Question: High GGT and urticaria
Hello, please excuse the long message but I figure more info is better than less…
I have been suffering from physical urticarial (dermatographia) for about five months now, mostly on my torso. It started at a time when I was under significant stress and persisted, with nearly daily welting and itching, burning hot skin. Even light pressure from a scratch would cause weals. Last week, I exfoliated my lower legs with a shower mitt and was a bit heavy handed and about 24 hours later, I started periodically coming up in more traditional hives (lumpy, red and swollen – burning) in the areas I had exfoliated – this carried on for about 3-4 days and so I decided to finally see my doctor because I suddenly had another form of hives and things have been getting worse. I have recently started to wonder if gluten might be another trigger and decided to raise this with her as well.
She examined my skin and said there was nothing of concern – smooth and no rashes. She did a full blood work up including thyroid and advised excluding gluten for a week and then eating a lot of wheat to see what would happen. She was adamant that nothing serious was wrong with me and offered me a referral to a dermatologist if I wanted one but said I wouldn’t need one. (I am 48 hours into excluding gluten and I believe my skin might be slightly less reactive, so I’m in a wait-and-see with this.)
I got my results back with a very high GGT score.
All results were in the normal range except:
Blood lipids:
Cholesterol 5.6 mmol/l
LDL 3.8 mmol/l
(my HDL was normal at 25% 1.4 mmol/l and triglycerides normal at 0.9)
Transferrin saturation low at 16%
Liver function:
GGT – 181
(Bilirubin -4, ALP- 92, AST 31, ALT 24, LDH 214, albumin 42)
About me:
I’m female, 43 years old, 5 foot 1, 140lb (so 10lb overweight). I’m more apple shaped.
I barely drink – perhaps 1-2 units of wine a month. (I had a glass of wine 48 hours before the test)
I am a pack a day smoker.
I walk 3-4 miles a day but could use some more intense cardiovascular exercise.
I do not tend to get enough sleep – have never needed much so am tired, but I have no fatigue when I have a decent night’s sleep.
I am on no medication, although I took two Claritin antihistamines in the preceding week, the last 48 hours before the test.
I take a multivitamin daily and various supplements when I remember – including turmeric and tulsi to reduce inflammation for the urticaria, garlic and coQ10.
My diet is reasonable but could improve – no junk food and little processed food. I’d say I get 4 out of 5 of my fruit/vegetable servings most days and could cut down on the red meat.
I have joint hypermobility syndrome and correspondingly suffer occasional panic attacks which I manage. I am prone to anxiety and stress for no good reason but am able to continue with my life unaffected.
I have had a few coughs and colds this winter and am recovering from a chesty cough at the moment.
My question:
Does my high GGT score warrant further investigations and if so what would you recommend if I were your patient? What might be wrong with me, looking at my urticarial (which may or may not be linked); my bloods and my general history?
(my doctor is adamant it’s no big deal and that given my other bloods, nothing is wrong with me and is convinced that my urticaria is either down to gluten or is just idiopathic. She was quite dismissive in fact. It’s not like I’m always seeing her with issues – I have not been to the doctor in over two years. I am concerned, however and would like a second opinion).
Thank you for bearing with me and reading all this and I would be very grateful for your opinion. I am not a health professional but can handle being spoken to above layperson language and really would appreciate a blunt, no ‘sugar coating’ response.
Many thanks!
XXXXX

Dear Dr. Tayal,

Thank you for your swift and full response. Just in follow-up, I really only drink one or two glasses of wine (small ones) a month. Sometimes not even that; I go whole months without a single drink. What concerned me from my doctor's response was that she said my smoking and my one glass of wine 36 hours before the test wouldn't elevate my GGT to that extent and nor would the antihistamine. In other words, she didn't know why it was up and didn't think it was important. But thank you so much for your reassurance, it really helps.

You mention tracking the liver enzymes - when should I ideally next test?

With thanks
XXXX