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Ask the Allergist

Could I have eczema?

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Question
Recently, I've struggled with strange tingling from my nose down to my lips. Then my lips turned red, burned/tingled, and swelled like I've had a bad lip injection. My primary care physician says it's eczema. The dermatologist says it's perioral dermatitis. The allergist thinks it's hereditary angioedema. One of these seems to explain my symptoms. What do you think it could be?
Answer

Eczema typically involves a red itchy rash that can sometimes be dry or discolored. This lasts for days. Perioral dermatitis is a type of eczema that may be from lip-licking or a contact allergy --often to a chemical (contact dermatitis). These both would look very different from hereditary angioedema (HAE). HAE is a rare swelling disorder that usually presents during childhood. Swelling occurs without itching or rash and lasts 3-5 days if untreated. Over 90% of people with HAE have abdominal pain episodes from bowel wall swelling. This also lasts 3-5 days. Swelling is gradual and evolves over several hours. 75% of people with HAE have a mother or father with HAE. Swelling in HAE can be very severe and dangerous if it involves the tongue or throat. A blood test for C4, C1q, C1 Inhibitor level, and C1 inhibitor function would be the appropriate tests to evaluate for HAE.

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Atopic Dermatitis (Eczema)
Answered by

Douglas T. Johnston, DO, FAAAAI, FACAAI, is an allergist/clinical immunologist at Carolina Asthma & Allergy Center in Charlotte, North Carolina, and Assistant Professor at Edward Via School of Osteopathic Medicine in Spartanburg, South Carolina. He is a fellow of the American College of Allergy, Asthma, and Immunology (ACAAI) and the American Academy of Allergy, Asthma, and Immunology (AAAAI). He has lectured at national and international medical conferences and has publications in several medical journals, including “Clinical Immunology,” “World Allergy Organization Journal,” “Journal of Allergy, Asthma, and Immunology,” “The Journal of the American Medical Association,” and the “New England Journal of Medicine.”

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