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Suggest Treatment For Flushed Skin When Suffering From Ankylosing Spondylitis And Psoriatic Arthritis
Question: Hi. I have CVID along with Ankylosing Spondylitis and Psoriatic arthritis. I'm due for Octagam infusion next Monday but I'm experiencing flushed skin..my left ear is red as a beet and hot, random itchy areas that look like mosquito bites but are not. I've not had this happen before. I have had four infusions and was previously on Enbrel but can no longer take due to CVID. any input would be great. Thank you
Brief Answer:
Your skin lesion could be due to Octagam
Detailed Answer:
Hi I did review your condition my friend.
Octagam is a infusion containing mixture of immunoglobulins formed from plasma of healthy donors. It mostly consists of IgG type of immunglobulin with some IgA. As you are using it is used when there is lack of antibody production in someones body due to lack or defective B cells. The problem is that this immunoglobulins themselves are partly antigenic for your body and hence whatever immunity your body has (partial) it will be activated to form some antibodies against these immunoglobulins. This might cause a range of hypersensitivity reactions ranging from skin rash to anaphylaxis. What you are experiencing is probably a manifestation of that in form of flushing, rash that looks like mosquito bites, itching and hives and so on.
Your doctor has stopped Enbrel and that is a good decision in lieu of your partial immunodeficiency. I would advice you to ask your doctor on his thoughts of using short term steroids or antihistaminics to curb these reactions in case he feels they are due to Octagam. The literature is controversial on this issue.
I hope this helps
Let me know if you have any other questions or concerns
I will be more than happy to help you
Wish you all the best!!
Sincerely,
Dr Parth Desai
Your skin lesion could be due to Octagam
Detailed Answer:
Hi I did review your condition my friend.
Octagam is a infusion containing mixture of immunoglobulins formed from plasma of healthy donors. It mostly consists of IgG type of immunglobulin with some IgA. As you are using it is used when there is lack of antibody production in someones body due to lack or defective B cells. The problem is that this immunoglobulins themselves are partly antigenic for your body and hence whatever immunity your body has (partial) it will be activated to form some antibodies against these immunoglobulins. This might cause a range of hypersensitivity reactions ranging from skin rash to anaphylaxis. What you are experiencing is probably a manifestation of that in form of flushing, rash that looks like mosquito bites, itching and hives and so on.
Your doctor has stopped Enbrel and that is a good decision in lieu of your partial immunodeficiency. I would advice you to ask your doctor on his thoughts of using short term steroids or antihistaminics to curb these reactions in case he feels they are due to Octagam. The literature is controversial on this issue.
I hope this helps
Let me know if you have any other questions or concerns
I will be more than happy to help you
Wish you all the best!!
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you very much. This has been quite a learning experience with all that has come to light these past two years. I am very thankful to have guidance on the subject matter. I am a very blessed lady with a loving family and precious daughter and sometimes peace of mind can make all the difference...at least until I speak to my hematologist and/or dr friend on perhaps more steroids or antihistamine. Once again, thank you for your knowledge and guidance.:) Have a blessed day!
Brief Answer:
You are welcome my friend. Please give me feedback after treatment.
Detailed Answer:
Hi,
You are a wonderful person and have a wonderful family. Inspite of the diseases you have stood like a brave person. It is very healthy site to see and hear in our patients. Half of the disease is won in minds and by will power. Yes, discuss the issue with your hematologist and he may have some better or newer options and help you out. But short dose of steroids and antihistaminics have worked according to literature.
Let me know if you have any more questions or concerns. Also let me know what your hematologist has to say about the rash and flushing and how he is going to manage about the thing.
God bless you and your family my friend!
Wish you a wonderful life ahead.
Sincerely,
Dr Parth Desai
You are welcome my friend. Please give me feedback after treatment.
Detailed Answer:
Hi,
You are a wonderful person and have a wonderful family. Inspite of the diseases you have stood like a brave person. It is very healthy site to see and hear in our patients. Half of the disease is won in minds and by will power. Yes, discuss the issue with your hematologist and he may have some better or newer options and help you out. But short dose of steroids and antihistaminics have worked according to literature.
Let me know if you have any more questions or concerns. Also let me know what your hematologist has to say about the rash and flushing and how he is going to manage about the thing.
God bless you and your family my friend!
Wish you a wonderful life ahead.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Prasad
Thank you so much! I will definitely let you know what he says. And yes it can be a winning battle as long as you put your mind to it:). I have a lot to live for:):). I decided long ago that I would not live a lif being handicapped by any of these things, even after port placement. I play volleyball, swim, school events..all with my daughter:). Life is what you make it, and we should all find the good in all things and count our blessings in doctors like you!! :) Many blessings to you and your family!
Brief Answer:
Thank you so much.God bless you too and your family!!
Detailed Answer:
Thank you so much.. Your bravery just exudes from your messages. Just keep going strong like you have been
Would be lovely to hear the feedback of your health again. it gives immense satisfaction to us as doctors.
Take care
God bless
Sincerely,
Dr Parth Desai
Thank you so much.God bless you too and your family!!
Detailed Answer:
Thank you so much.. Your bravery just exudes from your messages. Just keep going strong like you have been
Would be lovely to hear the feedback of your health again. it gives immense satisfaction to us as doctors.
Take care
God bless
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
You are exactly right!:) 10mg prednisone daily if rash/hives and flushing continue and I will be pretreated Tuesday before infusion with 30mg Prednisone an hour prior orally and 50mg Benadryl through my port before Octagam.
Bless you for giving me the guidance and courage to discuss with my doctor. I don't like to call and complain but it was deemed necessary and I thank you!!;)
Bless you for giving me the guidance and courage to discuss with my doctor. I don't like to call and complain but it was deemed necessary and I thank you!!;)
Brief Answer:
All the best for your treatment ahead!
Detailed Answer:
Hi i did review your followup..
It is good to hear that doctor has initiated your treatment. I am sure the steroids will make you feel lot better. But use of steroids has to be for short term only and only with the purpose of making your reaction go away for a while. Octagam is your main treatment and it will help you fight against microbes.
Thank you for the feedback. I am happy that you are being started on treatment that I would have started.
Let me know if you have any questions or concerns.
Stay brave always. you are a fighter!!!
God bless
Sincerely,
Dr Parth Desai
All the best for your treatment ahead!
Detailed Answer:
Hi i did review your followup..
It is good to hear that doctor has initiated your treatment. I am sure the steroids will make you feel lot better. But use of steroids has to be for short term only and only with the purpose of making your reaction go away for a while. Octagam is your main treatment and it will help you fight against microbes.
Thank you for the feedback. I am happy that you are being started on treatment that I would have started.
Let me know if you have any questions or concerns.
Stay brave always. you are a fighter!!!
God bless
Sincerely,
Dr Parth Desai
Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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