For the past several years, I have seen, and have been consulted in hospitals for, cases of localized angioedemas, anaphylaxes, and urticarias. So far all of them had normal labs. for CH50, C2, C4, C'1INH.,tryptase, CBCs, and alpha-gals. Skin tests for foods have been negative as well in some relevant cases. I know that, in the absence of serious systemic signs, malignancy will be out of the question.
Last month, one 18 year old Caucasian girl was seen by another allergist, for recurrent angioedemas and anaphylaxes, unrelated to any foods she knew of. Her ANA, complements, liver enzymes, ESR, C'1 INH, and CBC were normal, as ordered by that allergist. She came and saw me, for a second opinion, and I ordered serum tryptase and alpha-gal, which were normal, as well. Her mother was concerned that the other allergist raised a slim possibility of a small percentage of lymphoma and ordered many imaging studies, and which was why I saw her. That allergist also urged her to seek an opinion at Mayo and I recommended postponing it, since she was otherwise doing very well, physically. I have not done food skin tests yet, since her last reaction was less than 3 weeks ago.
A second case was a 70 year old Caucasian man with a few visits to the ER for apparently idiopathic anaphylaxes, since 2002. In his last visit he had an elevated serum tryptase of 20, and I repeated it. It came down to 2, and the tryptase as well as alpha-gal were normal. Skin tests in 2002 for common foods were negative. His physical exams have been otherwise unremarkable, except that he still is an obese man to this date.
Do you have different takes on these 2 cases, after your perusal? I will really appreciate scholarly and authoritative opinions on these subjects. Than you very much in advance.