Verdict

When Dr Cerio suggested that even though he wasn't convinced that my urticaria was the "contact" kind, he suggested I visit a colleague of his and have patch testing done, to which I agreed. If nothing else it would rule out any allergens that would have come into contact with my eyes that may have caused the repeated inflammation.

Patch testing is done in three sessions over five or six days. On the first visit after giving my medical history and emptying the contents of my cosmetic bag and medicine cabinet, the dermatologist reviewed the ingredients (making a few trips between the office and the lab next door, as I had a lot of bottles, jars, and tubes) and prepared small patches to be placed on my back. Each patch represents an ingredient, and when all was said and done I had about 100 of them in relatively neat rows from my shoulders to mid-back. I brought everything I could think of with me, even if I only used it once or twice and not in the last several months. 

Told to avoid strenuous exercise as not to sweat, I cancelled my tennis game and knew that the British weather would not be a problem--it has barely reached 20 this month (about 70 degrees F). To be safe I also limited my stair climbing at the office--I have a workstation on the third floor but spend quite a bit time in the lower ground training area four floors below (there is a ground floor to be counted in England), and generally avoid the elevator on my journeys between sessions.

Let me pause here to say that this was my first Harley Street experience. The street is well known for private medical offices--in fact since the 19th century the number of offices and people working on Harley Street to support them has grown dramatically. The lovely terraced houses hold waiting rooms and doctor's offices rather than living rooms and families. It's all a bit posh, but don't get the wrong idea--I don't expect to have to pay anything other than my excess (aka deductible) with my private insurer. The waiting room at Dr McFadden's office is bigger than our reception area in London, though it doesn't have half the charm.

Two days later I revisited the dermatologist to see whether any of the ingredients were beginning to react. Some patches were removed, others treated with something to percolate over the next three days. In fact Tim had noticed a few of the little circles seemed red and angry--a sign that I was possibly allergic to the ingredients. Time would tell.

Before I left the office Dr McFadden gave me "homework"--I was to look back into my bag of tricks and see which of them had two ingredients he was suspicious of--methylisothiazolinone and methylchlorisothiazolinone. If you've ever looked at the ingredients for cosmetics or face cream, almost everything is unrecognisable like those!

Not all of the products had the ingredients listed on the container; however, given an assignment, I'm not one to fall down. I dutifully went on the internet and within an hour had determined that four of my products--including my much-loved Palmer's Cocoa Butter lotion--had one or the other of the preservatives. Another guilty product was the facial cleansing wipes, though I'll admit to buying whatever is on sale at Boots rather than being committed to one brand or another. The final two products were my L'Oreal products, one which I'd been using for several months, I'd thought, and thought it odd that I hadn't reacted previously.

I have to admit I've been skeptical about the contact urticaria bit. Since January I'd barely put any ingredient on my face with the exception of an aqueous cream mostly made of paraffin. I'll admit to the occasional dalliance with the mascara brush to open up my eyes and pressed powder to take away the shine on special occasions, but those were Clinique products! Aren't they meant to be the best? And hypo-allergenic? 

The day of reckoning comes; it is Saturday, and I've missed a trip to Cowes--and the first race of the sailing season--for a mid-afternoon appointment to get my results. I proudly present my findings to the doctor, and he confirms that those are in fact the patches showing raised red skin. No more metho-whatever should touch my face.

In addition, I show an allergy to nickel--something eyelash curlers are often made from, and yes, I keep one in London and one in Cowes. Well, I did. I've also been cautioned about handling nickel-based products and water-based paint. And, gasp, no jewelry less than 18 carat gold! The doctor seemed to get a kick out of telling me I could tell "my partner" that he'll be caught red-handed if he dares buy anything less!

I walk down Harley Street back toward the bus on Oxford Street (with a short detour through my favourite department store, John Lewis, to window shop), satisfied that I have at last result. But I'm not 100% convinced that there isn't something else going on here. I am thinking about flares that I've had in the last few months--albeit few and far between--and trying to recall whether I'd used any of those products. Certainly the Palmer's, now relegated to the trash, though only a trace on my face that may have remained on my hands after applying it on my body after a shower. What about those pearl earrings I bought in Vietnam--I suspect the posts are not 18 carat gold; could they contain nickel? I do have a habit of touching the back of my earrings. I suspect I don't wash my hands before going near my eyes when I do it, either--it's more of an unconscious, casual tug of the earlobe.

The dermatologist told me something I found interesting that I didn't know--when you use a product it binds to the proteins in the skin, and so it will remain there until the layer of epidermis replenishes itself, which takes about a month. No wonder the healing process seemed to take ages! 

Was it ever about the food? I don't know. I have now disposed of any product that had those offending ingredients, have shopped at Boots for new creams, cleansers and cosmetics and suppose I should do the safe thing and introduce them one at a time, in case there is a reaction. 

And the same, then, continues with food. I've still not reintroduced some things--I haven't had wheat or aubergines or tomato sauce, among a few other high-histamine foods.I had pizza I recall over the last month and had a slight flare, so took a few steps back. I did have an avocado last weekend in a baguette on the Isle of Wight, and survived it. I've had my favourite Greek yogurt two days in a row now with breakfast. It's nice to get slowly back to normal.

