Do you experience flushing? It is dry or wet flushing?

Flushing is a sensation of warmth frequently accompanied by fleeting skin redness usually over the face, neck, ears, chest, and limbs (arms and legs). This is due to vasodilation (dilated blood vessels) with increased blood flow to the skin.

Wet flushing: This is when there is associated sweating. Causes of “wet flushing” include menopause, fever, exercise, heat exposure and some neurological disorders such as Parkinson’s disease and post-encephalitis syndrome (following a brain infection). The sweating comes from the autonomic nervous system that innervates the sweat glands.

Dry Flushing: This is flushing without sweating. When dry flushing is accompanied by low blood pressure (hypotension) there can be many potential causes. These include:

• Medications

1. Nicotinic acid (Niacin) used to treat high cholesterol is a common trigger. The newer formulations may be less likely to trigger flushing.

2. Anti-hypertensive (high blood pressure) medications: calcium-channel blockers (such as verapamil, nifedipine) and angiotensin converting enzyme inhibitors (ACE inhibitors); these typically end in “pril” such as captopril or enalapril)

3. Vancomycin: an antibiotic when infused through the IV quickly causes “Red man syndrome”

4. Phosphodiesterase-5 inhibitors: these medications are used for erectile dysfunction.

• Foods

1. Pharmacologic: capsaicin which is in spicy foods; alcohol beverages, sulfites (in wines and used as a preservative), MSG (monosodium glutamate) used as a preservative.

2. Toxic: This is called scromboidosis or scromboid poisoning where histamine is formed in bacteria-contaminated spoiled fish (such as tuna, mackerel and mahi mahi).

• Anaphylaxis (most severe type of allergic reaction)

1. Immunologic: (triggered by the allergic antibody IgE). This includes allergic reactions to penicillin, insect stings, latex, horse serum, biological chimeric monoclonal antibodies (used to treat arthritis and autoimmune diseases). Also, non-IgE reactions to blood products, aspirin, and dye used in CAT scans and MRI scans and some medications can trigger anaphylaxis.

2. Non-immunologic: direct release of chemical mediators that doesn’t require the IgE allergic antibody. This includes exercise, exposure to cold, and opiates (codeine, morphine, etc.)

• Sepsis: infection in the blood stream where there is fever, elevated heart rate, flushing, low blood pressure and typical findings on the CBC (complete blood count).

• Tumors

1. Carcinoid tumor: This tumor is usually in the GI tract (colon, small intestine, and appendix) but can be in the lungs. Flushing and diarrhea occur frequently. Treatment with epinephrine could precipitate a carcinoid crisis!

2. Mastocytosis: This is an overabundance of mast cells that may be found in the skin or internal organs including the bone marrow. Frequently there are reddish brown spots on the skin that when rubbed will turn into small hives (Darier’s sign). The mast cells can release histamine and tryptase triggered by exercise, alcohol, trauma, infections, contrast dye, aspirin, antibiotics, anesthetics, and even the stress of surgery. This causes a multitude of symptoms including fatigue, weight loss, fever, sweats, anorexia, flushing, hives, itching, dermographism, abdominal pain, diarrhea, bone pain, fainting, lightheadedness, chest pain, headache, decreased attention span, difficulty concentrating, forgetfulness, irritability and depression. Other neuropsychiatric symptoms include poor motivation, confusion, anger, anxiety, lethargy and sleepiness. In some cases, mastocytosis is associated with other non-mast cell tumors. Your allergist will work with dermatology and oncology to get to the bottom of things!

3. Thyroid cancer (Medullary carcinoma): The symptoms can be just like carcinoid with diarrhea and flushing especially if the tumor has spread to the liver. This thyroid cancer is the 3rd most common thyroid cancer and of these, about 25% are genetic in nature.

4. VIPoma: This is a rare VIP (vasoactive intestinal peptide) secreting tumor originating from the pancreas. The typical symptoms are watery diarrhea resulting in dehydration, high blood calcium and elevated blood glucose.

5. Pheochromocytoma: this neuroendocrine tumor of the adrenal gland (sits atop the kidney) secretes high amounts of catecholamine’s including norepinephrine and lesser amounts of epinephrine (adrenalin). This leads to palpitations, sweating, headache, increased blood pressure and heart rate as well as headache, and anxiety (panic attack).

At Family Allergy Asthma & Sinus Care, we go the extra mile to help our patients find the relief they desire and the underlying cause of symptoms. We will be your guide and partner in health. Let’s keep the flushing where it belongs, with the toilets!