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Urticaria
- Hives, Nettlerash
Urticaria is
commonly known as hives. First the skin itches, then it erupts into red
welts. The itching may be severe, keeping people from working or sleeping.
It's a distressing disorder which affects an estimated 20 percent of the
population at one time or another in their lives.
Most cases of urticaria are acute, lasting from a few hours to less than six weeks. Some
cases are chronic, lasting more than six weeks. The welts may appear in
one place, disappear after a short time, then erupt at another spot, then
another. They are made worse by scratching.
Bouts of urticaria have been traced to such triggers as certain foods and
additives, infections, drugs (including aspirin), cold, sun exposure,
insect stings, alcohol, exercise, endocrine disorders and emotional
stress. In some people, pressure caused by belts and constricting clothing
causes eruption. Urticaria may be a response to infection including the
common cold, strep throat and infectious mononucleosis. In the urticaria-prone
person, these triggers cause the body to release chemical mediators,
including histamine, from cells. Histamine (which causes itchy, runny
noses and watery eyes in hay fever sufferers) dilates the walls of blood
vessels, allowing fluids to leak out into the surrounding tissues.
Swelling and itching are the result.
If you have a lumpy and itchy rash which looks like the effect of a
nettle sting and occurs for more than six weeks, you are like the one
person in five who gets this at some stage of life. We call this a 'nettlerash'
even though it is not caused by nettles. The Latin name urticaria
means exactly the same thing, because it comes from the Latin word 'urtica',
which means stinging nettle. The English word 'hives' has the merit
that it does not suggest the rash is caused by nettles.
How is
urticaria treated?
Your allergist
first will alleviate the discomfort with medications, such as
antihistamines. Severe attacks of urticaria can be temporarily relieved by
injections of epinephrine; rarely in these cases, corticosteroids may be
prescribed for a short period. Other drugs may be required for specific
types of urticaria. If the cause can be identified, the best course of
treatment is avoidance of the substance that triggers urticaria. If a
problem with a specific food is strongly suspected, then it should be
avoided. This may require a careful reading of packaged food labels and
inquiry about ingredient in restaurant meals. Loose-fitting clothing will
help relieve pressure urticaria. Avoid harsh soaps and frequent bathing to
reduce the problem of dry skin, which can cause itching and scratching
that can aggravate urticaria. Vigorous toweling after a bath may
precipitate hives. Although success of identifying the cause of chronic
urticaria varies from clinic to clinic according to patient populations,
it usually is no higher than 20 percent of cases. It may last for months
or for years and burn itself out, never to bother the sufferer again
Hives, or "wheals", are
pale red swellings of skin that occur in groups on any part of the skin.
Urticaria is the medical word for hives. Each hive lasts a few hours
before fading without a trace. New areas may develop as old areas fade.
They can vary in size from as small as a pencil eraser to as large as a
dinner plate and may join together to form larger swellings. Hives usually
are itchy, but may also burn or sting.
Hives are formed by blood
plasma leaking out of small blood vessels in the skin. This is caused by
the release of a chemical called histamine. Histamine is released from
cells called "mast cells" that lie along the blood vessels in the skin.
Allergic reactions, chemicals in foods, or medications can cause histamine
release. Sometimes it's impossible to find out why hives are forming.
Hives are very common - 10-20
percent of the population will have at least one episode in their
lifetime. Most episodes of hives disappear quickly in a few days to a few
weeks. Occasionally, a person will continue to have hives for many years.
Typical outbreak of
urticaria
When hives form around the
eyes, lips, or genitals, the tissue may swell excessively. Although
frightening, the swelling usually goes away in less than 24 hours.
However, if you have difficulty breathing or swallowing you should go to
the emergency room.
Acute Urticaria
Hives lasting less than six weeks are called "acute urticaria." With this
type of hives, the cause can usually be found. The most common causes are
foods, drugs, or infections. Insect bites and internal disease may also be
responsible. Other causes can be pressure, cold, or sunlight.
Foods
The most common foods that cause hives are nuts, chocolate, fish,
tomatoes, eggs, fresh berries, and milk. Fresh foods cause hives more
often than cooked foods. Food additives and preservatives may also cause
hives. Hives may appear within
minutes or up to two hours after eating, depending on where the food is
absorbed in the digestive tract.
Drugs
Almost any prescription or over-the-counter medication can cause hives.
Some of those drugs include antibiotics, pain medications, sedatives,
tranquilizers, and diuretics (fluid pills). Diet supplements, antacids,
arthritis medication, vitamins, eye and eardrops, laxatives, vaginal
douches, or any other non-prescription item can be a potential cause of
hives. If you have an attack of hives, it's important to tell your doctor
about all of the preparations that you use to assist in finding the cause.
Infections
Many infections can cause hives. Colds are a common cause of hives in
children.
Chronic Urticaria
Hives lasting more than six weeks are called "chronic urticaria". The
cause of this type of hives is usually much more difficult to identify
than that of acute urticaria. In patients with chronic urticaria, the
cause is found in only a small number of patients. Your doctor will need
to ask many questions in an attempt to find the possible cause. Since
there are no specific tests for hives, testing will depend on your medical
history and a thorough examination by your dermatologist.
Physical Urticarias
Hives can be caused by sunlight, heat, cold, pressure, vibration, or
exercise. Hives due to sunlight are called solar urticaria. This is a rare
disorder in which hives form on exposed areas within minutes of sun
exposure and fade within one to two hours. Hives due to the cold are more
common. These appear when the skin is warmed after exposure to cold.
If
the cold has affected large areas of the body, large amounts of histamine
may be released which can produce wheezing, flushing, generalized hives,
and fainting.
Dermatographic Urticaria
Hives that form after firmly stroking or scratching the skin are called "dermatographism".
It affects about 5 percent of the population. Most people with this
condition are otherwise healthy. These hives can also occur along with
other forms of urticaria. They may typically appear in young women and
last for months or even years.
Treatment
The best treatment for hives is to find and remove the cause. This is not
an easy task and often not possible. Antihistamines are usually prescribed
by your dermatologist to provide relief. Antihistamines work best if taken
on a regular schedule to prevent hives from forming. No one antihistamine
works best for everyone, so your dermatologist may need to try more than
one or different combinations to find what works best for you. In severe
hives, an injection of epinephrine (adrenalin) or a cortisone medication
may be needed. Locate a dermatologist in your area.
http://www.aad.org/pamphlets/Urticaria.html
http://www.users.globalnet.co.uk/~aair/urticaria.htm#Urticaria
Urticaria is merely a symptom and not a disease by itself.
However, it should be regarded as a significant reflection of the internal
system dysfunction.
Urticaria ought to be appreciated as an external signal of internal
derangement and accordingly, should be treated with thorough assessment of
the entire human system.
DIAGNOSIS
Clinical diagnosis is made by close
examination of the skin eruptions. Once observed and experienced, the
patients can also recognise urticaria.
The exact diagnosis in terms of its causation is made after careful,
systematic case-history, by the physician. The patient's cooperation is
required to provide proper information and also by eliminating certain
food products once suspected.
A careful case analysis and evaluation is required to make a correct
diagnosis. A systematic history to evaluate the whole system ruling
our certain systemic disease such as endocrine disorders, malignancy,
lupus, respiratory disease, other allergic disorders, etc. is called for.
Hormonal study, thyroid profile may be indicated if the clinical picture
so suggest. Ruling out an uncommon possibility of malignancy if supported
by other clinical finding and factors is indicated at times.
A detailed clinical history running through the checklist of
various causes and considering the individual as a whole, is more
important than superficial, symptomatic medication with anti-allergic
medicines or cortisone.
TREATMENT
The treatment for urticaria could be planned as under :
-
General Treatment:
- Medicinal Treatment:
- Homeopathic Treatment
- Allopathic Treatment
(A) General Treatment:
Identification and then elimination of the factors inducing urticaria is
an important measure, whenever possible. Improved environment, corrected
food habits, etc. help whenever applicable. Treatment of other disease
where Urticaria is secondary to the underlying disease condition is an
important step.
(B) Medicinal Treatment : >>[Homeopathic Treatment:]
The system of homeopathic medicine has a promising role to offer for the
treatment of urticaria, inclusive of all its variants.
As established earlier, urticaria is nothing but an external expression of
internal, immunological disturbance, it also implies that the treatment of
urticaria should also be based on the inner level consideration. It just
can not be a symptomatic eradication of the urticaria rash. The
homeopathic treatment is precisely organised on a similar philosophy.
Homeopathy system does not believe in treating urticaria superficially
merely with some anti-allergic drug substance.
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>>[The Homeopathic Approach:]
As a rule, homoeopathy never looks at urticaria as a local disease.
Urticaria has been considered as a local expression of a system
disturbance. As per the classical homoeopathy, we believe in
constitutional prescribing. This calls for individual case study in every
case of urticaria.
There is no single specific remedy for all the cases of urticaria. The
exact treatment is determined only on in-depth evaluation of individual
case.
What is the Constitutional Approach?
What we understand by the Constitutional Approach in homeopathy is nothing
but analysis and evaluation of various factors affecting the human
constitution to determine the disease diagnosis and the exact treatment in
turn. Every case of urticaria calls for study of the patient's
constitution which includes various aspects of his physical aspects as
well as the in-depth study of the mental sphere, such as emotions,
psychosocial background, behavior and personality pattern.
The homeopathic remedy selected in every case after such a detail study is
called the constitutional medicine, which when administered in the correct
dose brings about harmony at the constitutional level, works at the
immunological level bringing about normalacy. It will be of interest to
note that the homeopathy medicines are essentially oral and not in the
form of creams, lotions or any local application on the skin.
How does the constitutional treatment help?
The very significance of the constitutional treatment in homeopathy is to
'treat the patient as a whole' or 'patient as a person' which is directed
to heal the body-mind system from within. The constitutional treatment
helps the body's own healing mechanism, enhances body's self-recovery
capacity hence leading to a long term cure.
Homeopathy: >> Natural approach:
Needless to say, that the entire homeopathy treatment, since based on the
natural law of cure, is essentially safe and absolutely harmless.
The Homeopathy Treatment :
After the
individual case study, one homeopathic remedy is selected which suits
the particular patient who has Urticaria. As you can imagine, the remedy
for every patient with Urticaria may be different depending on his or her
constitution.
There are over 3000 medicines in homeopathy used for a range of problems.
About twenty or more are often indicated for the cases of Urticaria. The
homeopathic medicines are prepared from a wide range of substances such as
the vegetable, herbs, minerals, chemicals, animal products, etc. The
methodology applied in
the making of the homeopathic medicines is unique and revolutionary.
Please refer to this for
more information.
The homeopathic medicine selected for the patient is administered in a
very small dose, which is expected to stimulate the healing process.
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The Duration of treatment:
If one has urticaria of recent origin(1-2 weeks), the treatment may be
required for 2 to 4 weeks. In case of chronic and recurring urticaria of
months or years duration, the treatment may be carried out for 3 to 6
months or so. The total length of treatment varies form case to case,
depending on various factors such as:
(a) the duration of eruptions
(b) the extent of spread of the eruptions
(c) the general health of the patient.
Does homeopathy cure urticaria?
Since our center in Bombay(India) specializes in treating difficult
disease conditions, we have ample opportunities of treating numerous cases
of Urticaria to establish the following conclusions:
(a) The homeopathic treatment has proved very effective in over 80%
cases of the urticaria sufferers.
(b) The treatment is based on individual study and evaluation of
the case.
(c) The results are obtained reasonably fast and long lasting.
(d) The course of medication varies from patients to patients,
depending on ones chronicity of urticaria. However, it may vary from two
to twelve months or more.
(e) The homeopathic treatment could be taken in association with
symptomatic, antiallergic medication if need be.
(f) Homeopathic treatment is 100% safe, absolutely harmless, very
effective, natural and free from toxic effects.
Allopathic treatment:
The main mode of medication in allopathy (modern medicine) is
antihistamines. Many other drugs are used by some dermatologists which
include ketoconazole, antibiotics, metronidazole, dapsone, deworming, etc.
Oral and injectable medication are used.
CAUSES
Causes of Urticaria:
What causes urticaria is more difficult then to answer what happens during
urticaria, as we described on the earlier page. In almost half the cases
we know what causes or induces urticaria. And half the time, the patients
or we have no clue to its exact causation.
We shall try to examine some of the most common exciting factors known to
induce urticaria,
which may be grouped as below:
(a)
Allergens: A large number allergens have been identified as causative
agents for some cases of urticaria. It may be noted that urticaria is an
individual hypersensitivity and the following factors may not cause
urticaria in all urticaria-prone individuals.
: food
allergens: Milk, cheese, egg, protein products, wheat, cereals,
certain daals as used in India, peas, orange, fish, chicken, etc.
Synthetic and natural food additives and artificially-flavored food
articles.
(b)
Environmental factors: Exposure to pollen, house-dust, buffalo dander,
fungi, change in temperature, etc. are known exciting factors. Extreme
cold, heat, pressure may also induce urticaria.
(c) Drugs: Man made drugs is the major cause for urticaria, such as
antibiotics (Penicillin), anti-inflammatory medicines (aspirin,
indomithasin), vaccination and foreign sera, etc. Hormonal preparation,
contraceptive pills, etc. Animals treated with penicillin excrete a small
amount of it in the milk sufficient to cause urticaria in sensitive
individuals.
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(d) Infections and infestation: Insect bites, Fungal, protozoal,
frequent bacterial Infections (Urinary tract), viral infection
(Hepatitis), Helminthiasis (worm infestation, such as round worms), etc.
Domestic contact with the pet animals should be examined, which are known
factors causing urticaria.
(e) Synthetic products: Use of personal products such as deodorant,
perfume, and talcum powder, cosmetic products, animal derivatives, and
similar synthetic substances may induce this disorder.
(f) Emotional factors: Especially in chronic, recurring cases of
urticaria the role of emotional factors must be examined. Emotional
stresses may directly or indirectly make on susceptible to develop a
tendency to urticaria. The psychological factors may work as exciting,
aggravating or maintaining cause.
(g) Systemic and general disease: Urticaria in some cases may
present as a sign of other systemic or general internal disease such as
hormonal disorders ( hyperthyroidism ), SLE, polycythaemia, reticuloses.
In certain variety of malignancies (cancer) urticaria may present as a
precursor.
(h) Idiopathic cause: No list of causation is complete without
adding a paragraph of 'Idiopathic' which simply implies causes which are
unknown!
http://www.urticaria.com/
Different kinds of urticaria
Heat rash
Almost all urticaria (perhaps all) urticaria gets worse if the skin is
warm. You may notice this if you have a hot bath or shower, or if the
weather is hot.
