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Suggest Treatment For Autoimmune Chronic Urticaria
Question: Hi,
I am 24 year old female. Recently I have been diagnosed by Autoimmune Chronic Urticaria. I have been suffering from hives, itchy skin from last 4 months. I have been put on various histamines and steroids. They help till I am on them. As soon as I stop them, I get hives all over my body and severe itching. For 1st 2 months, doctors gave me different anti-allergic and steroids. This went on from Sep till 15th Nov. During the 1st week, doctors took blood tests and urine tests. Urine report showed budding yeast cells present and blood tests showed Lymphocytes - 50 and Eosinophils -13.
After 2 months, when I finally asked that what is the reason behind this and when can I expect it to get better? Also, if this is some food allergy and should get skin allergy tests. My doctor said that since it has been more than 6 weeks with hives, its not food allergy and he put me on Montelukast. He said that this will work on mast cells in about 2 months. Till then whenever I feel itchy, I should take Citrazine.
Not being satisfied with my improvement after 4 months and already taken various mediciens, I started researching online. Since the doctor said autoimmune. I searched mostly around it. I came up with theory that it can be leaky gut and wanted to be tested for it but Doctor said its ridiculous.
I also went for blood tests, thyroid and other tests. The only abnormality came was Lymphocytes came as 45. And in stool sample traces of Lymphocytes were present.
Not happy with the response, I went to a Nutritionist thinking that even if I try this theory, I will just have to change my diet and take some supplements, and see if this improves my health. But the Nutritionist came up with a new theory that I have developed insulin resistance due to stress. Suggested me to just calm down and relax.
I still dnt have solution for my problem and I have to Citrazine in every 3 days. I want to come off my anti-allergic medicines and fix this problem from root. Could you tell me what it is and how can I fix hives and itchy skin? I am attaching the medicines I have been put on. Few are missing as I can only attach 3 images.
I am 24 year old female. Recently I have been diagnosed by Autoimmune Chronic Urticaria. I have been suffering from hives, itchy skin from last 4 months. I have been put on various histamines and steroids. They help till I am on them. As soon as I stop them, I get hives all over my body and severe itching. For 1st 2 months, doctors gave me different anti-allergic and steroids. This went on from Sep till 15th Nov. During the 1st week, doctors took blood tests and urine tests. Urine report showed budding yeast cells present and blood tests showed Lymphocytes - 50 and Eosinophils -13.
After 2 months, when I finally asked that what is the reason behind this and when can I expect it to get better? Also, if this is some food allergy and should get skin allergy tests. My doctor said that since it has been more than 6 weeks with hives, its not food allergy and he put me on Montelukast. He said that this will work on mast cells in about 2 months. Till then whenever I feel itchy, I should take Citrazine.
Not being satisfied with my improvement after 4 months and already taken various mediciens, I started researching online. Since the doctor said autoimmune. I searched mostly around it. I came up with theory that it can be leaky gut and wanted to be tested for it but Doctor said its ridiculous.
I also went for blood tests, thyroid and other tests. The only abnormality came was Lymphocytes came as 45. And in stool sample traces of Lymphocytes were present.
Not happy with the response, I went to a Nutritionist thinking that even if I try this theory, I will just have to change my diet and take some supplements, and see if this improves my health. But the Nutritionist came up with a new theory that I have developed insulin resistance due to stress. Suggested me to just calm down and relax.
I still dnt have solution for my problem and I have to Citrazine in every 3 days. I want to come off my anti-allergic medicines and fix this problem from root. Could you tell me what it is and how can I fix hives and itchy skin? I am attaching the medicines I have been put on. Few are missing as I can only attach 3 images.
Brief Answer:
daily antihistamines, provide further details
Detailed Answer:
Hello XXXXXXX
Thank you for asking at HCM.
I went through your history and would like to know more about you as follows:
1. So you have urticaria since September 2014. What is the frequency of urticaria? In which part of the body do they appear (more on exposed parts or covered parts)? Do they more occur at night or during daytime?
