Age: 20.0
Sex: M
Vaccine: COVID19
Symptoms: Antinuclear antibody negative, Autoantibody positive, Blood immunoglobulin E increased, Burning sensation, C-reactive protein normal
Clinical narrative: 2 weeks after receiving my second COVID-19 vaccine shot, I began getting hives on my back. They were red, swollen, itchy patches with some intermittent burning. I also got circular itchy, red bumps with a red dot in the middle. They began affecting my entire body, especially my back, chest, occipital scalp, and arms. The swelling would last about 20 minutes before resolving with residual redness. Within about an hour, the redness typically resolved. This condition would occur at any time in the day, but was worse at night.    I began to use an OTC topical steroid every day all over. It helped with itching, but the relief did not last long. I used quite a bit of it to cover my body. I also started using singulair once a day which provides mild relief.  My symptoms got progressively worse. I scheduled an appointment with an allergist at Facility for early February. I include below some notes about the physical exam and diagnosis I received at this visit.  Physical exam: Vitals: There were no vitals taken for this visit. GEN: This is a well developed, well-nourished male in no acute distress, in a pleasant mood.   Skin: Focused examination of the back within the consultation was performed.  - There are scattered pink edematous urticarial plaques on the back.  - Linear pink urticarial plaques forming immediately upon linear scratch of the back As above in HPI. No additional skin concerns. - upper respiratory tract: currently no obvious Rhinitis - lungs: no signs for active and present Asthma/Wheezing or coughing - eyes: currently no active conjunctivits - GI system/digestion: currently no problems, no bloating or Diarrhoea  Diagnosis/impression: - Chronic idiopathic urticaria with strong dermatographism; with severe itching.  DDx includes atopic predisposition with seasonal rhinoconjunctivitis in fall, food allergy (almonds) with breathing problem and urticaria, and dry skin.  Complement, CMP, and ANA were normal. Consider Xolair pending lab results, new treatment regimen. Labs ordered: CBC w/ diff, Anti IgE antibody, IgE, ANA, CRP Start doxepin 10 mg increase dose every 2-3 days until 30 mg Start Allegra 180 mg QAM  I took 30mg Doxepin for about 2.5 weeks with little to no major effects and still needed Benadryl and in the morning. During my follow up appointment with the allergist, we reviewed some of the labs I had done. CBC w/ diff, ANA, CRP normal, but IgE elevated 223 (is atopic), but anti-IgE antibodies elevated (could be the reason for hives). We discussed the use of Xolair (Omazilumab), initially 300mg and then monthly 150mg for at least 6 months.             ==> treatment with high dose antihistamines (Doxepin, Hydroxyzine, Allegra, Montalukast)  not efficient and we urgently need an alternative treatment. During COVID times Xolair the best option, because no immunosuppression  I began receiving Xolair injections in late March of 2021 and have been getting them monthly since. The injections have significantly reduced my symptoms and I no longer get hives.   Other important incidents you may consider helpful: I recall an occasion where I was prescribed naproxen and subsequently developed hives. There was also an event in 2019 where I developed trouble breathing with associated sensation of throat closing and arm hives from eating a granola bar with almonds in it. No reaction when I eat peanuts.