Thursday, September 02, 2010

idiopathic

We got a call from one of Cal's teachers this morning that he had a rash on his face and they were wondering if someone could come in to take a look at him. Luckily, I was on call last night and therefore was in a position to get out from work early today, so I headed in to school around 11:00am. It was as I suspected; that is to say, essentially benign. See, last year around this time of year, Cal had a period that lasted a few weeks where he would periodically get these urticarial rashes (I believe "hives" would be the closest corresponding colloquialism) on different parts of his body. His face, his chest, his torso, his limbs. We presumed they were allergic in nature and tried restricting this and that food product and this or that detergent or product, but since nothing new was being introduced and there seemed to be very little rhyme or reason to when the hives would appear (I had a few days where I was convinced that it was either heat urticaria or that he was allergic to his own sweat, though none of these theories panned out under more rigorous clinical tests: i.e. ice packs, warming pads, forced exercise, what have you) and since there seemed to be no untoward sequelae aside from some itching, we just chalked it up to idiopathic urticaria and eventually it went away.

Yesterday he had some hives on his legs before bedtime. I put some steroid cream on them and told him to quit scratching them, for God's sake. And this morning he had some hives on his face, though they had almost completely subsided by the time I arrived. He has eaten no new foods, no new lotions, we have not changed detergents, even his clothes are old. He has no wheezing, no swelling, nothing else but this urticarial rash which comes and goes. I expect this cycle will last for a few weeks like last time, and then go into hibernation again like last time. One of our friends (who happens to be a pediatric immunologist--see, sometimes having gone to medical school is useful, at least you always have someone to call) is also completely nonplussed, which is reassuring. Last year we gave him Benadryl every time he got the rash, but it hardly seemed to make any difference and anyway, I hated sending him to school with the prospect that he might fall asleep halfway through circle time, so I just stopped doing it and it was fine. So I guess we'll stick with the "less is more" approach for now.

Once I arrived at school and ascertained that Cal did not have some sort of purpuric fever nor was his airway swelling shut, I pointed him back towards the rest of his class and told him that I'd pick him up in a couple of hours, at the end of the school day. He scampered off, as did I. Then, on my way home to put Mack down for his nap, I got McDonald's for lunch and now I have post-McDonald's regret. It seemed like such a good idea at the time, though.

20 comments:

  1. It seems that Georgia breeds allergies and rashes. If you never had them before, you will develop them when you move here. As for McDonalds, really? Kind of reminds me of that breakfast picture you posted earlier. If you have a Bobby G's around you give them a try. They make fantastic burgers. (no, I don't own or work for Bobby G's.)

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  2. My son gets an odd rash every time he visits a certain state park. The best we can figure is that the pollen in the area triggers an allergic response. These things can be very mysterious!

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  3. Hmm, my son gets a funny nonspecific rash this time of year too. The only thing I could think of was that as he has just returned to school, it might be a reaction to those industrial chemicals they use to clean the school over the summer. He sits on the mat in circle time... and the mat sure looked far cleaner today than it has done in a long while. Or the restroom soap, which is rather harsh for kids, I feel. Possible?

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  4. Anonymous4:55 PM

    I'm an adult, and I get localized hives I cannot determine the cause of. So good luck with a kid! I think it's some sort of food or substance allergy, but it appears like a contact rash. Maddening.

    Loratadine, which I take for pretty bad seasonal allergies, seems to help limit the severity and spread, but it's not that great. Might be placebo.

    Also, OTC steroid creams are nearly worthless. Might as well get 'em wet and blow on 'em for equal relief.

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  5. Unexplained hives/rash ugh! I broke out a few years back and it was honestly one of the worst illnesses I have ever had (I, like you, seem to have the constitution of an ox, so I rarely get ill, but still). I happened to have a doctor appointment shortly after it started, and she was totally nonplussed. Never figured out what caused it, never happened again. But that makes it worse. I live in worry that it will happen again!

    Um, anyway, hope Cal recovers soon!

