In this slideshow, we present 5 cases involving allergic reactions. Click through the slides to read through the case reports and learn more about the treatments for each.
Allergy to American Football? A Case of Cold-Induced Urticaria
An otherwise healthy 20-year-old woman presented with a recurrent pruritic rash on her buttocks and upper posterior thighs. The rash had appeared on 5 occasions, all in association with attendance at collegiate American football games in environmental temperatures below 5°C. The rash had begun with the sensation of pruritus of the buttocks within 30 minutes of sitting on the metal bleachers.
Upon self-inspection and palpation, the patient discovered multiple erythematous papules and plaques on her buttocks and upper posterior thighs. After approximately 20 to 60 minutes in a warmer environment (approximately 21°C), the symptoms disappeared. During the episodes, the patient experienced no other symptoms such as rhinorrhea, tongue or throat swelling, or respiratory distress.
Lettuce Allergy and Hand Eczema
A patient in his 30s was referred to a dermatology practice for patch testing due to recalcitrant hand dermatitis. The rash had been present for approximately 5 years. It had begun on his hands and wrists. The patient described red itchy patches along with intensely itchy blisters on his palms and the sides of his fingers. The rash had at times involved the palms, the dorsal hands, the dorsal fingers, and the forearms.
The patient’s occupation was that of a kitchen manager. Although he used vinyl gloves, he had contact with foods including vegetables, flour, and cheese, as well as cleaners and work equipment. He reported a history of childhood eczema and reported a known allergy to certain types of lettuce. He first realized this at age 18 and described flares of hand eczema after touching or eating lettuce.
Allergy to “Natural” Fragrance
A woman in her late 50s was seen at a dermatology practice for consultation and patch testing. She reported that a rash had been present for more than 2 years. It had initially started on her face and then had spread to involve her neck and sometimes her arms. Although initially the rash had been intermittent, over the 6 months prior to presentation, she reported that the rash had been constant, with extensive red itchy patches.
Her dermatologist suspected fragrance allergy and advised her to change her skin care products. She switched to Vanicream brand bar soap and moisturizing cream for her daily skin care. However, she continued to use an additional over-the-counter moisturizing cream because it contained “no synthetic fragrances” and was advertised as being “hypoallergenic.” Review of the ingredients list found that it contained numerous essential oils.
Tomato Allergy and the Link to Fragrance Allergy
A woman in her 50s presented to a dermatology practice with concern for a rash that had developed 7 months prior to presentation. The rash had initially begun with dry scaling areas on the forehead and temples. She later developed more erythema. Over the next few months, the rash became more extensive, at times covering most of her face and extending to her neck. She also had periodic severe flares. She had more recently also developed redness and severe scaling of the lips.
Due to her severe and extensive facial rash, laboratory and histologic testing had been completed at an outside practice prior to presentation. The results of extensive laboratory testing for collagen vascular diseases, including lupus, had been negative. A skin biopsy from the face showed chronic dermatitis with eosinophils, consistent with allergic contact dermatitis.
Allergic Contact Dermatitis to Acrylate Chemicals in Artificial Nails
A woman in her 50s presented with a rash that had been present for 10 years. The rash had begun on her toes and then had spread to involve both feet and both hands. She was retired, and her activities included gardening, playing tennis, and cleaning her home. She had been using acrylic nails but had stopped using them due to concerns for allergy. She instead began using shellac nails.
On examination, red scaly patches were noted on several fingertips.
Allergy & Immunology
Slideshow: Cases Involving Allergic Reactions