Mistakenly, some people describe this as 'prickly heat'.
But prickly heat is completely different. It is an infection of the sweat
glands which some people get if they live in the tropics and do not
shower.
Some people get urticaria only on hot days. Many people call this a
'heat rash'. It is probably mostly ordinary urticaria which is just not
bad enough to show up on its own but needs the extra factor of heat to
make it show up.
Urticaria in which the lumps are especially tiny, appearing all over
the body when you get hot, especially when exercising, could mean it is
"cholinergic urticaria".
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Chronic 'idiopathic' urticaria: by far the commonest type.
(Long-lasting urticaria with no known cause)
The word 'idiopathic' is a ridiculous word used by doctors to
mean that they don't know the cause of something. It means 'self-causing',
which is obvious nonsense. But we're stuck with the word because all
doctors use it. There is a better word, even if you prefer Latin or Greek
words to English ones; it is 'cryptogenic', which means 'hidden cause'.
Nobody uses this more sensible word for urticaria with no currently
discoverable cause.
Of course there has to be a cause. Every sensible doctor will agree
that removing the cause would be the best treatment if only we knew what
the cause was, and if only we could remove it without doing you more harm
than the urticaria causes. Every patient would rather remove the cause
than take treatment all the time.
But most people with chronic (lasting more than six weeks) urticaria
have no cause found, no matter how hard everyone tries.
This frustrates everybody no end. Chronic urticaria is no joke, and the
itching makes people thoroughly miserable, and for good reasons. But if
you are the sort of person who won't accept that the doctor can't do
anything else to find a cause, then you and the doctor are going to have a
difficult time. More difficult than just having the illness alone.
It's not that your doctor does not care. It is that there are limits to
medical science. Perhaps you could help by making your contribution to
research, for example by volunteering to help with research tests, or by
collecting or donating money for research on urticaria.
There is an idea about the way some chronic urticaria comes about.
Research workers in London have found that a few patients have antibodies
to their own 'allergy-producing antibodies', i.e. antibodies to their own
antibodies. Others, far more numerous, have antibodies to molecules on the
surface of the histamine-producing cells (mast cells). In either case the
result is that these cells release histamine (and other chemicals) into
the skin. Histamine in the skin produces urticaria, though evidently it is
not the only substance which can do so. This discovery seems to apply to
quite a lot of patients in a clinic so specialised that other experts send
their especially puzzling urticaria patients there. Whether it applies
just as often among all urticaria patients is something which remains to
be found out, as far as I know.
Unfortunately this discovery makes no difference to treatment, even for
those people who have these antibodies. There are treatments which can be
used to remove the antibodies or to interfere with this mechanism, but at
the moment these have too many disadvantages to be worth using except for
research.
So mostly the treatment is just the same as for most kinds of urticaria,
and relies mainly on antihistamine tablets.
You can also avoid aggravating factors. Almost certainly hot conditions
will make you worse, and cool conditions will make you better. So, for
example, using a minimum of bedclothes, so that you are no warmer than
necessary, will help quite a lot of people.
The good news is that the treatment usually works, or can be made to
work by skilled choice of medicines. But there are a very few sufferers
for whom the usual specialist treatments do not work. They need to find a
specialist, usually a dermatologist, who takes a special interest in
urticaria.
The other good news is that sooner or later the urticaria nearly always
clears up. But this may happen in weeks or after decades, and is totally
unpredictable.
Doctors often treat severe urticaria which does not respond to the
usual treatment with 'steroid tablets'. This makes sense in the short run
if the urticaria is really getting you down, or is going to interfere with
something important you have to do, like an important interview or dealing
with an especially stressful situation. But in the long run the steroid
tablets would have serious side effects, so they must be stopped. When
they are stopped, the urticaria usually comes back.
'Steroid creams' usually don't work for urticaria.
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Cold Urticaria
In some people the urticaria is brought on specifically by cold
conditions. In fact we test for this 'cold urticaria' by placing an ice
cube on the skin for a few minutes. If you have this condition, a weal
(lump, hive, welt) will appear during the few minutes after the ice cube
is removed, as the skin becomes warm enough to be able to react. This is
rather odd, because most people with urticaria find that cooling the skin
(e.g. by taking a cool bath) makes the urticaria better.
One value of the 'ice cube test' is that you can use it to check
whether your treatment is working. It is pretty easy to do this test for
yourself at home in a standard way, with and without the treatment. Check
with your doctor or specialist how to do the test. In a few people the ice
cube test does not work, though they get into terrible trouble when they
immerse themselves in cold water.
Suggestions about the ice cube test: wrap an ordinary
ice cube from the freezer in a thin plastic bag. Fold a kitchen towel to
form an insulating pad through which you can hold the ice cube, in its
bag, in one hand. Apply the ice cube to the middle of your other
forearm, on the same side of your forearm as the palm of your hand. Hold
in place firmly for 1, 3 or 5 minutes (try each of these in succession
until you get a result or have tried them all). When you remove the ice
cube there will be a pale patch of skin where the ice was. If you get
slight but very definite swelling over the next 3 to 5 minutes, as the
skin warms up again, this is a positive result.
