Forgotten parasites in allergy practice

BACKGROUND

 

In USA and other western countries, parasitic infestations are often overlooked as a cause of allergic diseases.  In order to heighten awareness, the following three patients are being presented.

PATIENTS METHODS & RESULTS

 

Case I:  26 year old female presented with two year history of generalized urticaria and periorbital  angioedema.  Travel history included trip to India 6 months prior to onset of symptoms.  She had elevated eosinophil count (518/mm3), elevated total IgE (1376 K U/L).  Specific IgE antibodies to ascaris were elevated at 9.29 K U/L (normal <0.35).  The symptomatic treatment included Ceterizine (20mgm) twice daily and Sinequan (10 mg) at night.  She received a single dose of Mobendazole for treating ascariasis.  At 3 months follow up symptoms had completely resolved.  This case illustrates ASCARIASIS as cause of chronic urticaria/angioedema.

 Case II:  73 year old male presented with history of chronic urticaria of 5 years duration.  Complete blood count revealed absolute eosinophil count of 2688/mm3, total IgE 880.  Symptomatic treatment with Ceterizine,  Doxepin and H2 blocker had minimal beneficial effect.  He received multiple courses of prednisone with transient relief.   Skin biopsy revealed diffuse eosinophilic infiltrate.  Serology for parasitic infestation with Strongyloidosis was positive at 5.36 (normal <1.0).  He was treated with Thiabendazole 2gms/day as single daily dose for 4 days.  The urticaria lesions resolved.  He has been symptom free at 3 months follow-up.   This patient illustrates an example of Chronic Urticaria due to Strongyloidosis.

Case III:  29 year old male was referred for 4 months history of cough and 2 episodes of epididymorchitis.  The travel history included a 4 week visit to India.  Total WBC count 55000/cu mm, absolute eosinophil count 30,000/mm3, total IgE 3000 iu/, positive high titer antifilarial IgE and IgG antibodies.  Treatment with Diethylcarbamazine 2mgm/kg/dose, three  times a day for three weeks resulted in complete resolution of symptoms and decline in eosinophilis to <300/mm3.  This case illustrates clinical and laboratory findings of tropical pulmonary eosinophilia.

CONCLUSION

 

1. Parasitic Infestations can present as Chronic Urticaria or Chronic Cough.
2. Travel history is important.
3. Serologic Laboratory techniques provide helpful clues to the diagnosis of parasitic infestitations.