Hey, what's up? Enjoying your summer? It's been a pendulum swing between 98 degrees with 6000% humidity and 65 and raining here in Chicagoland. Climate change? What? Nah.
Spoiler: I do.
Today I'm going to change gears from my usual digestive system talk and move on over to a different thing - allergy. In my repertoire of medical doctors is an allergist/immunologist, whom I was sent to when my gastroenterologist suspected I had eosinophilic esophagitis.
Spoiler: I do.
A very recent study, like last month recent, suggests that EoE is a "late manifestation of the atopic march." The atopic march? When did that become a thing and why does it sound kinda ominous, especially given today's political climate?
Thankfully it's simply the tendency for a person who develops some sort of an allergy to go on and develop other allergic conditions as they age. Like a fine wine. Typically this starts with eczema as a baby, which I have no idea if I had. I don't think I did, but my brother had eczema as a baby so I'm sure I'm somehow guilty by association. I did, however, develop hay fever as a kid, then an allergy to cats as a teenager, which eventually evolved into adult onset asthma in my 20s.
The right breed of cat can send me into a serious wheeze today.
Around the time I figured out I was allergic to cats I underwent skin prick testing for other allergens. I'm allergic to trees. And grass. And mold. And dust mites. Earth. I'm basically allergic to Earth. Thankfully, prescription grade antihistamines became more accessible when they received the OK from the FDA to be sold OTC. And I cruised into my 30s on periodic zyrtec or allegra.
In 2013 I got pregnant with my my first, and I also got a rash on my foot. I assumed it was fungal because what the hell else could it be? It would flare up from time to time and I applied anti-fungal creams like it was my job for years. Literally, years.
It was not fungal.
About a year before the EoE stuff started, and 5 years into my "it's gotta be fungal" foot rash, I brought it up to my gastroenterologist as a possible side effect to my Crohn's medications. Certain medications, anti-TNF drugs to be exact, can cause psoriasis. Which is funny because they're also used to treat psoriasis. It goes to show you the human body will fuck with you at every opportunity. She referred me to a dermatologist who ruled out the fungal infection and gave me a generic diagnosis of eczema and prescribed me a topical steroid cream to be used as needed. Cool.
Except the rash didn't really go away. And it seemed to be getting worse. Let me break this rash down for a second. It's itchy AF. Like you want to take a belt sander to your skin level of itching. Put that on your foot. I should add this was only affecting my right foot, which confused everybody. Again, body fucking with you. The problem is, itching this rash makes it worse because it breaks the little blister thingies (technical term) and makes the skin raw and, subsequently, more pissed off.
But really, picture the most intense itch you've ever experienced and multiple it by 50.
After my second kid was born, so now 8 years into the rash, I heard about a good dermatologist and went to see her for a second opinion. At first she said she thought it was fungal. Clearly she hadn't gotten the memo. But a skin biopsy revealed a massive eosinophilic infiltration to the skin, along with other stuff that indicated an allergic response. I went on to get patch testing and 3 allergens were found: shellac, a disperse blue dye, and sorbitan sesquioleate.
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| I WILL ITCH YOU! |
After my second kid was born, so now 8 years into the rash, I heard about a good dermatologist and went to see her for a second opinion. At first she said she thought it was fungal. Clearly she hadn't gotten the memo. But a skin biopsy revealed a massive eosinophilic infiltration to the skin, along with other stuff that indicated an allergic response. I went on to get patch testing and 3 allergens were found: shellac, a disperse blue dye, and sorbitan sesquioleate.
Sorbitan sesquioleate is one of the main ingredients in the steroid cream I'd been using for years. Disperse blue dye is often used in blue and black fabrics, so most of my shoes and socks were offending to my foot. Shellac is in nail polish. Essentially my foot was being attacked from all angles by an army of allergens. The solution? Simply avoid any possible exposure to these 3 things.
Anyone know where you can find the ingredients list for shoes? Yeah, me neither. Assuming a wardrobe of white socks and shoes that don't have any blue, colors made with blue, or black has helped. I also received a prescription for a tacrolimus ointment to bypass the steroid cream issue. Sorbitan sesquioleate is actually in most lotions, so that's cool.
I decided to try a topical benadryl gel we had lying around for bug bites on the small people in my house as it advertises right on the label it's superior anti-itch properties. Plus, benadryl! Allergy! Win! And man did it work. Cleared that shit right up. It became part of my nightly regimen to keep the foot happy and offset any possible allergen exposures during the day, because let's be real I'm never going to figure out the shoe/sock thing 100% of the time.
Over the past couple of weeks I've noticed the rash has returned and isn't responding as it once did to the mighty benadryl gel. It crossed my mind a while ago "What if you get an allergy to the benadryl?" which I promptly shooed out of my brain because how can anyone become allergic to the drug everyone takes when they have an allergic reaction? Seriously, brain, you go too far.
But my researcher brain decided to investigate. I started with Dr. Wikipedia which listed the most common sources of allergic contact dermatitis.
"Topical anesthetics – such as pramoxine or diphenhydramine, after prolonged use." There are a handful of studies on Pubmed on the topic as well, so Dr. Wikipedia is vindicated.
Diphenhydarmine is the primary ingredient in benadryl gel.
I'm allergic to benadryl.
Ok, I'm not 100% sure and will test it out by eliminating the gel from my regimen, then trying it again to see if I react. But the odds seem high. I went on to look up allergy to tacrolimus and that's a thing, too. I feel like it's only a matter of time and prolonged use of that treatment until my foot says, nah, you're done.
These allergies never reverse themselves.
I don't know whether to laugh or cry. So I wrote a long blog instead. Thanks for reading.
--Dr. T2
Diphenhydarmine is the primary ingredient in benadryl gel.
I'm allergic to benadryl.
Ok, I'm not 100% sure and will test it out by eliminating the gel from my regimen, then trying it again to see if I react. But the odds seem high. I went on to look up allergy to tacrolimus and that's a thing, too. I feel like it's only a matter of time and prolonged use of that treatment until my foot says, nah, you're done.
These allergies never reverse themselves.
I don't know whether to laugh or cry. So I wrote a long blog instead. Thanks for reading.
--Dr. T2