Patient is 1-year-old boy who was brought in by his mom to discuss a rash that started to rise all over his torso after ingesting eggs. She said this started two to three months ago and she has noticed that after he eats eggs he develops a hives like rash up his belly. This seems to resolve fairly quickly and he does not seem to be bothered by it. He also has slight rash on his cheeks that appears to be an allergic atopic dermatitis today.
Amy does not notice that he has this type of rash with any other food ingestion. He is a product of a full-term normal delivery and was breastfed. He currently is eating a variety of foods. She states that he can tolerate baked egg products like pasta and bread and not have a problem that she is aware of. She does state that he has some sniffling although no other severe nasal congestion, signs or mouth breathing or snoring.
She denies any history of frequent bad colds, frequent tonsillitis, frequent ear infections. She also denies any eye irritation, redness, tearing, dryness or burning.
She denies any history of wheezing or lung problems. He has had a history bronchiolitis and pneumonia in the past but has resolved these infections easily without any complications He has not been evaluated for allergies before.
1. Possible egg allergy.
2. Allergic versus idiopathic urticaria.
3. Atopic dermatitis.
4. Molluscum contagiosum.
1. At this time, the testing for egg was negative although mom states that she does believe it is the egg that has been bothering him and since she has removed egg from the diet he has not had any other outbreaks of hives on the body. I think it would be safest to avoid whole egg at this time to reduce urticaria reactions. I did encourage her to continue having baked egg products in the diet as he seems to tolerate this fine without having hives or outbreak of his atopic dermatitis and we will see if he can quickly resolve this egg allergy as it seems to be very mild.
2. I also provided her atopic eczema action plan to give her some ideas of how to treat his eczema. She uses Aveeno and hydrocortisone cream 1% right now and a very gentle cleanser. I encouraged her to continue doing so and if she needs something stronger she can use 2.5% hydrocortisone ointment that I prescribed today. I also encouraged her to use cetirizine half teaspoon at night if the rash comes back or if patient appears to be itching.
3. We will follow up at least annually to further identify any egg allergy or if mom has any continuous complaints of other rashes or concerns of food allergy.