ITCHING TO GO TO THE DENTIST

Abstract

<h3>Introduction</h3> Chronic Spontaneous Urticaria (CSU) is characterized by itchy wheals on the skin that last for six weeks or more. In order for the condition to be deemed ‘idiopathic', an extensive history and physical must be taken to ensure that there are no underlying causes such as an infection. While the role of indolent infection in the treatment of chronic urticaria has been controversial, there have been reports of decreased symptoms following the eradication of infection. <h3>Case Description</h3> A 40 year-old healthy woman presented afebrile with recurrent facial swelling and urticaria. At the beginning of her clinical course, she was seen by infectious disease, oral and maxillofacial surgeons, as well as allergy specialists whom agreed that the patient's swelling was due to a histaminergic rather than infectious etiology, CSU. Her symptoms were frequent and difficult to control despite being with high dose antihistamines and eventually omalizumab. She frequently went to the emergency room due to fear of angioedema and only seemed to be responsive to oral steroids. This was source of frustration for the patient. The urticaria finally resolved after two years once she established care with a dentist who extracted a diseased tooth. <h3>Discussion</h3> As the above case demonstrates, as clinicians, it is important to take an extensive history of a patient, perform physical exams, and ensure that we re-evaluate patients who do not respond to therapy. While the role of indolent infections in urticaria is debated, it is always important to consider patient's comorbidities in difficult to treat urticaria.