Q:

2/21/2013
I was referred a healthy 24-year-old with a story of 3 episodes where she would awaken with finger swelling bilaterally. Over the next few days the swelling would decrease, and her skin would flake/peal. Not blistering, nothing that would appear dangerous. total symptoms would last 7-10 days.

She would not have diffuse urticaria, angioedema of other extremities. She was referred here because she had eaten lobster a couple of times and was concerned about lobster allergy. Seafood allergy testing was negative. She did have a positive skin test for dust mites, negative for cat, which she has.

She works as a dental assistant, we tested her for rubber and that was negative.

I recommended that she see a dermatologist, but was wondering if there is some type of inflammatory issue that rings a bell. It does not sound like a mast cell type of process, as it lasted, and the flaking persisted. The 3 episodes have occurred over the past 6 months.

Thank you for your time.

A:

Thank you for your inquiry.

I agree with you that these symptoms are not consistent with an IgE-mediated condition. The fact that the skin flaked and peeled clearly indicates an epidermal reaction, and if this is in any way allergic, one would suspect a contact dermatitis either irritant or immune in origin. The only other "allergy" testing that one might consider, from our standpoint, would be patch testing using a standard kit and perhaps to any occupational contactants that she might encounter.

I also agree with the referral to the dermatologist as well.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology