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Believe me, this is nothing made up. I also get a rash, I don't know why but its there whenever I don't feel good.

I wish your daughter luck, it is sad she is so young and has to deal with this.

Blessings

Sue

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The rash is so strange! It dosent hurt or anything and i didnt even know I had it untill my mom told me! And youre right it is good to have a sign to show its real, but it scares me beause i dont understand why a dysautonomic disease could cause a rash on youre chest. Thanks to ereryone for wishing me well, I wish the best of luck to all of you. Thanks for tring to find out for me mom! Love You! -Sara

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The only link reported that I am aware of between rashes and dysautonomia has been with those who have mitochondrial disease. Here are a couple Q&A's taken from the United Mitochondrial Disease Foundation's Q&A section on their website:

Question: My 21 month old son has been suspected of having a mitochondrial disorder for over a year (we are still in the process of diagnosis). Last week he experienced extreme high temperatures for 4 days. One day his temperature was 105.1. This week his temperature is lower than normal. A pediatrician saw him last week and found no reason for these extreme temperatures. He said this could be an indication of the disorder -- that the temperature "gauge" in his brain is now malfunctioning. Could this be true, and if so why does this happen? And, is this common to mitochondrial disorder patients?

Answer: Body temperature control is very complex, with many factors contributing to high and low temperatures, including infection, hormonal disorders, brain disorders, auto-immune diseases, tumor, drug reactions, etc. Body temperature is controlled by the autonomic nervous system, and in some individuals an abnormality in this system ('dysautonomia') can result in frequent high and low body temperatures. Other signs of dysautonomia can occur in the same individuals, and sometimes include changes in heart rate, breathing rate, blood pressure, sweating, skin color/temperature, and digestion.

Dysautonomia has been described in a few case reports in children with suspected mitochondrial disease. In my personal experience, dysautonomia is not rare in children and adults with probable mitochondria-related disease, especially those with maternal inheritance. Disease manifestations tend to be intermittent, as is the case with dysautonomias in general. Specific findings in some individuals include migraine-like headache, abdominal pain, racing heart rate, apnea, hyperventilation, fainting, severe reflux, cyclic vomiting or diarrhea, delayed gastric emptying, chronic constipation, blotchy skin rashes, pain, swelling, color or temperature changes in an extremity, and abnormal body temperature control (both high and low temperatures).

Since fever can be a sign of a serious illness, caution is prudent, especially in a child who appears to be ill. However, in some children diagnosed with dysautonomia who otherwise appear to be healthy, body temperature variations (up or down) that last only minutes to an hour can be ignored. However, first it is important that a knowledgeable physician establish the diagnosis of a dysautonomia and rule out other causes of an abnormal body temperature.

In rare cases, very high body temperatures (about 106 and higher) can cause brain damage. This rare situation usually occurs in children with significant brain/neurological disease. An MRI of the brain might be indicated.

Responder: Richard Boles, MD

Question: Our son is 2 1/2 years old and was diagnosed with complex IV defeciency via muscle biopsy. He has low tone, 100%g tube fed, gastric reflux, stridor, global developmental delays, heat intolerance, excessive sweating and seems to have crisis about evey six months or so which require hospitalization and IV fluids though all his blood electrolytes and blood gases are normal. With this past hospitalization they noticed elevated blood pressure which has continued since he has been home. They average around 125/65-70 he is 2 years 7 months and 93 cm in length. He also started having a red blothcy rash in his chest, neck and face area when overheated or stressed. As well, he vomits 2-3 times a day which started about one year ago and does not seem to repond to changes in rate, volume diet or mediction. His cardiac and renal function are fine. Could these symptoms be related to autonomic dysfunction, and if so are there any treatments you might be able to suggest? CMH

Answer: In my experience, dysfunction of the autonomic nervous system (dysautonomia) is not uncommon in patients with mitochondrial disease. Findings in your child which likely are related to dysautonomia are gastrointestinal dysmotility (including reflux), heat intolerance, excessive sweating, hypertension and a red blotchy rash. Episodic deterioration can be caused by many factors, including dysautonomic crises. Vomiting a little each day is likely secondary to reflux.

Treatment for dysautonomia is complicated and requires evaluation and follow-up by a knowledgeable specialist. Sometimes, frequent high carbohydrate feedings can help(but it sounds like this has been tried and did not help your child). Medical treatment, especially amitriptyline (Elavil) is usually effective for some of the symptoms of dysautonomia, but is not always appropriate in every patient. If used, EKGs should be checked before and after starting treatment for the possibility of a prolonged QTc or other rhythm disturbance.

Responder: Richard Boles, MD

Michelle

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Michelle, the only other thing I can think of is a histamine surge--although if that's happening often enough, it will present as a persistent rash rather than a new erruption (i.e. mastocytosis).

Nina

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Don't get rash on my chest that I have been aware of but do get this strange rash on the palms of my hands premenstrually (only pattern I've noticed) but it isn't every month...the months I have the rash though I feel much worse and have that feeling of being weighed down by gravity or like my head is a balloon in a more pronounced way. Have no idea what it is and have had it coming and going for at least a few years now. I told my doctor next time it popped up I'd come in and show it to him or at least take some pictures so maybe they can figure out what it is. (Never thought of a histamine surge, but you say MightyMouse that the rash would be persistent which mine is not...it usually clears up after my period or sometimes stays the whole month. I defin. think it has something to do with immune system and hormones but what?)

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I get the red splotches -- however, I've always gotten these when I get nervous, embarassed, when I drink even one sip of alcohol, etc. So maybe it's my body's own sensitivity to anything unusual. I agree with Nina that it involves histamine. It seems harmless.

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