N.B.: a specialist will know more than this.
Usually we don't know why people get cold urticaria, though it is very
clear that it is not all one disease; there are quite a few variant forms.
Your specialist may do some blood tests for things called cryoglobulins,
cryofibrinogen, cold agglutinins and other things, but in our experience
these are most unlikely to be abnormal. However, occasionally they are,
and quite a number of underlying illnesses can cause cold urticaria. This
is an area for a specialist. So one reason why it is useful to know if you
have cold urticaria is that you probably should see a specialist, even
though the outcome is likely to be reassuring to you. If you have any
other symptoms of illness as well as cold urticaria, then a specialist
consultation may be important. Your family doctor will be able to help you
decide.
It is important to know if you have cold urticaria, particularly if you
take part in water sports. If you fall in the water, the sudden cooling of
all of your skin (even in the tropics!) is dangerous. This is because cold
urticaria all over your body at once can make your blood pressure drop
because so much fluid comes out of your blood vessels to make the
swellings. You may become unconscious, with a risk of drowning. If you
have cold urticaria, take extra care not to fall in the water or to make
sure you can be fished out promptly and easily (e.g. if yachting, clip on
a safety harness even in circumstances when others would not). Take a full
dose of a good antihistamine beforehand. Wearing a wet suit or dry suit
even when you otherwise would not will provide considerable protection.
And of course an efficient life jacket is more important for you than for
others.
Antihistamines
often don't work so well in cold urticaria, although we
still recommend them. However, modern low-sedating antihistamines
cetirizine (Zyrtec, Zirtec) and loratadine (Clarityn) worked just as well
as some older antihistamines which have a reputation in this condition but
make you drowsy. The new antihistamines terfenadine (Allegra, Telfast) and
desloratadine (Neoclarityn) should also turn out to be good.
Information for doctors: Villas Martinez F,
Contreras FJ, Lopez Cazana JM, & others: A comparison of new nonsedating
and classical antihistamines in the treatment of primary acquired cold
urticaria (ACU). J Investig Allergol Clin Immunol. 1992;2:258-62.
People have tried other treatments.
Information for doctors: One group (Husz S,
Toth-Kasa I, Kiss M, Dobozy A. Treatment of cold urticaria. Int J
Dermatol. 1994;33:210-3.) found tablets normally used for asthma (terbutaline
and aminophylline) helpful. Theophylline is essentially the same drug as
aminophylline, but less likely to cause rashes.
It may be possible to 'desensitise' yourself against cold exposure by
starting with a form of washing which you know does not harm you, and
repeating this, slowly increasing your exposure to cold. You must get
advice from a specialist about this before trying it, as people with cold
urticaria are so different from each other. Done badly, it could be
dangerous in some people.
25% of people with cold urticaria lose the problem within about 1 to 2
years, but 20% continue to have it for more than 10 years
(Habif, Clinical Dermatology, 3rd ed.). These are global figures;
they will obviously differ between different forms of cold urticaria.
Unfortunately, some people may never lose the cold urticaria.
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Pressure Urticaria
Many people who have urticaria notice that it appears especially in
areas where clothing applies pressure or friction to the skin, for example
at the waist. In most people this is probably similar to
dermatographism, the tendency of the skin to come up in weals (hives)
from mechanical disturbance. Although this is described in textbooks as if
it were a separate condition, my opinion is that it is often just a
feature of urticaria, whether chronic idiopathic or acute urticaria due to
allergies. The treatment in my opinion is the same as for those
conditions.
A generally more serious form of urticaria produced by pressure is
delayed pressure urticaria. It may also appear under bra straps and
belts, and may be a problem in people who carry heavy items over the
shoulder, or in the feet of people who have to stand a lot. This typically
comes on some hours after sustained pressure on the skin, but the time
ranges from 30 minutes to 9 hours after pressure. Although this is called
urticaria, the appearance is typically quite different from ordinary
urticaria. It is a more diffuse swelling, and not really a typical weal or
hive. The microscopic changes in the skin are also different from those in
common urticaria.
Unfortunately delayed pressure urticaria is difficult to treat.
Antihistamines are usually a big disappointment, and people have generally
found that the only successful treatments are steroid tablets at quite
high doses (e.g. prednisolone or prednisone 30 mg daily), or avoiding the
pressure. Steroid tablets at these doses do have important side effects,
so doctors will be reluctant to use them for more than short periods.
Avoiding pressure may mean changing jobs for people who encounter the
problem at work. There is an isolated report (Engler
RJ; Squire E; Benson P. Chronic sulfasalazine therapy in the treatment of
delayed pressure urticaria and angioedema.. Ann Allergy Asthma Immunol.