2. Do you have any other allergies like nose allergies, asthma, etc? Did you have urticaria in past?
3. Any particular food that may aggravate your urticaria?
4. How much your urticarial lesions last? do they respond to antihistamines?
5. Do you have associated swelling in any areas like lips, eyes, etc?
6. Does your urticaria get aggravated by heat, hot water, cold water, sunlight, exercise, pressure or vibration? Do you sweat a lot? Is your skin dry?
7. Do you have any other medical condition? Do you need to take any other medicines frequently/regularly? (for example, pain killers, oestrogen containing pills for menstrual problems/birth control etc)
8. Do you have any digestion related problems? Do you get repeated acidity/chest burning etc? Are you often exposed to outside food/water?
9. Is stress an important factor for you? Does stress aggravate your urticaria?
Please provide above details on follow-up. They would help me to understand your problem better.
I have gone through your reports. At present, your reports are not contributing towards any particular cause.
I would like to make suggestions for you as follows:
1. If initial investigations are almost normal, I usually suggest my such patients "second line" investigations like serum ANA, thyroid tests (T3, T4, TSH & thyroid antibodies), serum total IgE and Phadiatop-adult (as a screening test for allergy). I also suggest to get ESR & CRP done while one is having active urticaria episode.
These investigations might give clue towards autoimmune or allergic basis.
However, please note that despite extensive laboratory investigations, 25% of chronic urticaria remain undiagnosed and all reports come out as normal.
2. I usually prescribe my such patients a course of anti-parasitic drugs like nitazoxanide for 3 days as parasites are frequent causes of urticaria in XXXXXXX
3. For symptom control, I would suggest you to take an antihistamine like fexofenadine in morning and hydroxyzing (can cause sedation) before going to bed.
I usually do not prescribe steroids unless episode is very severe and is not controlled by antihistamines. I also don't find necessity of further antibiotics now.
4. Please avoid drugs like pain-killers (NSAIDs groups of drugs), they can aggravate urticaria.
5. Please avoid too hot/spicy foods/fluids. I usually also suggest my such patients to avoid wearing tight fitting and woolen clothes. Loose fitting, cotton clothes are usually good for urticaria patients.
6. Please do not scratch the itchy areas as scratching aggravates itching. I would suggest you to apply lotion like calamine over the itchy areas.
7. I usually also prescribe my chronic urticaria patients a daily multivitamin-multimineral supplement and vitamin D for at least 2-3 months. It may help.
8. If stress is a factor in your life, please adopt stress-reduction strategies.
Hope above suggestions will be helpful to you.
Should you have any further query, please feel free to ask on follow-up. I will try my best to help you with best of my knowledge and experience. Also, please provide further details as asked above.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
daily antihistamines, provide further details
Detailed Answer:
Hello XXXXXXX
Thank you for asking at HCM.
I went through your history and would like to know more about you as follows:
1. So you have urticaria since September 2014. What is the frequency of urticaria? In which part of the body do they appear (more on exposed parts or covered parts)? Do they more occur at night or during daytime?
2. Do you have any other allergies like nose allergies, asthma, etc? Did you have urticaria in past?
3. Any particular food that may aggravate your urticaria?
4. How much your urticarial lesions last? do they respond to antihistamines?
5. Do you have associated swelling in any areas like lips, eyes, etc?
6. Does your urticaria get aggravated by heat, hot water, cold water, sunlight, exercise, pressure or vibration? Do you sweat a lot? Is your skin dry?
7. Do you have any other medical condition? Do you need to take any other medicines frequently/regularly? (for example, pain killers, oestrogen containing pills for menstrual problems/birth control etc)
8. Do you have any digestion related problems? Do you get repeated acidity/chest burning etc? Are you often exposed to outside food/water?
9. Is stress an important factor for you? Does stress aggravate your urticaria?
Please provide above details on follow-up. They would help me to understand your problem better.
I have gone through your reports. At present, your reports are not contributing towards any particular cause.
I would like to make suggestions for you as follows:
1. If initial investigations are almost normal, I usually suggest my such patients "second line" investigations like serum ANA, thyroid tests (T3, T4, TSH & thyroid antibodies), serum total IgE and Phadiatop-adult (as a screening test for allergy). I also suggest to get ESR & CRP done while one is having active urticaria episode.
These investigations might give clue towards autoimmune or allergic basis.
However, please note that despite extensive laboratory investigations, 25% of chronic urticaria remain undiagnosed and all reports come out as normal.
2. I usually prescribe my such patients a course of anti-parasitic drugs like nitazoxanide for 3 days as parasites are frequent causes of urticaria in XXXXXXX
3. For symptom control, I would suggest you to take an antihistamine like fexofenadine in morning and hydroxyzing (can cause sedation) before going to bed.
I usually do not prescribe steroids unless episode is very severe and is not controlled by antihistamines. I also don't find necessity of further antibiotics now.
4. Please avoid drugs like pain-killers (NSAIDs groups of drugs), they can aggravate urticaria.
5. Please avoid too hot/spicy foods/fluids. I usually also suggest my such patients to avoid wearing tight fitting and woolen clothes. Loose fitting, cotton clothes are usually good for urticaria patients.
6. Please do not scratch the itchy areas as scratching aggravates itching. I would suggest you to apply lotion like calamine over the itchy areas.
7. I usually also prescribe my chronic urticaria patients a daily multivitamin-multimineral supplement and vitamin D for at least 2-3 months. It may help.
8. If stress is a factor in your life, please adopt stress-reduction strategies.
Hope above suggestions will be helpful to you.
Should you have any further query, please feel free to ask on follow-up. I will try my best to help you with best of my knowledge and experience. Also, please provide further details as asked above.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks for the quick reply. Please find the details for the question asked below:
1. So you have urticaria since September 2014. What is the frequency of urticaria? In which part of the body do they appear (more on exposed parts or covered parts)? Do they more occur at night or during daytime?
Ans - Yes, from Sep 2014. I can get hives anytime. It may be night or in day. I get hives all over my body. Sometimes legs, foot, hands, neck. My itching and hives started from foot area. In next 15 days, they covered almost every part of my body. Covered or exposed doesnt really matter. My current state is I need Citrazine(Anti-allergic) in every 3 days. It seems like in every 3 days, the work which Citrazine was doing is gone. Every 3 days, 3-4 hives come up. Area or time doesnt matter. If I take the medicines, it will subside otherwise start spreading all over my body with intense itching. The hives are in 1 cm size usually with pale pink color. When these 3-4 hives come up and if I apply aloe vera gel/calamine, it will subside from that area but after some times, some new hives will come up on some other area. The last solution is to take anti-allergic.
1 month ago, I had visited gyneo for this problem to check if she is able to figure out. I also told that that I have been getting boils on my skin since August 2014. The first one was on hand and after that it has all over my body. Till now, I have got 7 boils from August. During the 1st 2 boil, ie, 12th Aug and 2nd boil, ie. on 30th Aug, I had taken Antibiotics. The Antibiotics I took are Augmentin 625 mg, Becelac Forte, Chymorac Forte. And she said that this is happening because of candidiasis and that basically means that my good bacteria is dead. I should take Probiotics. I did take Probiotics which was diary product. During this time only, my time period of taking Citrazine every alternate days shifted to 3 days. But I had to stop taking that diary product bcoz my dermo said that curd products will make my situation worse.
2. Do you have any other allergies like nose allergies, asthma, etc? Did you have urticaria in past?
Ans - I dnt have asthma. But from may/june, when I used to get up, I used to sneeze alot. This automatically went away in July. Currently, I dnt sneeze. I never that urticaria in past.
3. Any particular food that may aggravate your urticaria?
Ans- Not really. It has been constant. On regular interval, I need anti-allergic. Currently, I am not having any citric foods/Curd. Having simple homemade food that includes dal/sabzi/rice. No pickles either.
