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Another Mystery Rash

Posted 12/07/2010

In last week’s Case of the Mysterious Rash, a young man’s near-daily eruption of hives turned out to be triggered by a latex sensitivity he’d developed while walking the sandy beaches of Hawaii wearing rubber flip-flops.

This brings to mind another patient. Liz, too, had seen a bevy of dermatologists, none of whom could identify the culprit behind her hives. Liz knew from her internet research that the trigger is discovered in only about 60% of cases. Still, she persevered. There had to be something behind her rash, which had been coming and going for years.

She arrived in our office with an agenda, specifically requesting a common blood test that screens to see if a sensitivity to any of 96 commonly eaten foods might be causing problems. Let me pause here to differentiate between allergies and sensitivities, seemingly a minor issue, but actually a contentious one among doctors.

• Allergies are immediate reactions during which the offender (a certain food, pollen, etc.) prompts your body to release histamine. The time from exposure to symptoms is usually minutes. Most people know already if they have a food allergy. For example, if you eat strawberries and your lips swell, you’re allergic to strawberries. If you eat shrimp and your throat tightens up…well, there’s no mystery here.

• Sensitivity responses are much slower, sometimes occurring up to two days after exposure. They’re generally less dramatic and the symptoms more subtle: sinus congestion, joint/muscle pain, fatigue, gastrointestinal issues, headaches, even mood changes.

One of Liz’s dermatologists had already sent her to an allergist who tested her for food allergies (not sensitivities) using scratch tests, in which a tiny amount of suspect food is literally scratched into the skin and everyone waits around to see what happens (seriously). In Liz’s case, what happened was nothing.

She told me she’d read about blood tests for allergies, and I politely corrected her on this, explaining she’d been correctly tested for allergies, and we could look for sensitivities. (I do go on about this, don’t I?)

However, I was reluctant to order the test for her, for what seemed like a good reason to both of us: Liz’s eating habits were fairly constant, week in and week out, and she rarely added new foods. Her rash made its appearance every few weeks no matter what she ate (or deliberately didn’t eat). In fact as regularly as clockwork the itchy rash would appear, often in large swaths on her body. She’d take antihistamines and slowly the rash would subside, only to pop up again in several weeks. But there seemed to be absolutely no correlation between what she was eating and her rash.

I asked, “Does your rash happen to appear fairly consistently during the week just before your period and go away when it starts?”

And Liz answered, “Oh, my God. I hadn’t thought about it. Yes. Yes, it does.”

I once heard Christiane Northrup, MD, author of Women’s Bodies, Women’s Wisdom , explain to an audience of physicians that she guessed upward of 50+ plus separate and seemingly unrelated symptoms could be triggered by the hormonal shifts that occurred during a woman’s premenstrual week. If as a doctor you’re faced with a patient who has any undiagnosed and repeated symptom that seems to appear during that especially vulnerable week, she advised, PMS is likely the cause and you should treat the PMS, not the symptom. Get the PMS under control and the mystery symptom will probably go away.

Although I wouldn’t wish severe PMS on anybody, it really would be helpful if skeptical men could experience some of the symptoms caused by the monthly hormone shifts the other half of the planet’s population routinely endures. Men would probably insist doctors create a new medical specialty and turn certain hospitals into “centers of PMS excellence.” Women just tough it out.

Indeed, for some women, that PMS week (or weeks!), with its hormonal shift and subsequent effect on neurotransmitters (brain chemicals) like serotonin, can be hell.

PMS symptoms fall into two main groups:

• Hormonal symptoms (breast tenderness, bloating, headaches) are caused by too much estrogen in proportion to progesterone. These symptoms can be helped by using progesterone cream or the herb chasteberry. Changing the way you eat–especially clearing out junk food–definitely helps too. For more on treating PMS, click here.

• Another slew of symptoms occurs when a drop in sex hormones pulls down the stress-buffering effect of neurotransmitters including feel-good serotonin, leaving you incredibly vulnerable, both physically and emotionally, to apparently minor stressors. Although mood shifts lead the pack for many women, any system in the body can be vulnerable when you’re PMSing, and the response can include an allergylike, stress-induced skin condition called neurodermatitis.

I explained to Liz that because once monthly she lacked this stress buffer, she became hypersensitive and a reaction was triggered, causing her body to release histamine, which in turn caused her to rash up (as she discovered, this was helped by taking antihistamines).

Diagnosis: Neurodermatitis, triggered by hormonal-neurotransmitter PMS shifts.

Treatment: Chasteberry. Also called vitex, this herb acts at the level of the pituitary, your “master gland,” and is effective in correcting imbalances between estrogen and progesterone. For patients who experience mood changes, I’ll sometimes add St. John’s wort to shore up serotonin.

After two or three cycles, Liz’s rash, as well as a few other PMS symptoms she’d been experiencing, all disappeared.

I always learned something really interesting when Chris Northrup gave her lectures.

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