Urticaria

What is Urticaria?

Nettle-rash or Hives also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. They may also burn or sting. Often the patches of rash move around.

Urticaria is an allergic or non-allergic immunological disease, shown on the skin. Characteristically the skin eruptions are erythematous, raised above the skin level, with intense itching and usually worsened by itching an with slight local warmth. It can be acute or chronic; largely having a tendency to recur frequently for many months or years.
These eruptions can remain on the body for variable period anywhere between few seconds to even hours. They have tendency to disappear and reappear. They tend to disappear without leaving behind any trace.
Location and duration:
Well, urticaria may appear on any part of the skin. Angioedema is a condition when deep tissues are affected. The typical lesions may last for one minute to half an hour. Some may last even longer. Some patients may get the eruptions once in a while and some may have many times during the day. It may be restricted to a couple of spots in some patients, while some may have wide spread rashes appearing for days or even months together.

There are acute, sub-acute, chronic and recurring variants as far as the frequency and duration are concerned.

Histopathological view:

Under the microscope, a typical urticarial rash may exhibit perivascular, cellular infiltrate consisting of lymphocytes and eosinophils, is indicative of it’s allergic behavior. There are findings related to edema (swelling) and mucosal inflammation.

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Urticaria: The Inner War:

The urticaria rash is a symptom of an allergic and immunological event taking place at the dermal level. The exact understanding is illusive to an extent. In brief, urticaria is a hypersensitive reaction due to the histamine release. The histamine release could be from the mast cells when antigens and antibodies (IgM or IgG) combine to activate the immunological reaction. The histamine release could IgE induced. There are certain drugs, pharmacological agents (e.g.: antibiotics, morphine, aspirin, etc.), food articles (proteins, milk products, etc.) Urticaria is a sign of antigen-antibody reaction. During this process of antibody-antigen reaction, histamine and/or acetylcholine is generated which has the property of causing vessel dilatation (vasodilation) swelling, itching, pain and rash.

Causes of Urticaria (Hives)

Like many other disease conditions, we know what happens in urticaria more that what exactlycauses urticaria (hives). In almost half the cases we know what causes or induces urticaria; and half the time, the patients or we have no clue as to its exact cause.

Many people including some doctors believe that urticaria is allergic in nature. Actually, tt must be noted that Urticaria is not always allergic in nature. There are allergic and non-allergic causes for chronic urticaria. The non-allergic causes include auto-immunity related, hormonally triggered, stress triggered, exercise, drugs, temperature based and other factors.

We shall try to examine some of the most common exciting factors known to induce urticaria (hives), which may be grouped as:
Allergens: A large number of 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, nuts, certain daals as used in India, peas, orange, fish, chicken, etc. Synthetic and natural food additives and artificially-flavored food articles.
Urticaria and alcohol:
True anaphylactic reactions to alcohol (ethanol) are rare and most reactions to ingested alcoholic beverages are secondary to other chemicals in the beverage such as metabisulfite, papain, dyes or yeasts. However, there are reports of true allergic reactions in which the offending agent was shown to be the ethanol itself. Generally the symptoms of anaphylaxis occur in such patients following the ingestion of beer and/or wine. Urticaria rashes have been reported with ethanol ingestion; and hives on contact with ethanol have also been reported for some patients of urticaria.
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.
Drugs:
The major cause for urticaria are man-made drugs such as antibiotics (Penicillin), NSAIDs, anti-inflammatory drugs (aspirin, indomethacin), vaccinations, foreign sera, hormonal preparations, contraceptive pills, etc. Animals treated with penicillin excrete a small amount of it in the milk sufficient to cause urticaria in sensitive individuals.
Cholinergic factors:
Urticaria often gets triggered or aggravated by exercise, pressure on some part of the body as well as change in temperature of body after sweating. Such changes affect nerve ending of skin which lead to development of urticaria rash. In this variety of urticaria one experiences itching, burning and local heat on skin.
Urticaria and cocaine:
There have been reports of morphine-induced hives in some people. Bronchospasm may occur in some patients who smoke cocaine or in those who inject heroin. This may occur more often in patients who have a previous history of asthma. Hypersensitivity pneumonitis to cocaine has also been described and is associated with elevated levels of IgE.
Infections and infestations:
Insect bites, Fungal, protozoal, frequent bacterial infections (Urinary tract), viral infections (Hepatitis), helminthiasis (worm infestations such as round worms, tapeworms), etc. are factors known to cause urticaria. Domestic contact with the pet animals should be examined as cause for urticaria.
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.
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. Especially, if you are under prolonged stress, anxiety, sadness or insecurity, such intense emotions could alter your immunological state and in turn lead to hypersensitivity.
Autoimmune causes:
Chronic urticaria is now understood to have autoimmune link. Presence of auto antibodies against Immunoglobulin E (IgE), CD23 (FcεRII or Fc epsilon RII) which releases histamine, hence leading to chronic urticaria.
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, etc. In certain variety of malignancies (cancer) urticaria may present as a precursor.
Idiopathic cause:
No list of causation is complete without adding a paragraph of ‘Idiopathic’ which simply implies causes which are unknown.

