Q:

5/2/2013
Over the last 3 yrs, a 36 yr old woman has had episode of swelling around eyes and face, without urticaria, that occurs when she visits and stays for a wk or so at a mobile home park in Daytona beach, Florida, for a motor bike meet. It starts about 24 hrs after she arrives and last for the duration of stay, about 1 wk, and resolves during the trip back home. There is no systemic sx associated with the swelling. Anti histamines and even a short course of prednisone have not helped resolve the sx.

Skin tests for common inhalants in the Northeast are negative. Is there some allergen in Florida that could be the cause of her sx? Her meds include simvastatin, depakote , lexapro.

A:

Thank you for your inquiry.

Unfortunately, I am not going to be able to give you much help. I can only give you a few suggestions. But, to answer your basic question; that is, whether or not there is something in Florida that is causing her symptoms - I do not think so. There are several things that I can suggest you do, however:

1. First and foremost is to further assess the nature of the swelling. For example:

a. Is it associated with pruritus?

b. Is it associated with erythema of the skin?

c. Is it unilateral or bilateral?

d. Is it asymmetric or symmetric?

2. She should be asked whether or not there is any change in habits during her trips. Sometimes patients complain of swelling which is really a puffiness, and occasionally we have seen this appear when the salt intake is increased in the diet. Does her diet remain the same?

3. I assume since she is staying at a mobile park that she is in a motor home that she takes elsewhere. Has she ever developed the swelling in a mobile park in other places?

4. Finally, I suggest that she, with a good camera and good lighting, take pictures of the swelling to show you. This will help you discern whether or not it is truly angioedema (very doubtful) or the type of puffiness mentioned above. It will also tell you whether or not the skin is involved. This is important since, if it is, one might consider a contactant. In this case, it might be due to a change in her makeup habits (for example, applying more makeup more frequently).

Even with this additional information, I am not sure that you will be able to pinpoint the culprit, but hopefully these suggestions will be helpful to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology