Connecting the Dots: Strongyloides stercoralis and Chronic Urticaria with Angioedema

Urticaria and angioedema are common in allergy clinics, but their association with parasitic infections is underexplored. A 70-year-old Puerto Rican woman with hypertension, diabetes, and asthma presented with chronic urticaria and angioedema. She had chronic eosinophilia (maximum 1600 cells/μL), elevated IgE (1417 IU/mL), and IL-5 (2.9 pg/mL). A parasitic workup confirmed S. stercoralis IgG. Ivermectin treatment resolved her angioedema and urticaria, led to mild improvement in her asthma, and resulted in normalized eosinophil and IL-5 levels, along with a decrease in IgE levels. Like our case, a few other studies have shown improvement in allergic conditions after treatment, though this area remains understudied. This case highlights the importance of parasite testing in chronic urticaria and angioedema, especially in eosinophilic patients from endemic regions. Antiparasitic treatment can significantly improve symptoms, underscoring the need for more research on the connection between parasitic infections and allergic diseases.