4. How much your urticarial lesions last? do they respond to antihistamines?
Ans- My urticarial lesions usually last from 36-48 hours. They do respond to antihistamines. They dnt come back as long as I am on antihistamines. As soon as, some time passes, I get hives back. My my aim to write to you is that I want to get off medicines. Not just take medicines and keep the symptoms away.
5. Do you have associated swelling in any areas like lips, eyes, etc?
Ans- No, I have never got swelling in area like lips, eyes. Once my ear did started to get swell(that was in 1st month), Doctor gave me some injection. Since then, I have never seen any swelling on face area. I do get hives/itching on scalp and foot alot.
6. Does your urticaria get aggravated by heat, hot water, cold water, sunlight, exercise, pressure or vibration? Do you sweat a lot? Is your skin dry?
Ans - My urticaria doesnt get aggravted by heat/ hot water/ cold water/ sunlight/exerise/pressure and virration. I dnt sweat alot. Before urticaria, I had very oily skin but now I have super dry skin.
7. Do you have any other medical condition? Do you need to take any other medicines frequently/regularly? (for example, pain killers, oestrogen containing pills for menstrual problems/birth control etc)
Ans- Yes, I have migrane but I take pain killer only in emergency situation and that's like once or twice in 2 months. I have alot of chin/facial hair but I dnt have PCOD. My gynec put me on XXXXXXX in Nov 2013. I have been on till XXXXXXX I also took Emergency pill in Aug.
8. Do you have any digestion related problems? Do you get repeated acidity/chest burning etc? Are you often exposed to outside food/water?
Ans - Yes, I get constipation very easily. And yes, I get acidity also very easily if I dnt eat food on time. No, I dnt eat alot of outside food. Since I get constipation very easily, I have made sure that this doesnt add to my problem, I am drinking milk in night and this helps to me take care of my constipation problem.
9. Is stress an important factor for you? Does stress aggravate your urticaria?
Ans - I cant stay stress has aggravated my urticaria. It has been preety constant. I need my Citrazine in every 3 days from last 1 month. When this itching started, yes, I was under stress due to work. But since then, I have made sure that I dnt get stressed out.
I have got done thyroid tests and the results are:
T3 - 1.36, T4-9.87, TSH-0.96. These tests were done on 15th Dec only.
I have taken T. Zentel 400 mg 2 months ago. I took this only once. I can take course of anti-parasitic drugs i.e,nitazoxanide(is this tablet name or chemical?) for 3 days. Just conform in your next reply and I will start taking this.
I have been mostly following all the suggestions from last 3 months. I dnt scratch. Usually on hives, I apply Calamine lotion/ Aloe vera gel/Castor oil/ Coconut Oil with Camphor. These seem to help temporarily for some time.
I am also taking Antioxid HC(Antioxidants), Ultra D3(for Vitamin D) from last 10 days.
I am also thinking of adding Vitamin C.(Not sure of this or I was also thinking of adding amla juice instead of tablets)[suggest any]. Also, thinking of adding quercetin tablets(suggest on this).
The most imp suggestion I want from you is that while I was on Probiotics diary liquid, my time of taking anti-allergic went from 2 days to 3 days. I took this for a week. Do you suggest of adding any probiotics tablets or something. This might be just right timing but I am still not sure. Suggest accordingly on this. If u do suggest to add Probiotics/ Digestive enzymes.. plz suggest some names/brands which I can buy in XXXXXXX
I am also doing Yoga from last last 15 days to remove any stress. Also, thinking of going gluten-free to reduce stress on my intestine. Suggest on this.
Also suggest what diet changes I can do which might help in this situation.
1. So you have urticaria since September 2014. What is the frequency of urticaria? In which part of the body do they appear (more on exposed parts or covered parts)? Do they more occur at night or during daytime?
