A Mood-Lifting Mystery
November 02, 2004
by Rita Zeidner, Washington Post

Whodunit
In a case of hives, you can round up the usual suspects -- infections, drugs, certain foods and insect bites. But usually you can't pin the rap on any of them, according to the American College of Allergy, Asthma and Immunology. Not only that, treatment is elusive. But some patients may get relief from an unexpected source: the antidepressant Prozac (fluoxetine).

The Plot Thickens
That finding, if proven, could be welcome. Doctors estimate that 20 percent of people suffer at some time from the red, itchy welts. Though some cases improve with antihistamines, many respond only to powerful corticosteroids like prednisone. But continuous use of prednisone over time -- for some, the only antidote that keeps hives at bay -- is linked to serious conditions including osteoporosis, glaucoma and stomach ulcers and is generally discouraged.

Disappearing Act
Talal Nsouli, a D.C.-based allergist and Georgetown medical professor, said he was out to relieve depression, not a skin rash, when he prescribed Prozac to a 53-year-old business owner despondent over the hives covering most of his body. But the patient's hives disappeared days after starting Prozac -- and returned just as quickly once he stopped taking the medication. Nsouli repeated and documented the successful treatment with two more patients with chronic hives. His peer-reviewed findings will be published in January's Annals of Allergy, Asthma and Immunology.

Elementary, Watson
Nsouli, who said he has no ties to the drug's manufacturer, theorizes that hives -- like some cases of depression -- could result from an imbalance of serotonin in the brain, an imbalance that fluoxetine restores."The brain is connected to the spinal cord, and the spinal cord links to the nerve endings in the skin," he said. But a firm understanding will require further study. Meanwhile, University of Maryland junior David Rapoport, one of Nsouli's three test patients, is glad his case is solved. The treatment, he said, "definitely changed my life."