EOSINOPHILIC ASCITES.

She was only 12 yr old . went out for christmas break with family in a nearby resort

but had to be hospitalised due to severe abdominal pain.

Was kept on symptomatic treatment and was being investigated thoroughly as the pain was recurrent.

The only clue in investigations was significant  eosinophilia and  Ascites.

All the common causes of ascites were ruled out .

Ascitic fluid was tapped which revealed significant eosinophils in ascitic fluid.

Endoscopy was normal .

She was treated with steroids to which she responded.

Three months later she again developed pain abdomen with bleeding per rectum.

She was hospitalised as ultrasoung examination revealed ascites progressing rapidly.

Ascitic fluid was full of eosinophils,

Colonoscopy was done with biopsies at all levels.

Colon , cecum , ileum , rectum at various levels revealed significant eosinophilic infiltration

EOSINOPHILIC GASTROENTERITIS is a well known entity though is very rare.

She was investigated further for food allergy which revealed SIgE raised for Fish and ST also positive for fish.

History revealed that during both episodes she had consumed fish .

She was treated with steroids but was instructed to avoid all sea food strictly .

She is symptom free for past 7 months.

It does not mean that FISH or sea Foods are bad but it simply means that one mans food can be another ones poison . ROLE of FOOD ALLERGY testing in difficult situations is highlighted here.

ALLERGIC RHINITIS MARCH TO ASTHMA

Symptoms which begin as watery , itchy , blocked nose,  persist for days and keep recurring every now and then could be due to Allergic rhinitis.
People just manage this with home remedies or over the counter pills and carry on for years together.
This results into chronic sinusitis , Asthma , headaches spread of allergy to eyes resulting into red itchy eyes.
Allergy is like growing tree , if the roots are intact new branches are bound to come .
Allergic rhinitis may become quiet but can erupt as Urticaria , rashes , iching etc.
Migraine may also be due to allergy.
Abdominal symptoms can also be due to food allergy or even an accompniment of allergic rhinitis , asthma , skin allergy etc.
the severe manifestations can be recurrent  angioedema which can be life threatening.
I have seen patients with swelling of tongue so that it is difficult to fit tongue within the mouth
resulting into medical emergency.
Laryngeal edema causes choking and is always life threatening.
Therefore nasal allergy should not be neglected.
Treatment is succesful if scientific and persistent.