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Swollen face after eating seafood. Taken Bendaryl. Hives, itching and swelling even after prednisone. What to do?

As of tomorrow evening it will have been an entire week that i have had hives and swelling. It started last thursday, about two to three hrs after eatining various fish fry samples and two different samples of soup that I later found out had crayfish and lobster pieces in it. By friday evening (the next night) it had gotten worse (even though I took loratidine and a few doses of hydroxyzine ). I should note that Ive never had a seafood allergy so I didn t think anything of associating eating it with the problem. However I had started dicyclomine for a different issue 3 days prior to the onset of symptoms, which I discontinued immediately assuming it was the source of reaction... So that friday at dinner I didn t think it would be a big deal to eat steak and 3 shrimp. Within 2-3 i hrs my lips/face swelled up significantly. Took more hydroxyzine, the face swelling went down a bit by morning, but throughout that day, saturday, my hands and feet swelled up before my eyes to the point that making a fist hurt and became impossible, and when walking the bottoms of my feet hurt like I had bruises. That evening I switched to benadryl , added zantac , and began zyrtec instead of loratadine the next morning. Finally on Sunday went to urgent care as swelling/hives/itching was intolerable. Was prescribed 5 days of 60 mg of prednisone and advised to continue antihistamine regiment, and given a epipen rx to keep on hand if breathing became difficult. Tomorrow will be 5th day on prednisone but still wake up with hives, severe itching and mild swelling. I almost used the epipen on Monday because I thought my chest was tight but after taking my dose of prednisone it eventually subsided. What do I do? Prednisone helps but relief is mild and seems to be short lived, lasting a few hrs to 12 hrs max. I can t take it anymore. Why would I still have reaction if it was the seafood? I have never had food allergy, only hives and mild swelling when taking various antibiotics. I did have a retreatment of a root canal by an endodontist on a molar the friday afternoon prior to the reaction (almost an entire week went by with no hives, just mild swelling on cheek near tooth). Sorry for so many details but I need help! Am I going to end up needing longer prednisone therapy? Why hasn t it helped more by now? Is that typical? Any advice on what to do and expect? I am a 27 yr old female, and am allergic to at least 10 antibiotics. Lastly, am in anatomy and have been working with a human cadaver and dissecting cats twice a week for several weeks, and earlierly on the day this all started I dissected a cow eye, but wore latex free gloves of course. I can t pinpoint the source so maybe I m still being exposed? Im clearly going to have to go back to the doctor but I d like to know what to expect... Thanks in advance!
Asked On : Sun, 11 Nov 2012
Answers:  1 Views:  686
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Allergist and Immunologist 's  Response
You are clearly in distress with the acute generalised urticaria and angioedema episode and not helped by the fact that even prednisolone is taking its time.
It is unlikely seafood allergy as the reaction does not proceed for so long even though all of us think of an event as the trigger. Most allergists though would like to ensure you have a blood test against the food panel that you had on the day and of course, shrimp crab lobster etc by a specific IgE blood test.
Skin testing would be required at a later stage (if blood tests are negative) and you are off all antihistamines for 2 weeks.
Saying that, I think all of them will be negative (i.e., no allergy) and at the same time you ought to get a blood test for CBC, LFT, creatinine, Mast cell tryptase, IgE, TSH TPO antibodies as the 'urticaria' may have an autoimmune component.
Prednisolone is reserved for the end if antihistamines do not work, but ultimately all will work once this acute phase is over. If you have required 30-40mg for more than 10 days, it is best you slowly taper it down and stop at 6 weeks. By then, fexofenadine 180mg and hydroxyzine 25mg at night only would have started to work.
20% do not respond to several antihistamines, and would need steroid sparing agents that must be discussed in detail with your doctor.
Answered: Sun, 11 Nov 2012
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