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41yo F with no significant PMHx presents with rash of 6 month duration. States rash comes and goes without noticeable inciting events and has progressively been getting worse. No exacerbating or relieving factors noted. Denies any recent exposure to new chemicals, clothing, perfume, detergents, animals, or other allergens. Denies recent travel. The rash does not itch.

Seen 2 weeks ago and given prednisone for 5 days. States on day 4 of taking her prednisone, the rash "erupted" and she felt "like my throat was being pinched off." States she stopped the prednisone and the sensation has not returned.

Told patient to take Benadryl daily until rash resolved. Instructed to go to the emergency department if she feels throat constriction again. Would send for dermatology and allergy/immunology referral but patient unwilling.

Thoughts?