1995; 74: 155-9) claiming that a drug called sulphasalazine
helped two patients, but this is a drug with enough potential for side
effects to merit careful consideration by a specialist before it should be
prescribed for you. The absence of other reports of benefit since 1995
makes me wonder whether this treatment works for many people. I have tried
it without success. The condition is sufficiently distressing in many of
the people who have it, and is a sufficient area of interest to skin
specialists, for new ideas to be tried pretty quickly.
A skin specialist will have more detailed knowledge about pressure
urticaria, and we definitely recommend that you should see one if you have
delayed pressure urticaria or if your urticaria does not go away after
your usual doctor has tried all the treatments he or she can think of.
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Cholinergic urticaria
Tiny lumps (2 to 4 mm diameter) all over appearing when the body gets
hot, especially when exercising, are typical of 'cholinergic urticaria'.
The word 'cholinergic' was used because the rash can also be
produced in some people by injections of a chemical released by nerves and
called acetylcholine. It is not clear that this is the way the rash
comes about in people who have cholinergic urticaria.
Cholinergic urticaria is difficult to treat, so seeing a specialist may
be well worthwhile.
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Sunlight can cause urticaria. Solar urticaria
All urticaria is made worse by heat. But if you get true urticaria only
when sunlight has been shining on your skin, you may have solar
urticaria. This is rather rare, and people often confuse it with a
much more common rash called polymorphous light eruption
(polymorphic light eruption). If you have solar urticaria, you get weals
in minutes and they last for less than an hour. But if you have
polymorphous light eruption the rash takes hours to appear, takes days to
disappear, only rarely looks like real urticaria (though it can have a
number of different appearances), and needs different treatment. There are
other kinds of skin problem which can be caused by sunlight, and a skin
specialist will be expert on these. Some skin specialists take a special
interest in rashes caused by light.
There are different kinds of solar urticaria, and your specialist may
want to do some blood and urine tests. The effectiveness and choice of
sunscreen creams depends on which kind of solar urticaria you have, and
some people may need sunscreen creams with titanium oxide or zinc oxide.
Some people will not get it if they are behind glass, but others will. The
effect of antihistamines varies a lot.
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Urticaria caused by water. Aquagenic urticaria.
Some people get urticaria when their skin comes into contact with
water, whether it is hot, cold or anything in between. Antihistamines
before contact with water or taken regularly are the standard treatment.
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Vasculitic urticaria, urticarial vasculitis, hypocomplementemic
urticaria (hypocomplementaemic urticaria)
If each lump (weal, hive) of your urticaria stays in the same place for
more than 24 hours, if it leaves a bruise mark or pigmented stain when the
lump has gone, or the rash is painful or burning rather than itchy, or if
you have other symptoms apart from urticaria which seem to be part of the
same illness, you may have this. Your specialist may also discover your
vasculitic urticaria because of blood test results or for other reasons.
Some people with vasculitic urticaria have an abnormal blood test
result showing that something called 'complement' is present in lower
amounts than normal. The urticaria is then called hypocomplementemic (hypocomplementaemic)
urticaria . As far as I am currently aware, the significance is much
the same as in vasculitic urticaria generally, but it would certainly make
your doctor want to test you for autoimmune diseases, particularly
systemic lupus erythematosus (SLE), usually with the result that you
turn out not to have this. The word autoimmune means that the immune
system of the body, which is mainly meant to defend us against invaders
such as bacteria and viruses, is reacting against the body itself.
Autoimmune reactions are common, particularly later in life, and do not
necessarily make you ill. Rheumatoid arthritis is a common example of an
illness caused by autoimmune reactions, but there is quite a variety of
such illnesses.
SLE is a moderately common autoimmune condition and
ranges in severity from trivial to life-threatening. It has its own
range of treatments, which are highly effective if used promptly and
with appropriate long-term vigilance by a specialist, but which in all
but the mildest cases do involve a risk of side effects which you would
definitely want to discuss with the doctor.
Most people with vasculitic urticaria do not have a low result for
complement.
Complement is a collection of protein substances in
the blood plasma involved in the removal of foreign substances. The
complement proteins which we normally have in our blood help to remove
bacteria, viruses and other micro-organisms from our bodies. They also
help the removal of the body's own proteins when these have become bound
to antibodies, something which does happen and in fact is important for
health. Usually we do not understand why they can be low in some
vasculitic urticaria. When complement is at work it can also mimic some
allergic reactions because it can trigger cells in your body to release
substances such as histamine, which can bring about allergy-like
symptoms including urticaria.
Vasculitic urticaria is really something quite different from the other
kinds, and should have specialist attention. Although it may be part of an
illness which also affects other parts of the body, most people with this
condition do well except that they have the skin condition.
Your specialist may well remove a small piece of skin (take a skin
biopsy) to have it looked at under the microscope. This is often the best
way of knowing whether you have vasculitic urticaria.
Treatment is more difficult than for ordinary urticaria, and usually
needs quite different medicines.
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Contact Urticaria
Some allergies cause hives just where something touches your skin.
Babies with milk allergy may get this round the mouth, where food with
milk touches them, and it also happens with egg allergy and allergy to
nuts. Nurses and others working with latex gloves may also get contact
urticaria on their hands and wrists, exactly where latex rubber gloves
they have been wearing have touched their skin.
