CHRONIC URTICARIA CAUSED DUE TO ASCARIS LUMBRICOIDES - A CASE REPORT

This is a case presentation of a 3-year-old girl child suffering from recurrent episodes of itchy, erythematous plaques mainly on extremities relapsing to standard antihistamine drug that was prescribed after each episode. A diagnosis of Chronic urticaria (CU) was made as the duration of symptoms presentation was for past 2 months. An extensive workup was planned initially with general examination and routine blood tests which did not reveal anything significant. Allergy tests found slight sensitization to cow milk and epithelium. But the total Serum Immunoglobulin (Ig) E and eosinophils were dramatically elevated. A simple repeated stool analysis exposed the presence of Ascariasis lumbricoides. The patient was started on anthelmintic drug albendazole and follow-up in one month and three months showed total symptom relief with no relapse. Total serum IgE and eosinophils progressively declined reaching baseline values after three months and Total serum IgE and eosinophils progressively declined simultaneously with negative workup for A. lumbricoides in stool. This case strongly links CU to parasitic infestation especially A. lumbricoides which in literature has been demonstrated to be prevalent in CU patients but has not been elicited as direct cause. It should also be noted that our case forms a guide for physicians to evaluate such parasites as a strong association for CU and aim for curative intent with anthelmintic drug as CU can sometimes present with fatal angioedema and can also be distressing for the patient given the poor quality of life. This is especially true for paediatric population where GI parasitic infestations are more commonly found and also the asymptomatic nature of this infestation should be considered. This should also form the basis of future research to look for complete remission in a large-scale population and establish causality to lay down clinical guidelines.