Urticaria: Features

The urticaria eruptions may be irregularly shaped or round or may be like a vertical lines.. They may appear single or multiple, occasional or many appearing at once or a appearing and disappearing in random order.

The most annoying concern for the sufferer is intense itching which, when uncontrolled makes the patient restless and impatient. At times, the eruptions and itching may lead to disturbance at work and sleeplessness.

Angioneurotic edema (ANO, also called as Giant Urticaria) is a variant of urticaria which simply means large (massive or giant) urticaria with severe swelling (edema) of the skin at a deeper cellular level. When this involves respiratory organs such as larynx, it may lead to suffocation and to a medical emergency. The lips may get terribly swollen with ANO.

Urticaria Diagnosis

Clinical diagnosis is made by close examination of the skin eruptions. Once observed and experienced, the patients can also recognize, urticaria.

A careful case analysis and evaluation is required to make a correct diagnosis. A systematic history to evaluate the whole system ruling out certain systemic disease such as endocrine disorders, malignancy, lupus, respiratory disease, other allergic disorders, etc. is called for. Hormonal study and thyroid profile may be indicated if the clinical picture so suggests. 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.

Homeopathy Treatment for Urticaria

The treatment for chronic urticaria requires to be addressed at the very root of the disease. Urticaria being an immunological disorder, the treatment must target the correction of the immune system in such a way that the hypersensitive behind urticaria is taken care of; and the body does not react the way it does with the disease of urticaria.

Anti-histamines offer symptomatic relief for urticaria. However, they work superficially, without addressing or correcting the underlying immunity problem. So the effect of antihistamine stays for a short period of eight to ten hours; and you need it almost daily. Similarly, cortisone when used for urticaria, works instantly but it is habit forming and it has its own challenge in terms of adverse effects, and more importantly, dependency. Chronic urticaria dependent on the use of cortisone is more difficult to treat over the period of time.

Homeopathy offers research proven and effective treatment for Chronic and Recurrent Urticaria. Patients with Chronic urticaria are almost always put to mercy of life long use of antihistamine medicines or cortisone by regular doctors. Once started, it becomes almost impossible to stop it even for a couple of days. You need treatment which is more than just antihistamines. That is homeopathy.

Chronic urticaria

Chronic and recurring urticariais a challenging problem for the medical world as on most occasions the exact cause remains unknown. Unfortunately, chronic urticaria is treated only symptomatically using the conventional medicines. What causes urticaria is more difficult to answer than 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, we or the patients have no clue to its exact causation.

Acute urticaria is a condition where one experiences urticaria for a short time, may be for a few minutes. However, chronic or recurring urticaria is a major problem, as urticaria keeps appearing again and again, say 3-4 times in a day for a few months or few years. Chronic urticaria is a real challenge, where homeopathic treatment is required.

We shall try to examine some of the most common exciting factors known to induce chronic urticaria, which may be grouped as:
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.
Environmental factors: Exposure to pollen, house-dust, buffalo dander, fungi, change in temperature, etc. are known exciting factors. Extreme cold, heat, pressure may induce urticaria.
Drugs:Man made drugs are major cause for urticaria. Antibiotics (Penicillin), anti-inflammatory medicines (aspirin, indomethacin), vaccinations and foreign sera, hormonal preparations, contraceptive pills, etc are few common ones. Animals treated with penicillin excrete a small amount of it in the milk sufficient to cause urticaria in sensitive individuals.
Infections and Infestations:Insect bites, fungal, protozoal, frequent bacterial infections (Urinary tract), viral infections (Hepatitis), helminthiasis (worm infestations such as round worms, tapeworms), etc. are factors known to cause urticaria. Domestic contact with the pet animals should be examined as cause for urticaria.
Synthetic products:Use of personal products such as deodorant, perfume, talcum powder, cosmetic products, animal derivatives, and similar synthetic substances may induce this disorder.
Emotional factors:Especially in chronic, recurring cases of urticaria the role of emotional factors must be examines. 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.
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, reticulosis. In certain variety of malignancies (cancer) urticaria may present as a precursor
Idiopathic causes: No list of causation is complete without adding a paragraph of ‘Idiopathic’ which simply implies those causes which are unknown. Urticaria is one of the many disease of which the exact cause is not fully understood.

Urticaria Pigmentosa (Mastocytosis)

Urticaria pigmentosa is a skin disease, which is a form of urticaria as well as mastocytosis, in which you find brown, intensely itching patches on skin. On rubbing the spots, one gets hives or urticarial patches.

It is one of the forms of mastocytosis. For understand mastocytosis, we need to understand a bit about mast cells. Mast cells are normal cells found in skin all over the body. Mast cells contain certain granules which when activated or stimulated, lead to release of histamine and other such chemicals, leading to the condition called mastocytosis. You may say, mast cells are inflammatory cells.
Incidence:
Urticaria pigmentosa is most commonly seen in infants and children but can also be found in adults.