The thing about histamine intolerance is that you don't eat one thing and suddenly get inflamed; instead the histamine your body can't get rid of accumulates for a bit, and only when it reaches its tipping point do the eyes swell. So, one ingredient at a time, a pause to let my body think about it, and so on.

I'd like to think mystery solved. I need to stay on antihistamines for at least another week until my back heals, and then perhaps take a lesser dose until I completely wean off. I am experimenting with the histamine blocker--what I considered the miracle that kept the inflammation in check--by only taking it when my eyes start to feel funny. My last tablet taken was on Friday. And I will hope that just as it comes close to five months of dealing with uncertainty, the issue will no longer be there. Five months happens to coincide with my five-year anniversary in England at the end of May. Truly a reason to raise a toast!

You Are What You Eat

I suppose I always knew that what you take in has a profound impact on what you look like, but never has it been more apparent than in the last three months.

Having seen several doctors and read hundreds of pages of information on the internet, I have come to the conclusion that the urticaria I’ve been diagnosed with—after ruling out all types of allergens—is directly related to the foods I take in, and the only way to help myself is to take in less of those that make a bad situation worse.

Urticaria and its companion angioedema have plagued me on and off since just after Christmas. The former is often controlled with antihistamines, as it is related to histamine intolerance. I won’t bore you with the details; suffice to say that my body is producing more histamine than it knows what to do with, and while large doses of anti-histamines have been prescribed, it’s not been enough to control the problem. It seems like every week I have a flare up, with swelling above and below my eyes (the angioedema part) and a deep redness around my eyes, usually starting in the outer corners and spreading below. It ain’t pretty.

When I visited the dermatologist who diagnosed me with urticaria, we briefly discussed a few foods I should stay away from—citrus, sugar, fizzy drinks, and aspirin or aspirin substitutes—none of which were part of my regular diet anyway. A substantial dose of anti-histamines to take for four weeks was meant to control the problem—you never cure urticaria, you simply tolerate it by keeping it in check.

But then I’d wake up one morning with the red swollen eyes all over again, wondering what might have been the “trigger” and knowing I didn’t eat any of the taboo foods. More reading on the internet and I found a restricted diet on the Urticaria Society web page that included most of what I in fact did have in my regular diet—fish, tea, chocolate, wine, eggplant (aubergine), spinach, soya, tomatoes or tomato products like sauce, most berries, yogurt, leftover meat, olives, vinegar, mustard—and that’s not all of it. While wheat was specifically mentioned, the breads and cereals section suggest “plain” breads and pasta, while I have generally gravitated to the whole-wheat kinds for both flavour and fibre.

The idea is to restrict one’s diet of the “trigger” foods for one month and then slowly re-introduce foods to see which ones your body can tolerate. It has been slightly daunting thus far to introduce variety—a lot of porridge (aka oatmeal) for breakfast, plain pasta for dinner with a variety of vegetables like broccoli or peas or bok choy with garlic and olive oil, and a simple salad with olive oil, salt and pepper—no bottled dressing allowed.

Perhaps some of you are not challenged by the list—I have to admit the hardest part of the day is actually lunch, where four days a week I would usually head out for a sandwich (alas, no processed meats or fish these days) or a salad (and no cheese or tomatoes); there’s not much left on offer! I have found a vegetarian wrap of falafel that has the smallest amount of yogurt, at the EAT takeaway just across the road, and for now that will suffice. There was one day last week where I went to four places near the office to find something that had only the allowable ingredients, and came up empty and marched back to EAT. I would have settled for oatmeal again, but most places stop serving porridge, typically a breakfast meal, at 11 am. I think I will start making lunch at home, or having cereal at midday, which thankfully has always been a favourite no matter what time it is!

I returned to the doctor today and requested blood tests to rule out an auto-immune disorder or a thyroid problem, whose symptoms are not all that dissimilar to what I’m experiencing. If nothing else, I’ll be relieved to know I’ve had some additional testing and perhaps it’s just this chronic urticaria that I will have to learn to live with. I also asked the doctor to consider a second anti-histamine—not that I want to be pill-popping, but combination therapy to mediate the inflammation while also treat the symptoms sounded like an approach worth taking after reading about it and having a chat with a few people at the office who have similar issues or know others who do. Fingers crossed, as they say.

Time heals, and I keep digging down for a bit more patience and strength to just keep calm and carry on. It is the chronic nature of this urticarial that makes it so frustrating, and while it is not life-threatening or even remotely a terrible disease, it distorts my ordered life in the smallest of ways that drives me crazy. Right now my eyes are sore, red, and probably a half day away from being swollen. I will not sleep well—it’s hard when your eyes feel odd, as though they do not fit properly in your head.

I will of course persevere. Tim has adjusted beautifully to my (or shall I say our) eating habits and is genuinely wonderful about bringing home the right kind of oatcakes and beans and apples along with a dozen roses to lift my spirits. The other night he called my sister Robyn to have her chat with me, one of those nights when I was really feeling a bit sorry for myself and lost about what to do but crawl under the duvet and pout. And you know what? It was terrific to hear her voice, to get a little of the angst off my chest, and to laugh again with my best friend. Gosh I needed it, and it worked a treat.

Even in my most miserable moods, Tim offers a hug, an embracing solace. And when I am in that way, there is nothing that beats the feel, the smell of a warm hug—a lean on the shoulder, breathing in the odour of warm cotton on warm skin. That will make me smile no matter what the day brings.