Recurrent skin allergy and persistent low-grade asthma with pain in the abdomen

A 17-year old schoolgirl came in early today complaining of itchiness in all her extremities for about three days. On general examination she appeared perfectly in good health. Both her forearms and lower legs were covered with raised coin-like rashes (in medical jargon they are described as maculo-papular lesions). She also complained of abdominal pain and at times her mouth would get swollen as well.

In a busy primary care clinic, a doctor would have been tempted to just ascribe the condition to some allergy caused by  the patient eating something that she was allergic to. In fact, she did mention that she was allergic to seafoods. An attending doctor would just prescribe an anti-histamine to reduce the skin reaction and alleviate the itchiness and send her away.

My instinct told me that something was not right. I therefore decided to engage her by asking for her history. She has been having these allergic reactions since 2004 ( when she was 11 years old) in fact she was hospitalised in the paediatric ward for one week for a severe allergic reaction around that age. She also said that she had asthma since childhood and that her mother suffered from the same condition , asthma and recurrent skin eruptions. Ahah.......

I asked her what she used for her asthma and she told me it was the blue metered dose inhaler (MDI) (ventoline) and she had been buying it  from the pharmacy on her own with no medical follow-up!! She said it was not that effective and that she had difficulty breathing almost everynight! Daytime was usually fine.

I decided to listen to her chest and yes I could discern the mild rhonchi (wheezy breath sounds) scattered on both sides of her chest. I gave her a questionnaire for asthma control test (ACT) and she scored 8 out of 25 revealing how poor her asthma control was.

The overall picture shows that the girl has an hereditary allergic condition which is not properly managed. What is affecting her lungs (respiratory system) and her skin is also affecting her gut (stomach and intestines) causing recurrent abdominal pain.

Her asthma is poorly controlled and she obviously needs a stabilising medication what we refer to as a "preventer"  on a daily basis along with what she is using now (as and when an asthmatic attack comes on)  referred to as  a "rescue medication".

I explained to her the need to come for a regular medical follow-up to assess her condition and perhaps for a specialist referral later on should the situation warrants it.

And to think that people self-medicate for this condition is really worrying to say the least.  Buying MDI ventoline without a doctor's prescription is also unthinkable in countries like UK, US, Canada or Australia.