Causes:

The exact cause of this uncommon disease is unknown but recent research suggests genetic change in a protein (called c-kit) on the surface of mast cells may result in the abnormal proliferation of these cells.
Variety of factors can cause or worsen the symptoms of urticaria pigmentosa:

  • Physical stimuli such as heat, friction, and excessive exercise
  • Bacterial toxins
  • Venom
  • Eye drops containing dextran
  • Alcohol
  • Morphine
  • Emotional stress

Symptoms:

  • Brownish lesions on skin are seen typically around chest and forehead.
  • Rubbing the skin sore causes hive like bump.
  • A fluid filled blister may form if it is scratched, especially seen in younger children.
  • Face may become flushed.
  • In severe cases diarrhea, headache and palpitation may be seen.

Darier’s sign:

A typical presentation called Darier’s sign is observed in Urticaria pigmentosa. By rubbing one of the brown patches the rubbed area becomes reddened, swollen and itchy. This confirms the presence of mastocytosis

Something about mast cells:

Mast cells are normally widely distributed in the skin. They contain granules that contain histamine and other chemicals. When the mast cell is disturbed, these chemicals are released into the surrounding skin. The chemicals make the blood vessels leaky, resulting in localized itching, swelling and redness.

Diagnosis and Investigations:

  • The disease is most often diagnosed clinically
  • Doctors can confirm the presence of mast cells by rubbing the skin. If hives appear, it most likely signifies the presence of urticaria pigmentosa.
  • Skin biopsy shows an increase in mast cells and confirms the diagnosis.

If there are any symptoms suggesting internal involvement the following tests may be helpful

  • X-rays of skull and long bones may show areas of bone thinning, or a diffuse ground glass appearance
  • Urinary histamine levels or 1,4-methylimidazole acetic acid may be elevated

Prognosis:

  • It goes away on its own till the time of puberty in 50% of the cases but medication is required as it is a troublesome disease.
  • In adults it may develop into more serious condition called systemic mastocytosis.

Treatment:

a. Conventional treatment for Urticaria pigmentosa: Urticaria pigmentosa is hard to treat with the conventional medicine.
1. Oral antihistamines are useful because they reduce the mast cell’s ability to react to histamine.
2. Disodium cromoglicate orally may be helpful in some cases as they act as mast cell stabilizers.
3. Topical steroids have limited role.
4. Photo chemotherapy for longer periods may be helpful to some extent.

b. Homeopathic treatment for Urticaria pigmentosa:
1. Homeopathy works effectively for urticaria pigmentosa. Homeopathy evaluation takes into account genetic, immunological and allergic factors in particular while treating this conditions. Results are positive and encouraging. Strongly recommended.
2. The line of homeopathic treatment is largely constitutional therapy. Some of the commonly indicated homeopathic medicines include Natrum muriaticum, Sulphur, Thuja occidentalis, Silica, Apis melifica, Arsenic iodum, etc.

Adverse effects of Antihistamines in Urticaria

Anti-histamines (also called as histamine antagonists) are conventionally used medicines for various allergic diseases such as urticaria, hay fever, colds, eczema, etc. Antihistamines are available as OTC (over the counter) products. As the name suggests, they are targeted against the release of histamine. Histamine is often an end product of allergic reaction in our body, which leads to allergic rash such as urticaria, inflammation, and itching. Antihistamines are the chemicals which block the effect of histamine, whereby the symptoms are suppressed for the time being, of course not cured. Actually, histamine is a part of our natural defense mechanism. Histamine release, per se, is not bad. The allergens and the hypersensitive state are to be treated. Unfortunately, this concept is not appreciated by the conventional medicine. Use of antihistamines, thus, becomes more suppressive and superficial than curative, which does not treat the disease at deeper level.

Some of the commonly used antihistamines are Levocetrizine, Allegra (Fexofenadine), Cetirizine, etc. There are hundreds of products in the market. There are patients who keep consuming Allegra (Fexofenadine), Cetirizine, Levocetirizine for months and years. There are thousands of patients who keep consuming such antihistamines for very long time and they almost become addict to antihistamines such as Allegra or Cetrizine.

Antihistamines are good for superficial control of the symptoms. However, they do not cure urticaria, especially chronic urticaria.

Some of the common adverse effects of antihistamines are listed here for readerâ as reference:
a. Sleepiness or drowsiness
b.Dullness of senses
c. Giddiness
d. Headache
e. Loss of appetite
f. Blurring of vision
g.Dryness of mouth, nose and throat
h. Difficulty in passing urine
i. Nausea and / or vomiting
j. feeling sick or vomiting
k. Constipation or loose stools
l. Stomach upsets
m. Irritability

If you taking certain antihistamine, you should check the instructions on the medicine information. It is often written that one should avoid driving after taking antihistamine, since some of them tend
to produce sleepiness and dullness of senses.

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