[24F] With itchy hives and red, hot skin

Patient Description

A 24-year-old female has been experiencing itchy hives and red, hot skin for the past three days. The hives appeared suddenly and cover her entire body, including her mouth and throat. They swell up and turn into large white patches. The most intense itching is on her legs and throat. The skin on her cheeks, nose, chest, and shoulders feels both burning and itching. She has not been exposed to any new foods, medications, or environmental factors recently. She is unsure about any recent infections or illnesses, although she mentioned a tick bite in July with a rash at the bite site but no further symptoms. She has experienced difficulty breathing and has a history of asthma, diagnosed a few years ago. Her gallbladder has been removed. Currently, she is taking Benadryl (50mg twice a day), Prednisone (20mg, 2 tablets once a day), Pepcid (20mg, one tablet twice a day), epinephrine as needed, and Albuterol as needed. She has been using Albuterol for a few years, while the other medications have been taken for the last three days. She has no known allergies to medications and is not taking any over-the-counter medications, supplements, or herbal remedies.

Arora's Assessment

What might be happening

Based on the information you’ve provided, there are a few serious conditions that could be causing your symptoms:

Anaphylaxis: This is a severe allergic reaction that can cause hives, swelling, difficulty breathing, and other symptoms. Given that your hives are covering your whole body, including your mouth and throat, and you are experiencing difficulty breathing, this is a medical emergency. Anaphylaxis can be life-threatening and requires immediate treatment.
Angioedema: This condition involves deeper swelling beneath the skin, often around the eyes and lips, and sometimes the throat. It can be associated with hives and can also cause difficulty breathing if it affects the throat.
Severe Asthma Exacerbation: Given your history of asthma, it’s possible that your symptoms are related to a severe asthma attack, especially since you are experiencing difficulty breathing. However, the presence of hives and widespread skin involvement suggests that an allergic reaction is more likely.

What you can do

Seek Immediate Medical Attention: Given the severity of your symptoms, you should seek emergency medical care immediately. Call 911 or have someone drive you to the nearest emergency room. Do not attempt to drive yourself.
Use Your Epinephrine Auto-Injector: If you have an epinephrine auto-injector (EpiPen), use it immediately as directed. This can help reduce the severity of the allergic reaction and buy you time to get to the hospital.
Continue Taking Your Medications: Continue taking your prescribed medications, including Benadryl, Prednisone, Pepcid, and Albuterol, as directed by your healthcare provider. These can help manage your symptoms until you receive professional medical care.
Avoid Known Triggers: Although you mentioned not being exposed to new foods, medications, or environmental factors, try to avoid any known allergens or triggers that could worsen your condition.
Stay Calm and Monitor Symptoms: While waiting for medical help, try to stay calm and monitor your symptoms. If you notice any worsening of your breathing, increased swelling, or other severe symptoms, inform the emergency responders immediately.

Remember, I am not a doctor, and it is crucial to seek care from real health professionals to receive a formal diagnosis and appropriate treatment. Your symptoms are serious and require immediate medical attention.

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4 mo ago

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[24F] With itchy hives and red, hot skin

What might be happening

What you can do

Experiencing symptoms?