Ans - Yes, from Sep 2014. I can get hives anytime. It may be night or in day. I get hives all over my body. Sometimes legs, foot, hands, neck. My itching and hives started from foot area. In next 15 days, they covered almost every part of my body. Covered or exposed doesnt really matter. My current state is I need Citrazine(Anti-allergic) in every 3 days. It seems like in every 3 days, the work which Citrazine was doing is gone. Every 3 days, 3-4 hives come up. Area or time doesnt matter. If I take the medicines, it will subside otherwise start spreading all over my body with intense itching. The hives are in 1 cm size usually with pale pink color. When these 3-4 hives come up and if I apply aloe vera gel/calamine, it will subside from that area but after some times, some new hives will come up on some other area. The last solution is to take anti-allergic.
1 month ago, I had visited gyneo for this problem to check if she is able to figure out. I also told that that I have been getting boils on my skin since August 2014. The first one was on hand and after that it has all over my body. Till now, I have got 7 boils from August. During the 1st 2 boil, ie, 12th Aug and 2nd boil, ie. on 30th Aug, I had taken Antibiotics. The Antibiotics I took are Augmentin 625 mg, Becelac Forte, Chymorac Forte. And she said that this is happening because of candidiasis and that basically means that my good bacteria is dead. I should take Probiotics. I did take Probiotics which was diary product. During this time only, my time period of taking Citrazine every alternate days shifted to 3 days. But I had to stop taking that diary product bcoz my dermo said that curd products will make my situation worse.
2. Do you have any other allergies like nose allergies, asthma, etc? Did you have urticaria in past?
Ans - I dnt have asthma. But from may/june, when I used to get up, I used to sneeze alot. This automatically went away in July. Currently, I dnt sneeze. I never that urticaria in past.
3. Any particular food that may aggravate your urticaria?
Ans- Not really. It has been constant. On regular interval, I need anti-allergic. Currently, I am not having any citric foods/Curd. Having simple homemade food that includes dal/sabzi/rice. No pickles either.
4. How much your urticarial lesions last? do they respond to antihistamines?
Ans- My urticarial lesions usually last from 36-48 hours. They do respond to antihistamines. They dnt come back as long as I am on antihistamines. As soon as, some time passes, I get hives back. My my aim to write to you is that I want to get off medicines. Not just take medicines and keep the symptoms away.
5. Do you have associated swelling in any areas like lips, eyes, etc?
Ans- No, I have never got swelling in area like lips, eyes. Once my ear did started to get swell(that was in 1st month), Doctor gave me some injection. Since then, I have never seen any swelling on face area. I do get hives/itching on scalp and foot alot.
6. Does your urticaria get aggravated by heat, hot water, cold water, sunlight, exercise, pressure or vibration? Do you sweat a lot? Is your skin dry?
Ans - My urticaria doesnt get aggravted by heat/ hot water/ cold water/ sunlight/exerise/pressure and virration. I dnt sweat alot. Before urticaria, I had very oily skin but now I have super dry skin.
7. Do you have any other medical condition? Do you need to take any other medicines frequently/regularly? (for example, pain killers, oestrogen containing pills for menstrual problems/birth control etc)
Ans- Yes, I have migrane but I take pain killer only in emergency situation and that's like once or twice in 2 months. I have alot of chin/facial hair but I dnt have PCOD. My gynec put me on XXXXXXX in Nov 2013. I have been on till XXXXXXX I also took Emergency pill in Aug.
8. Do you have any digestion related problems? Do you get repeated acidity/chest burning etc? Are you often exposed to outside food/water?
Ans - Yes, I get constipation very easily. And yes, I get acidity also very easily if I dnt eat food on time. No, I dnt eat alot of outside food. Since I get constipation very easily, I have made sure that this doesnt add to my problem, I am drinking milk in night and this helps to me take care of my constipation problem.
9. Is stress an important factor for you? Does stress aggravate your urticaria?
Ans - I cant stay stress has aggravated my urticaria. It has been preety constant. I need my Citrazine in every 3 days from last 1 month. When this itching started, yes, I was under stress due to work. But since then, I have made sure that I dnt get stressed out.
I have got done thyroid tests and the results are:
T3 - 1.36, T4-9.87, TSH-0.96. These tests were done on 15th Dec only.
