Most people think of allergists as the doctors who help solve sneezing, wheezing and itchy eyes. They might not realize allergists are the medical mystery detectives with the expertise to discover what is causing all sorts of unusual allergic responses.
Two abstracts presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting illustrate how an allergic response can be the unexpected clue in a medical mystery.
In mystery #1, a 48 year-old woman sought the advice of an allergist after two weeks of chapped, dry, itchy and swollen lips. During her exam, the woman said that when her boyfriend recently died, she kissed his lips during the funeral. The next day, she woke up with dry and chapped lips. She tried treating her lips with an over-the-counter lip balm, topical antibiotic and topical vitamin E, which seemed to make her symptoms worse. Patch testing revealed the woman was allergic to both formaldehyde - used to preserve corpses - and her lip balm. With avoidance of those items, the rash and swelling completely resolved.
In mystery #2, a 45 year-old woman went to an allergist complaining of itching and rashes on her scalp, face and neck. She said she'd been suffering for several years. Her history revealed that her problems began when she started dying her hair blue. Patch testing revealed she was allergic to disperse blue 106 - which is known as a potential allergen for causing skin rashes. The woman was instructed to avoid all products containing blue dye - although the study noted that she still has blue hair and still suffers from itching and rashes.
"Getting a detailed history from a patient is one of the most important steps we can take in solving allergy problems," said allergist Ali Saad, DO, ACAAI member and author of the study on the woman with swollen, dry and itchy lips. "Sometimes an issue is very straightforward. But sometimes we need to do investigative work to determine how the person in our office ended up there with a very specific set of symptoms. We're thrilled when we can help solve a problem that had previously been unsolved."
Allergists specialize in the diagnosis and treatment of asthma and other allergic diseases, and are specially trained to identify the factors that trigger asthma or allergies. After earning a medical degree, an allergist completes a three-year residency-training program in either internal medicine or pediatrics. Next the allergist completes two or three more years of study in the field of allergy and immunology.