Heartburn

Patient is 46-year-old female who comes in due to recent outbreak of face, lip and tongue swelling, swelling in arms and feet, and hives on legs. She states that earlier this last fall, she developed some itching over hands and feet as well as feeling hot to the touch. She also has developed hives of her legs and has never had anything like this before. She has used Benadryl to help resolve this and it seemed to go away and afterwards it cleared on its own. She then states in the mid October she has been burning sensation on her lip. She also has been swelling in her entire chin at that time and it takes about 24 to 48 hours to resolve and then same thing happened again after Christmas. She then states that yesterday she had a swelling event on her lip again and it seemed to involve her tongue as well, so she went to the emergency room. They did give her epinephrine at that time and IV Benadryl and gave her prescription of Prednisone 60 mg daily for the next week as well as chloroquine 10 mg. She has never had any problem of this in the past as states before fall of last year. She denies any use of ACE inhibitors. She also denies any ibuprofen use that is associated with these events. She does use ibuprofen as needed but has not used it quite in few times. She denies any new medications although she did start Lexapro from last July and that has been taking every day without any troubles. She denies any changes in her environment, new pets, or other factors in her lifestyle at home. She also denies any family history of swelling like this. She does have sister and brother who do have significant food allergies and that she has never had any problems with food allergies in the past.

ASSESSMENT:
1. Acute idiopathic angioedema with urticaria.
2. Heartburn.
3. Depression.

PLAN:
1. At this time, it is likely that her recent swelling and urticaria event due to an acute idiopathic etiology. She has not had any problems with food allergies in the past or has had any changes in medications with or has used any ACE inhibitor. She also denies any recent NSAIDs that are associated with swelling attacks.
2. We will start her with trying Zyrtec two tabs three times daily for two weeks and then she can reduce it two tabs twice daily for two weeks if managing 95% control of her swelling attacks. I also told her to taper off prednisone and began with 40 mg for two days and 20 mg for two days and then 10 mg for two days and then stop. I also prescribed her an EpiPen just in case she has another swelling attack that seems to involve her throat or tongue, to use for emergency. I also described with her that if she does start to have any swelling again, she can start the prednisone 10 mg every eight hours until her swelling is resolved.
3. We will follow up in one month’s time to see if she maintains controls. If she does have onset of outbreaks or has rebound of episodes after the antihistamine, we will pursue basic lab work as well as surgical or any hereditary or acquired angioedema and any autoimmune disorder this lab work.

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