I have taken T. Zentel 400 mg 2 months ago. I took this only once. I can take course of anti-parasitic drugs i.e,nitazoxanide(is this tablet name or chemical?) for 3 days. Just conform in your next reply and I will start taking this.
I have been mostly following all the suggestions from last 3 months. I dnt scratch. Usually on hives, I apply Calamine lotion/ Aloe vera gel/Castor oil/ Coconut Oil with Camphor. These seem to help temporarily for some time.
I am also taking Antioxid HC(Antioxidants), Ultra D3(for Vitamin D) from last 10 days.
I am also thinking of adding Vitamin C.(Not sure of this or I was also thinking of adding amla juice instead of tablets)[suggest any]. Also, thinking of adding quercetin tablets(suggest on this).
The most imp suggestion I want from you is that while I was on Probiotics diary liquid, my time of taking anti-allergic went from 2 days to 3 days. I took this for a week. Do you suggest of adding any probiotics tablets or something. This might be just right timing but I am still not sure. Suggest accordingly on this. If u do suggest to add Probiotics/ Digestive enzymes.. plz suggest some names/brands which I can buy in XXXXXXX
I am also doing Yoga from last last 15 days to remove any stress. Also, thinking of going gluten-free to reduce stress on my intestine. Suggest on this.
Also suggest what diet changes I can do which might help in this situation.
Brief Answer:
Diet changes, antihistamines SOS, additional testing
Detailed Answer:
Hello XXXXXXX
Thank you for your comprehensive follow-up.
I can see that you already have a lot of work done for "chronic urticaria".
Your detailed follow-up would help me to make more specific suggestions for you and also to answer your queries. I would like to make suggestions for you as follows:
1. Regarding probiotics, I don't think they can aggravate urticaria. Of course, curd also contains good bacteria that some probiotics contain. But it does not mean that you cannot take probiotics.
Even for curd, I would suggest you not to take curd only if you feel it aggravates your itching. In my experience, fresh, non-sour curd does not aggravate itching. Old, sour curd can aggravate itching.
One more, probiotics are not conventionally used drugs for urticaria, but I would suggest you to take them because you have digestions problems & constipation. Chronic urticaria may improve with improvement in digestion.
So, basically, I would suggest you probiotics to improve digestions and not specifically urticaria. Common probiotics that I use are saccharomyces boulardii, lactobacillus GG, etc.
2. All the drugs that you have mentioned are known to cause urticaria - analgesics, XXXXXXX emergency pills, etc. Please note that you can develop chronic urticaria sometimes even later after taking some of these medications. Unfortunately there are no laboratory tests that can prove or disprove whether cause of chronic urticaria is a particular drug. So I usually suggest my such patients to avoid NSAIDs (pain killers like ibuprofen, diclofenac, etc) and oestrogen containing drugs (OC pills, etc).
Please consult your Obs-Gyn specialist regarding this and to suggest alternatives.
For pains and fevers, paracetamol is the safest drug in my opinion for urticaria patients.
3. I assume physical factors like heat/cold do not aggravate your urticaria as you have mentioned.
Dry skin aggravates itching. So to my such patients, I usually suggest regular application of moisturizing lotion over dry skin, especially immediately after bathing. This practice retains moisture within skin and reduces itching gradually.
For dry skin patients, I also prescribe them supplements containing multivitamin-multimineral, especially vitamin A, vitamin D, vitamin E, zinc & selenium. It may help to improve skin over time.
4. Regarding diet, I would suggest you foods that might aggravate itching - too spicy foods, too sour foods, too hot foods. I highly recommend all packed foods that might be containing preservatives/colors/additives. You are already avoiding pickles. It's good that you are following a simple diet.
As you have specifically asked, amla juice is very good for vitamin C but it will be sour and can aggravate itching. You can try it once and if it does not aggravate itching, then you can take it safely.
Regarding diet, I usually usually suggest my patients taking turmeric as in Ayurveda, it is considered one of the best medicines for urticaria. As you are taking milk at night, I would suggest you to take turmeric + warm milk before going to bed. It will also improve constipation.
