High sed rate, neg ANA

[TennesseeNP123]

Question--I have a 22 y.o. female who presented initially w/a red, pruritic rash that had been recurring for one year off and on, and unable to distinguish the cause of the rash. I sent her for allergy testing, and it came back negative for all environmental allergies and food...Blood work showed a sed rate of 24 but a negative ANA titer....Any thoughts? She has no other health problems and only takes Zyrtec for SAR. No significant family history. No painful joints. No fever. The rash is erythematous, slightly raised, and itchy. Dry, no vesicles or pustules.

[BritFNP]

Assuming you r/o pregnancy?

ESR is not really that high and is non specific for inflammation. Every lab is a little different, of course. My Lab app says

Where is the rash located?

[BCgradnurse, MSN, RN, NP]

Hi,

I'm a FNP working in Allergy and Immunology. Sed rate is a very non-specific test for inflammation, and is almost meaningless in of itself. 24 isn't that high, as it could be slightly elevated for any number of reasons. As far as the rash is concerned, did she have chemical testing in addition to environmental (pollen, mold, dust mites, etc) and food testing? Did you do a thyroid and a liver panel? Does the rash get better or worse with exposure to heat, cold, friction, or other physical changes? Has she had a skin biopsy done? Unfortunately, most cases of chronic urticaria are idiopathic and eventually resolve on their own. It's very frustrating for the patient when you can't find a cause., Zyrtec can help, as can Doxepin, cyproheptadine, ranitidine, and in extreme cases, cyclosporine. I often have patients take Allegra in the AM and Zyrtec in the pm when the rash flares. She should also avoid NSAIDs, yellow food dyes, fresh tomatos and strawberries, and spicy/salty foods. I hope this helps.