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Urticaria caused by aspirin, and by food colouring and preservatives,
and salicylates.
Some people get urticaria or
angioedema.
or both if they take aspirin or painkillers such as ibuprofen (e.g.
Nurofen in the UK) called 'NSAIDs'. This abbreviation stands for 'Non-Steroidal
Anti-Inflammatory Drugs', but a wit wrote that it
stood for 'New Sorts of Aspirin In Disguise'.
Reactions can endanger life, and the fact that a remedy contains aspirin
or a similar drug may not be obvious at all. For example in the UK
Beecham's powders and Alka Selzer both contain full doses of aspirin. If
you have this condition, consult a specialist, and do not take any
painkiller or similar remedy without checking with a doctor or qualified
pharmacist that it is all right for people with aspirin hypersensitivity.
Reactions are also caused by amidopyrine, a painkiller banned in the USA
and UK but used in many other countries under many trade names.
Paracetamol is usually all right for people who are hypersensitive to
aspirin, and if it does cause reactions in them, they are always much
milder. Also all right are the codeine family of painkilers, codeine
phosphate, dihydrocodeine and dextropopoxyphene. HOWEVER, DO NOTE THE
DISCLAIMER AT ON THE HOME PAGE OF THIS WEBSITE, AND NOTE THAT NOTHING IN
THIS WEBSITE IS INTENDED OR CAN BE REGARDED AS INDIVIDUAL MEDICAL ADVICE.
IRRESPECTIVE OF WHAT YOU READ IN THIS SITE, YOUR MEDICAL TREATMENT SHOULD
FOLLOW THE RECOMMENDATIONS OF YOUR OWN DOCTOR, WHO SEES YOU IN PERSON.
Some people with chronic or recurring urticaria (or
angioedema.)
get complete relief if they avoid food and drink (and medicines)
containing substances called salicylates, which are present in some plant
foods, and if they also avoid foods containing some artificial colouring (azo
dyes) or preservatives (benzoates). The effect is dramatic and makes
antihistamines unnecessary in these people. SUCH PEOPLE ARE ALSO
HYPERSENSITIVE TO ASPIRIN AND NSAIDs, WHICH MAY BE DANGEROUS IN THIS
CONDITION. Often they have not used aspirin as such, and people may come
to the wrong conclusion that because of this aspirin cannot be the cause.
If you have this problem, you need to see a dietitian. Although some
doctors hand out a diet sheet for this, dietitians get better results.
In my own experience this cause of urticaria is by far the commonest
discoverable cause of chronic urticaria which you can do something about,
even though this applies in only a minority of people with chronic
urticaria. Moreover, the benefits of discovering this cause are that you
should be able to do without medication except when you eat the offending
foods, and that it is important to know that you must not have aspirin or
NSAIDs.
There is no blood test or skin test for aspirin hypersensitivity.
Avoidance and consumption are the only known ways of diagnosing it. IF YOU
THINK YOU MAY BE HYPERSENSITIVE TO ASPIRIN IT COULD BE EXTREMELY DANGEROUS
TO TEST YOURSELF BY TAKING ASPIRIN. RELY ON A DOCTOR WITH SUITABLE
EXPERTISE TO HELP YOU GET A DIAGNOSIS.
Experts are not agreed about whether aspirin and related substances are
the fundamental cause of this urticaria, or whether some people who have
urticaria for another reason (usually unknown) have it worsened or made
apparent by aspirin. For practical purposes the consequences are the same,
and it is valid to refer to aspirin as a cause of such urticaria, even if
it is not the sole cause.
We do not understand why aspirin and the other substances mentioned
here cause urticaria. There is good evidence that it has little or nothing
to do with common allergies such as hay fever, asthma, allergy to pets,
and common food allergies.
People who are hypersensitive to aspirin are often puzzled because they
have previously used aspirin without becoming unwell. This is quite
typical, and we have no real idea why people suddenly get urticaria from
aspirin when they did not get any trouble previously. One theory is that
some virus infections may bring the change about. Aspirin hypersensitivity
rarely runs in families and when it does this could be mere coincidence,
but it is still possible that people with some genes are more likely to
get it than others.
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Can urticaria be caused by stress?
If you have urticaria, you may be told that it is caused by emotional
stress, or that at least this is a possible explanation. The same claim is
made for many physical illnesses for which we do not know the cause.
Stress is very much a part of life. All of us will encounter stressful
events, and quite a lot of us are so badly affected by stress that it
makes us ill in a variety of ways. We may, for example, have difficulty
sleeping, suffer from obvious depression or anxiety, or get gut symptoms
which do relate in time to the severity of the stress. Many people who
have physical illnesses such as asthma or urticaria tell us that their
symptoms become worse when they are stressed. Often there is no way of
knowing whether someone who is stressed really does get more symptoms, or
whether they just notice the symptoms more when stressed.
