-up: Episode of angioedema,hives,thyroid with no deficiency,steroids and histamine 3 hours later
Well, I'm not sure if that helps. I have both hives (that will changed locations on my body) and angioedema which will be localized to my face. And it's every day. I'm pretty sure it's not allergy related. And the regular 10mg benadryl is not enough. I need 50mg and cortisone to keep it under control. I see of lot of things about auto immune urticaria which could be what I have but I see little conclusive diagnostic about anything. I just need some guidance to recommend my doctor as I feel all the allergy test and the thyroid test in the world will not solve my problem.
 
 
Answered by Dr. Naveen Kumar 44 hours later
Hi

Welcome back,

1. I'm pretty sure it's not allergy related.

A: Even though angioedema is thought to be of allergy related, many a times the exact cause is very difficult to identify (idiopathic) and it challenges the diagnostic ability of the treating physician.

2. I see of lot of things about auto immune urticaria which could be what I have but I see little conclusive diagnostic about anything.

A: As you have developed this problem at the age of 19, it falls under the category of both acquired angioedema as well as hereditary angioedema. But you do not seem to have any abdominal related symptoms as noticed in Hereditary angioedema, hence it could considered to be acquired angioedema itself. And acquired angioedema can be secondary to either B-cell lymphoproliferative diseases or auto-immune disorders apart from allergy related.

It requires a battery of investigations to look for the prime cause of this problem.

3. I feel all the allergy test and the thyroid test in the world will not solve my problem.

A: You are right; these are only part of the investigations, to rule out the susceptible allergen and auto-immune disorder such as Hashimoto's Thyroiditis. You need to perform many more tests apart from this, such as:
i). Protein electrophoresis - For Bence XXXXXXX protein
ii). Serum Calcium
iii). Renal function tests
iv). MRI of the brain and spinal cord
v). Complete blood count

All the above mentioned tests are recommended to be performed to rule out multiple myeloma and other lympho-proliferative disorders.

Till the exact cause is not diagnosed you need to continue with the steroids as well as antihistaminic, because angioedema will be considered as allergy related problem.

One more thing, I would like to bring to your notice that with long term use of Benadryl there are chances of getting addiction, so it is better to request your doctor to change over to more potent antihistaminic such as fexofenadine or Loratidine and this can reduce the amount of cortisone also.

Hope this was informative.

I thank you once again for writing to me. Wish u good health.

Regards
Dr. Naveen Kumar N.
Above answer was peer-reviewed by
 
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