A woman in her late thirties who is 15 weeks pregnant (G1P0) presented in the clinic with the complaints of urticaria, flushing, and cramping abdominal pain with exercise. She has a history of positive anti-thyroid antibody (subtype unknown) which was diagnosed ten years ago and was treated with levothyroxine. These symptoms can also be evoked by hot showers and urticaria occasionally develops in areas of skin exposed to pressure or friction. The symptoms began occurring occasionally 20 years ago and have been progressively increasing in frequency and severity.
The symptoms are generally well controlled by daily doses of fexofenadine and ranitidine taken 30 minutes prior to exercising. The patient also states that she experiences at least two mild headaches per week. She is concerned about the safety of her current medication regimen, given her pregnancy. The physical exam is…
