Should You See a Rheumatologist for Persistent Allergy Symptoms?

It is uncertain whether further evaluation by a rheumatologist or immunologist is necessary for allergy issues?

Two weeks ago, on Monday night, I stayed up late and woke up the next morning to find that my lower eyelid was swollen, extending to my cheekbone.
I confirmed there was no external trauma and thought it might be due to allergies and fatigue, expecting the swelling to subside.
By Monday noon, the condition had improved somewhat, but in the evening, the swelling returned.
This time, I noticed that my upper eyelid looked like it had been bitten by a mosquito, indicating an allergic reaction, while the lower eyelid and cheekbone remained swollen.
On Tuesday morning, I still had swelling in the lower eyelid and cheekbone of my right eye.
By Wednesday, there was slight reduction in swelling, but I still felt noticeable swelling in the cheekbone area.
Later, I visited a family medicine clinic and took allergy medication for three days, which resulted in significant reduction of swelling.
Now, two weeks later, I can see that there is still a noticeable darkening under my right eye, larger than the left eye's dark circle.
There is still a bit of swelling in the right cheekbone area.
I would like to ask the doctor if I should see a rheumatologist to test for allergens, as this discomfort has persisted for many days and is quite concerning.
Thank you!

Miss Hsiung, 30~39 year old female. Ask Date: 2020/10/27

Dr. Zeng Guosen reply Internal Medicine

Hello, based on your situation, it may be angioedema, which can have many causes, with allergies being just one of them.
I recommend that you visit a dermatologist or an immunology/rheumatology specialist for further evaluation and treatment.
Thank you for your question.

Reply Date: 2020/10/27

More Info

When dealing with persistent allergy symptoms, particularly those that involve significant swelling and discomfort, it is essential to approach the situation methodically. Your symptoms, which include swelling of the lower eyelid and cheekbone area, could indeed be indicative of an allergic reaction. However, the persistence and severity of your symptoms warrant a thorough evaluation to rule out other underlying conditions.

Initially, it is important to understand that allergies can manifest in various ways, including localized swelling, redness, and itching. The fact that your symptoms improved with antihistamines suggests that they may be allergy-related. However, the continued presence of swelling and the noticeable difference between your eyes raises concerns that should not be overlooked.

In terms of whether you should see a rheumatologist, it depends on the broader context of your symptoms. Rheumatologists specialize in autoimmune diseases and conditions that affect the joints and connective tissues. If your symptoms are purely allergic in nature, a visit to an allergist or an immunologist may be more appropriate. These specialists can conduct specific tests to identify potential allergens and help you manage your symptoms effectively.

However, if you have other symptoms that suggest a systemic issue—such as joint pain, fatigue, or skin rashes—it may be prudent to consult a rheumatologist. Conditions like lupus or other autoimmune disorders can sometimes present with symptoms that mimic allergies, including facial swelling. A rheumatologist can perform a comprehensive evaluation, including blood tests for inflammatory markers and autoimmune antibodies, to determine if there is an underlying rheumatic condition contributing to your symptoms.

In addition to seeing a specialist, consider keeping a detailed diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare provider in diagnosing the issue.

As for the testing of allergens, skin prick tests or blood tests (such as specific IgE tests) can be performed by an allergist to identify specific allergens that may be causing your symptoms. If allergies are confirmed, the allergist can recommend avoidance strategies and potential treatments, such as allergy shots or other medications.

In summary, while your initial symptoms may suggest an allergic reaction, the persistence and severity of your condition warrant further investigation. If your symptoms do not resolve with standard allergy treatments or if you develop new symptoms, it would be wise to consult with a healthcare provider who can guide you through the appropriate next steps. Whether that be an allergist or a rheumatologist will depend on the broader context of your health and any additional symptoms you may be experiencing. Always prioritize open communication with your healthcare providers about your concerns and symptoms to ensure you receive the most appropriate care.

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