I know of no evidence that psychological stress is can be anything
more than an aggravating factor for urticaria. Even then, I know of no
evidence that such stress can increase the number or severity of weals
except by increased scratching, which can of course cause weals to
develop. I have never seen any evidence that relief of stress, whether
by disappearance of the circumstances which caused it or by medical
treatment, has any beneficial effect on the number or severity of weals
other than because many antidepressants happen to be very effective
antihistamines too, or because relief of stress causes you to take less
notice of physical symptoms. I know no evidence that urticaria is more
common in mental hospitals or other circumstances in which people are
more stressed.
Since urticaria typically varies in severity for reasons we often do
not understand, you or someone else with urticaria may by pure
coincidence find that urticaria appears, improves or disappears at the
same time as stress. It is possible that someone else finds the
opposite, but fails to mention this because it does not fit an idea
which other people support. To check whether stress really does cause
urticaria we would have to make observations in such a way that we could
be reasonably sure that chance and personal bias did not explain our
results. It seems to me that no-one has done this.
You could rightly argue that 'absence of evidence is not evidence of
absence'. However, if you choose to believe in ideas for which there is
no evidence, a vast array of wrong and useless ideas could claim equal
place in your brain with a much smaller number of useful ones. That way
lies confusion at best and a kind of madness at worst. There is nothing
wrong with having new ideas for which at first there is little or even
no evidence. There is something wrong with basing actions on such ideas
even when they have not proved useful despite having been around for
decades.
People often believe that theories in science are a kind of absolute
truth, either right or wrong. Oddly enough, people who really are
scientists don't think that at all. Scientists regard theories as a help
in exploring the world and the universe, and change theories as we learn
more. The test of a theory is whether it is useful. The theory that
stress causes urticaria would be useful if it helped us to treat
urticaria. I believe that it does not. In another sense the theory might
be useful if it provided solace (even if it was a lie). I believe it
does the opposite.
I do not believe that urticaria is ever fundamentally caused by
emotional stress. In fact, blaming physical symptoms on a psychological
cause seems to be a way of adding insult to injury because the patient is
blamed for causing his or her own physical symptoms. Such claims should
not be made without evidence because it is immoral to do so.
But even if stress is not a true cause of urticaria, urticaria is
undoubtedly a cause of stress. The best way to treat this stress is to
treat the urticaria.
http://www.users.globalnet.co.uk/~aair/urticaria.htm#Urticaria
Treatment of urticaria
-
Antihistamines (H1 blockers)
Antihistamines are the mainstay of treatment, and most patients need
no other treatment. It is very important that you should have an
antihistamine which is appropriate for you. We are talking here about
the sort of antihistamine usually used for allergies, even though
chronic urticaria is rarely if ever caused by true allergies. This type
of antihistamine is called an 'H1 blocker'. These commonly used
antihistamines are two main kinds.
- Older H1 blocker antihistamines, which make you sleepy
- Newer H1 antihistamines, which cause little nor no sleepiness
Actually this is an oversimplification; the real difference is even
more serious. The older antihistamines affect driving safety even
when they don't make you feel noticeably sleepy. They also affect
learning by schoolchildren.
However, this same sedative effect of the older antihistamines means
they help better against itchiness at night.
Whether your doctor chooses the older or the newer type is an
important matter; it needs to be the best one for your particular needs.
Click here to find out more about antihistamine tablets, capsules, or
liquid medicines
-
Antihistamines which are usually used for stomach or duodenal ulcers
(H2 blockers)
Some clinical trials showed that taking a different kind of
antihistamine called an 'H2 blocker' as well as one of the H1 blockers
increased the success rate of treatment slightly. But a view is growing
that they contribute little help for urticaria in practice, and I share
that view. H2 blockers are mainly used for ulcers and inflammation in
the gullet, stomach and duodenum. You should not take them if an H1
blocker gives you adequate relief. If you do try them and they do not
cause an obvious improvement, ask your doctor whether it would be better
for you to stop taking them.
-
Other medicines
These are mostly the province of specialists. If the ordinary
treatments don't work well enough, you should surely see a specialist.
The point is that alternatives do exist. In the difficult situation in
which antihistamines don't help chronic urticaria, doctors often resort
to prescribing steroid tablets such as prednisone or prednisolone. It is
definitely worth seeing a good specialist if you are facing long-term
treatment with these steroids, because there is a view that other
treatments are preferable and that long-term steroid tablets are rarely
necessary. Recent book chapters and articles by M. Greaves and A. Kobza-Black
cover this point.
Other websites on urticaria
http://www.users.globalnet.co.uk/~aair/urticaria.htm#Urticaria
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Is it a cold or
allergies?
Allergies ---
·
Eyes, ears, nose and/or throat
(especially the palate or roof of the mouth) are itchy.
·
Symptoms may last for weeks or
months, or may be chronic, depending upon exposure to offending allergen (s)
Colds ---
·
Nasal discharge is usually clear
initially, but may become thick and yellow after several days.
·
Symptoms typically end within 3 to
10 days.
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