“I've been having hot flashes for three years and no one knows why,” stated a thirty-one-year-old secretary. It soon developed that not only did she get sudden flushes, but they were accompanied by both hives and headaches during severe attacks. She had noted that both the flushing and hives began about an hour after arising, and continued to develop throughout the day and evening, vanishing while she slept. The flushing then began again the next morning as a gradual wave of warmth spreading over her head, neck, and shoulders. The hives were small and scattered over the trunk.

Complete gynecologic and endocrinologic workups were to no avail. She was taking no medications and denied chemical exposures at work. Furthermore, the flushing, hives and headaches did not remit during vacations. It was not occupational.

Examination at her first visit found our patient to be healthy, but her face, neck and shoulders were flushed and warm. There were isolated small wheals, less than a half inch in diameter, scattered over these areas as well as her trunk. Individual hives faded in one to two hours, even as new ones developed. Firm stroking of her skin produced a linear hive, the cardinal sign of dermographism, a condition known as “skin writing.” More importantly, it told us that the cause was something circulating in her blood. It could be a food or something she was inhaling.