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  6. I have an irritatingly messed up immune system, in which I have zero resistance to colds but a fantastically robust response to mild (and imaginary) allergens. Sometimes the creams, benadryls and other anti-histamines don't work for the itch. My boyfriend hit on a solution which is shockingly helpful - BenGay. I'm not sure why it works, I'm thinking maybe the hot/cold stimulation overrides the pain pathway because they're both spinothalamic?? (I am so proud of myself that I even remember that at all...) Anyhoo, it works. Cal might smell like a little old man, but at least he won't scratch.

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  7. PS, can't tell you how much I agree with your previous post on getting sick. I caught the pediatric bug right before starting surgery for real, and it was awful. I am still coughing, and everyone is still looking at me like I have The Consumption. I am really looking forward to the lawsuits where the patient complains that I sneezed into the abdominal cavity. =P

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  8. Molly7:34 PM

    You have to have McDonalds every once and a while to at least feed the craving, otherwise you think about it forever.
    I have broken out in hives all over, and I can only think it was attributed to cranberries or Stella Artois, neither which I have tried since.

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  9. Ugh. I hate that post-McD's regret. I get it every time I stop for a strawberry shake and fries. But sometimes it's hard to resist!

    Hope Cal gets better!

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  10. I get hives quite often and after extenseive bloodwork and sking testing (I work for an allergist/immunologist and they've loved using me as a guinnea pig), still can't quite figure out why...I've been told that it's probably just unspecified urticaria. I take OTC Loratadine when I have an outbreak - it seems to keep the hives from spreading or getting worse - and unless it's a REALLY bad attack, tends to lessen the itching, too. It's non-drowsy, so it keeps me from randomly passing out because I've taken a Benadryl. Good luck! I know that it's not fun :(

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  11. pedsdoc2:42 PM

    Happens to my 4yo son every fall. And every fall, we have to come in and tell the school its fine. We've found a little zyrtec at bedtime does wonders.....

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  12. I first noticed hives on my kid when he went swimming and thought it was the chlorine. Then we went to the ocean and he got them there, too. His ped told me about cold urticaria and figured that's what he has. (Not any kind of cold though, just water). I give him benadryl about 20 minutes before he gets in, and that lessens them.

    But then, he'll get them on dry land in warm weather now and then, too. So go figure. But even though he has no other symptoms, I still find the sight of my child covered in humongous red welts pretty disturbing.

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  14. Anonymous5:14 PM

    Well, I hope he isn't stuck with the same crap luck as me. Urticaria sprung up out of the blue 10 years ago, no one knows why, it lasted 2 years and has resurfaced again and again. Every doctor has always said the same thing. 'Don't know what causes it, or how to get rid of it for good. You'll just have to live with it.'

    I hope he's feeling better soon. And I second the no scratching advice. It only makes it worse...way, way worse.

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  15. I recently (in the past few months) read an article that researched urticaria in the GP's office in The Netherlands (it was in Dutch too, plus, I forgot where I've read it). It was concluded that most (>50%, but I think it might have been up to 85%) of urticaria are NOT allergic, contrary to what most doctors used to know (believe).
    The funny thing is that anti-allergic medicine does help to relieve symptoms, but no actual allergy can be determined in lab tests.

    For me personally I'd already given up the 'allergy' thing, I'm just glad levocetirizine works (half a tablet and I'm still groggy, not very funny). But I'm glad anyway that I know now any more tests won't help finding a cause. It's just hives, and I'm NOT allergic to anything.
    I just really hope that this article is right, though I do think from what I've seen in peds and in the GP's office, this could be a very good explanation!

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  16. Melissa8:48 PM

    I feel like a jerk for posting this, but...being completely perplexed is not reassuring. Maybe it is, in fact, what you and the other commenter both meant? I just really like words.

    non·plus
       /nɒnˈplʌs, ˈnɒnplʌs/ Show Spelled [non-pluhs, non-pluhs] Show IPA verb, -plussed or -plused, -plus·sing or -plus·ing, noun
    –verb (used with object)
    1.
    to render utterly perplexed; puzzle completely.
    –noun
    2.
    a state of utter perplexity.

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