Urticaria

Because it had hives! Saw this funny cartoon on the internet. Hives or urticaria is a common allergic condition. Here one gets red, raised areas, often large and shaped like maps on various parts of the skin. These are called wheals and are often hot to touch. Patients sometimes feel they have fever, but nothing shows up on the thermometer. The characteristic thing about urticaria is that individual hives last for a few hours, never exceeding a day. Of course a succession of new hives is on its way, so one feels they are persistent. Itching can really be maddening at times.

Triggers

Urticaria is often triggered off by certain foods and drugs. Common offenders include fish, sea food, eggs, lemon, tomatoes, chocolates, cheese, strawberry, nuts and pain killers like aspirin. Preservatives, colouring and flavouring materials used in packed foods and beverages can be culprits. Various infections can precipitate hives, more so in children. Although there many other causes of urticaria, there is large group of people who suffer from chronic urticaria. This group of patients get wheals daily for more than 6 weeks. Even after a battery of tests, no cause is identifiable in these people.

Nailing the habitual offender

The manner of presentation of urticaria will often give clues as to the cause. Investigations to exclude infections or hormonal causes may sometimes be necessary. Allergy tests provide relevant information only in a handful of cases. Your dermatologist may sometimes ask you to maintain a food diary. If urticaria is unremitting, special tests for ‘autoimmune urticaria’ may provide insights for specific therapy.

The Desi Connection

Urticaria is considered a type of 'pitta' due to 'heat in the body' and 'hyperacidity'. I am not sure how much 'cooling the body from within' and using neem in various forms helps hives.

The Healing Touch

The obvious thing is to rectify the cause once it is identified. Foods are often considered the do all and be all of hives. Patients often stop various foods randomly for prolonged periods of time to ease the assault of hives. Family and friends have their own two bit to add to the confusion. I had a Jain patient who undertook a one week fast where only boiled water was permitted for consumption. Throughout that one week period, she continued to get hives. So foods are not the only cause of urticaria.

The first and most important treatment for relieving hives is oral anti-allergic medications called antihistamines. They are of various different kinds. The newer versions of antihistamines require to be taken just once or twice a day and do not affect your alertness. This is in contrast to the older antihistamines which had to be taken 3-4 times daily and used to produce drowsiness. Antihistamines may be required for prolonged periods but the good news is they are safe for long term use. Special medications like cyclosporine and omalizumab may be considered for non-responders. Calamine lotion can soothe the skin until the effect of antihistamines kicks in.