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May 13, 2022

A relentless rash 'was ruining her life.' One doctor found the cause.

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on Nov. 9, 2022.

    When a 68-year-old woman suddenly developed a rash with "irregular, roundish raised blotches of red," doctors initially believed she was suffering from chronic hives. When the woman didn't respond to treatments, her doctor ran additional tests, revealing an unexpected diagnosis, Lisa Sanders writes for the New York Times Magazine.

    'The itch was ruining her life'

    One morning, a 68-year-old woman started mindlessly scratching at an itch on her stomach. When she lifted her pajama shirt, she noticed "irregular, roundish raised blotches of red," Sanders writes.

    The woman immediately called her dermatologist, who prescribed her a steroid cream for what she believed to be hives. When the hives were still bothering the woman two weeks later, she decided to contact her primary care doctor, who immediately prescribed a week of prednisone and referred her to Vanderbilt University Medical Center's Asthma, Sinus & Allergy Program.

    While the prednisone helped her itch, it "returned with a vengeance" as soon as she ran out of pills, Sanders writes. The woman's rash was relentless, "and the itch was ruining her life," she adds.

    "It moved around but never went away. Sometimes it was on her arms, sometimes her neck," Sanders notes. "Always her stomach, her back, her legs and her feet."

    What could cause this relentless rash?

    Six weeks later, the woman went to her scheduled appointment with Basil Kahwash, a young specialist in allergy and immunology at Vanderbilt. 

    As Kahwash listened to the woman's story, he was reassured by the fact that her hives did not seem to be linked to bruising or pain, which could be indicative of a serious illness.

    However, the woman had already spent weeks trying to identify potential triggers. She was not on any new medications and was not using any new products. Her diet hadn't changed either. In fact, the only new thing in her life was the rash.

    After hearing the woman's symptoms, Kahwash told her she had a condition called chronic idiopathic urticaria (CIU), which is the medical term for hives that persist beyond six weeks, due to an unknown cause. Most of the time, Kahwash explained, a cause is never identified.

    Fortunately, he told the woman that the "good news is that the itching and rash are usually easily controlled with medications," including steroids and high-dose antihistamines, Sanders writes.

    Just one week later, Kahwash received a message from the woman through his patient portal—she was still suffering from the same symptoms. So, he immediately ordered an intravenous medication called omalizumab.

    After taking omalizumab for six weeks, the woman reached out again. "Just give me the steroids," she begged. "That was the only thing that helped," Sanders writes.

    At their next appointment, Kahwash was shocked to see that the woman's hives had still not improved.

    According to Sanders, "[t]here are a handful of autoimmune diseases that can cause chronic hives. A form of autoimmune thyroid disease can do it. Lupus too. It's a rare symptom in both, but possible. Another disease, mastocytosis, involves the body simply creating too many mast cells, with that proliferation causing all sorts of misery, including chronic hives. Finally, a handful of food allergies might do this."

    When Kahwash realized the woman's rash could be caused by one of these conditions, he sent her for additional tests. One week later, the tests revealed the true cause of her illness—an allergy to meat.

    'A small price to pay'

    After he received the woman's test results, Kahwash called the patient with the news of her diagnosis. He advised her to give up meat from all animals with hooves and animal milk products.

    Soon after, the patient reported that after not consuming meat or milk for just one week, she felt great, Sanders writes. "For the first time in months, she was completely hive-free, itch-free and, most important, able to sleep."

    One year later, the woman still does not eat red meat.

    Ultimately, "[n]ot eating meat seemed a small price to pay for the luxury of good nights of sleep and days forever free of hives and the irresistible scratching at an insatiable itch," Sanders writes. (Sanders, New York Times Magazine, 5/9)

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