5. Diet and life style changes will help you to improve digestions problems like acidity and constipation. Regular walking, physical exercise, Yoga & Pranayama will surely help you to improve your overall health gradually. Please note that these practices work very slowly and you should not expect immediate changes. You need to be regular with them and to have a lot of patience.
Stress, especially if long-standing, reduces immunity and makes an individual prone to immune diseases and allergies. So stress reduction strategies are helpful for patients with chronic urticaria in my opinion.
6. Thyroid reports are normal.
7. As you have already taken Zentel, please consult your doctor before taking further anti-parasitic drug. Nitazoxanide is a generic name, not a brand name.
8. As you have asked about quercetin and antioxidants. They are generally good for overall metabolism of body, but specifically for urticaria, their role is not known at present. You can take them as per your physician/dermatologist's advice.
9. As you have acidity problem, I would also suggest you testing for H. pylori. Usually stool is tested for H. pylori antigen. If the test is positive, you may require a course of antibiotics. H. pylori causes both acidity and chronic urticaria.
10. In your over all lab testing, tests for autoimmunity are not done. They may be done as suggested in previous reply (ESR, CRP, ANA, etc). Also, you can screen yourself for allergies. However, any of both airborne allergens and food allergens may be the cause. Please note that there is no known "cure" for autoimmune urticaria in modern medicine at present and long-term antihistamines is the main option.
I would like to mention again, that despite all possible testing, usually 25-30% of chronic urticaria remain undiagnosed.
11. As you have asked about gluten-free diet, I would not suggest you in my opinion. Wheat is usually our staple food and it's difficult to stay completely gluten-free as gluten is also "hidden" in many food items. Frankly, I am not sure it will help you. Rather, I would suggest you to take steps towards improving digestion like take high fibre diet, plenty of fluids, etc.
12. Please note that suggesting brand names and dosing of drugs would violates T&Cs of HCM. It is highly recommended that you consult your physician before making changes in your treatment.
In nutshell, I can understand that chronic urticaria is a "nagging" condition. But it takes a lot of patience and understanding of the disease from patients side. Lab testing can help mostly to "diagnose". With suitable diet changes and life style changes, it is possible to improve the condition gradually and reduce usage of antihistamines, but these things are unpredictable until final diagnosis is made.
Hope above suggestions will help you to understand yourself better.
Were I treating you, my personal suggestion for you would be not to be too "stressed" to cure only urticaria, but try to see the whole picture. Improving digestion, improving skin, improving immunity and improving diet will gradually improve your physiology and hopefully improve urticaria. So my personal suggestion would be to focus on your overall health and well-being with minimum possible use of medicines such as NSAIDs and estrogen pills.
If you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
Diet changes, antihistamines SOS, additional testing
Detailed Answer:
Hello XXXXXXX
Thank you for your comprehensive follow-up.
I can see that you already have a lot of work done for "chronic urticaria".
Your detailed follow-up would help me to make more specific suggestions for you and also to answer your queries. I would like to make suggestions for you as follows:
1. Regarding probiotics, I don't think they can aggravate urticaria. Of course, curd also contains good bacteria that some probiotics contain. But it does not mean that you cannot take probiotics.
Even for curd, I would suggest you not to take curd only if you feel it aggravates your itching. In my experience, fresh, non-sour curd does not aggravate itching. Old, sour curd can aggravate itching.
One more, probiotics are not conventionally used drugs for urticaria, but I would suggest you to take them because you have digestions problems & constipation. Chronic urticaria may improve with improvement in digestion.
So, basically, I would suggest you probiotics to improve digestions and not specifically urticaria. Common probiotics that I use are saccharomyces boulardii, lactobacillus GG, etc.
2. All the drugs that you have mentioned are known to cause urticaria - analgesics, XXXXXXX emergency pills, etc. Please note that you can develop chronic urticaria sometimes even later after taking some of these medications. Unfortunately there are no laboratory tests that can prove or disprove whether cause of chronic urticaria is a particular drug. So I usually suggest my such patients to avoid NSAIDs (pain killers like ibuprofen, diclofenac, etc) and oestrogen containing drugs (OC pills, etc).
