Solar urticaria versus sun poisoning

Patient comes in today for an acute swelling and rash that occurred while she was visiting. She was there for a wedding and left on March 17, 2016. Thursday to Sunday she was having great time at the wedding and celebrating. She does state that she was drinking alcohol heavily and got lots of sun exposure and was in a swimming pool where lots of chemicals. She was also using various potent bug sprays including deet because of the Zika virus outbreak and wanted to make sure she did not have too many bites. She states that she had lots of different sunscreens applied and lots of sun and different various foods. On Monday she started having this facial swelling on her lips and her eyes. Her eyes were so swollen that she could hardly see out of them. She does feel that it has been getting better. She does still have some swelling under her eyes and she has developed maculopapular rash on her legs that is very itchy. She is very sunburned and appears that her skin is very itchy and irritated from the sun. She denies any low grade fevers or joint pain. She denies any conjunctivitis or any other symptoms associated with it or arthropod infection such as Zika virus, chicken guinea or dengue fever.

ASSESSMENT:
1. Acute allergic reaction to unknown substance versus chemically induced.
2. Solar urticaria versus sun poisoning.
3. Allergic rhinitis.
4. Allergic conjunctivitis.

PLAN:
1. At this time, I discussed with that it is really hard to identify what may have triggered this severe reaction. There could have been multitude of things contributing with severe sun exposure and the chemicals in the pools and bug sprays and sunscreens that she is not usually exposed to. She does have a history of allergies. She is very allergic person. We do provide immunotherapy for her to help with all of her allergies. I do want her to hold off on her shot today and we will try to resume shot next week.
2. I do want give her treatment of prednisone to take 20 mg today and then 40 mg tomorrow and the next day to see if this will help reduce her swelling and maculopapular rash. She can do this for up to five days and then discontinue. I did tell her to stop once the rash and swelling resolves to minimize the prednisone use.
3. I did also give her Zyrtec 10 mg daily to help as well for the itching and allergic reaction.
4. We will follow up next week to pursue her allergy immunotherapy and we will see if this reaction has resolved.

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