A 15-year-old boy complained of itching all over his body. His symptoms had started a few months back; the pruritic lesions were reddish and seemed to disappear and reappear. His parents reported that their child had disturbed sleep ever since his symptoms began.

The patient had a family history of allergies. The teen had been treated with antihistamines earlier – non-sedating H1 blockade; which was then up-titrated until four times the approved dosing. This was followed by an H2 blockade along with a leukotriene modifier. Both these therapies were not beneficial. 

On allergen-specific immunoglobulin E (IgE) testing, the boy was not sensitive to dust mites, animal dander, roach, pollens, weeds, molds, and galactose-a-1,3-galactose, and latex. His serum tryptase and anti-IgE receptor antibody were elevated, while his thyroid-stimulating hormone (TSH) was normal. His 25(OH)-D (vitamin D) was low – 23 ng/mL. 

The boy was diagnosed with generalized chronic recalcitrant urticaria. 

The patient was prescribed omalizumab – 300 mg every 4 weeks, which was not helpful. His symptoms progressed and he developed diffuse urticaria and facial angioedema. The lesions encompassed his face, extremities, abdomen, and back.

A 3-week course of oral corticosteroids failed to improve his symptoms. Thereafter, the boy was started on hydroxychloroquine 200 mg daily and vitamin D supplementation (50,000 IU weekly for five doses, and then 2000 IU daily). His symptoms of itchiness completely resolved within a week with this therapy.

After this, his doses were tapered; he had minor recurrences later which did not necessitate extensive treatment.