Please consult your Obs-Gyn specialist regarding this and to suggest alternatives.
For pains and fevers, paracetamol is the safest drug in my opinion for urticaria patients.
3. I assume physical factors like heat/cold do not aggravate your urticaria as you have mentioned.
Dry skin aggravates itching. So to my such patients, I usually suggest regular application of moisturizing lotion over dry skin, especially immediately after bathing. This practice retains moisture within skin and reduces itching gradually.
For dry skin patients, I also prescribe them supplements containing multivitamin-multimineral, especially vitamin A, vitamin D, vitamin E, zinc & selenium. It may help to improve skin over time.
4. Regarding diet, I would suggest you foods that might aggravate itching - too spicy foods, too sour foods, too hot foods. I highly recommend all packed foods that might be containing preservatives/colors/additives. You are already avoiding pickles. It's good that you are following a simple diet.
As you have specifically asked, amla juice is very good for vitamin C but it will be sour and can aggravate itching. You can try it once and if it does not aggravate itching, then you can take it safely.
Regarding diet, I usually usually suggest my patients taking turmeric as in Ayurveda, it is considered one of the best medicines for urticaria. As you are taking milk at night, I would suggest you to take turmeric + warm milk before going to bed. It will also improve constipation.
5. Diet and life style changes will help you to improve digestions problems like acidity and constipation. Regular walking, physical exercise, Yoga & Pranayama will surely help you to improve your overall health gradually. Please note that these practices work very slowly and you should not expect immediate changes. You need to be regular with them and to have a lot of patience.
Stress, especially if long-standing, reduces immunity and makes an individual prone to immune diseases and allergies. So stress reduction strategies are helpful for patients with chronic urticaria in my opinion.
6. Thyroid reports are normal.
7. As you have already taken Zentel, please consult your doctor before taking further anti-parasitic drug. Nitazoxanide is a generic name, not a brand name.
8. As you have asked about quercetin and antioxidants. They are generally good for overall metabolism of body, but specifically for urticaria, their role is not known at present. You can take them as per your physician/dermatologist's advice.
9. As you have acidity problem, I would also suggest you testing for H. pylori. Usually stool is tested for H. pylori antigen. If the test is positive, you may require a course of antibiotics. H. pylori causes both acidity and chronic urticaria.
10. In your over all lab testing, tests for autoimmunity are not done. They may be done as suggested in previous reply (ESR, CRP, ANA, etc). Also, you can screen yourself for allergies. However, any of both airborne allergens and food allergens may be the cause. Please note that there is no known "cure" for autoimmune urticaria in modern medicine at present and long-term antihistamines is the main option.
I would like to mention again, that despite all possible testing, usually 25-30% of chronic urticaria remain undiagnosed.
11. As you have asked about gluten-free diet, I would not suggest you in my opinion. Wheat is usually our staple food and it's difficult to stay completely gluten-free as gluten is also "hidden" in many food items. Frankly, I am not sure it will help you. Rather, I would suggest you to take steps towards improving digestion like take high fibre diet, plenty of fluids, etc.
12. Please note that suggesting brand names and dosing of drugs would violates T&Cs of HCM. It is highly recommended that you consult your physician before making changes in your treatment.
In nutshell, I can understand that chronic urticaria is a "nagging" condition. But it takes a lot of patience and understanding of the disease from patients side. Lab testing can help mostly to "diagnose". With suitable diet changes and life style changes, it is possible to improve the condition gradually and reduce usage of antihistamines, but these things are unpredictable until final diagnosis is made.
Hope above suggestions will help you to understand yourself better.
Were I treating you, my personal suggestion for you would be not to be too "stressed" to cure only urticaria, but try to see the whole picture. Improving digestion, improving skin, improving immunity and improving diet will gradually improve your physiology and hopefully improve urticaria. So my personal suggestion would be to focus on your overall health and well-being with minimum possible use of medicines such as NSAIDs and estrogen pills.
If you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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