What causes itching on hands and feet followed by diarrhea and vomiting despite normal thyroid diagnosis?
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I have had 7 episodes in the last 2 1/2 months where my hands and feet itch and get red, then I have diarrhea. Two of the episodes included vomiting and two of them also included fainting or feeling faint. I have been unable to identify a food related to these episodes. I have had blood tests and a thyroid ultrasound with no red flags. What should my next step be?
Posted Thu, 9 Jan 2014 in General Health
Answered by Dr. Yogesh D 1 hour later
Brief Answer: An upper GI endoscopy would be the next step. Detailed Answer: Hello, Welcome to healthacremagic. I am delighted to be able to to help. The first thing that comes to mind is Celiac Sprue, but you have not been able to identify any particular food that could trigger these episodes. However, I would still consider gluten sensitivity to be the probable cause. Celiac sprue is genetic disorder which is characterized by autoimmune response mediated through Immunoglobulin A. There could be other causes for this as well, like Chron's disease, inflammatory bowel disease, or an allergy to particular foods. The next step in identifying the problem correctly would be to do an upper GI endoscopy, and get a biopsy done, which will yield tremendous insight into what exactly is going on. Serological tests and genetic tests are available to diagnose Celiac sprue, and these include, tissue transglutaminase IgA, endomysial IgA, and reticulin IgA correlated with the degree of mucosal damage. Estimation of (HLA) haplotypes (DQ2 and DQ8) will also guide in making a diagnosis. To complete the workup, you can consult an immunologist and request for a patch test to find out the exact allergen. Hope you will find this information useful and informative, if you have further concerns, please do not hesitate to write back to me. Wishing you speedy recovery. Warm regards.
Follow-up: What causes itching on hands and feet followed by diarrhea and vomiting despite normal thyroid diagnosis? 14 hours later
You mention Celiac sprue. I did have blood tests that came back negative for Celiac sprue. I'm sorry I don't have the tests in hand to scan and send to you. Are blood tests a fairly accurate indication of whether or not one has Celiac sprue? You mention both an upper GI endoscopy and a patch test with an immunologist. Am I correct that these two tests are going two different directions? The patch test looks for an allergen. The upper GI looks for other possible causes. The upper GI seems like a pretty major, expensive test. How frequent would a patient's "episodes" need to be before you would recommend such a test? Mine seem a little more frequent than once every two weeks. Finally, what do the itching hands and feet and the fainting mean? Is this a common thing to happen along with diarrhea and vomiting? I am, by the way, about 10 pounds overweight and an active exerciser. I tend to eat a variety of healthy foods, with a love of vegetables.
Answered by Dr. Yogesh D 9 hours later
Brief Answer: Blood tests I have mentioned are very accurate. Detailed Answer: Hello again, Thanks for writing back with additional details. The blood tests I have mentioned in my earlier response are quite accurate and very sensitive too, however, the gold standard in investigations for celiac sprue is GI endoscopy. And you are correct in assuming that a patch test and GI endoscopy will look at the problem from two different angles, however, the findings of each may add to the whole picture. Upper GI endoscopy is not a major procedure, and it is a routine investigation employed to diagnose conditions of the stomach and upper intestines. And I am sorry, I do not know the prevailing costs for this procedure in your country and if you do not have an insurance or if it is a co-pay policy, I would advice you check the prices and insurance coverage before deciding on it. As for the frequency of the symptoms, once every two weeks and a total of 7 or so episodes is a strong indication for going ahead with the investigations. & episodes spread by 2 week interval would mean about 3 months time, this is the more crucial factor in deciding the necessity of the said test. Itching in the hands and feet, fainting along with diarrhea and vomiting can mean, you might be having an immune mediated reaction. And no, this kind if thing does not happen so commonly, hence the suspicion of immune mediated response. Continue to eat healthy and do continue with your exercise regime, however, I would advice you keep a note what you eat and correlate that with your symptoms, if a pattern emerges, then you will know what is causing all this. Hope I have addressed all your questions, however, if you have further queries for me, I would be more than happy to help you. Wishing you all the very best. Kind regards.