Brief Answer:
Antihistamines SOS, minimum steroids, please provide more details

Detailed Answer:
Hello,

Thank you for asking at HCM.

I went through your wife's history and would like to make suggestions for her as follows:

1. From your history, I would agree with diagnosis of "urticaria". It is a very common condition and one needs to find out the cause of urticaria.

2. Whatever the cause, common treatment for urticaria remains antihistamines only. Both HistafreeM (Fexofenadine + Montelukast) and Atarax (Hydroxyzine) contain antihistamines.

Atarax may cause more sedation but may be more effective for itching.

3. Thus, if her urticaria stays for more than a few hours, I usually suggest my such patients Fexofenadine in morning and Hydroxyzine before going to bed.

However, if they last only for a few minutes/hours, use of a single dose of Fexofenadine/Hydroxyzine would suffice.

4. There are many types of urticaria. First of all I would like to know frequency of her urticaria.

I know that the first episode was before 2 months. I would like to know how frequent her urticaria are in last 2 months. Also, how they respond to medications.

Please provide details on follow-up.

5. If urticaria respond to antihistamine drugs, I usually do not prescribe steroids (Tricort) because possible side effects are numerous, especially with long term use.

6. I would also like to know how she was diagnosed with hypothyroidism, what investigations done for thyroid, etc as some of the urticarias ("autoimmune urticaria") are associated with hypothyroidism. They tend to recur again and again.

Please provide these details on follow-up.

7. I would also like to know -
a. whether she needs to take any other medications frequently/regularly (for example pain killers, etc).
b. why is she taking antihypertensive medications (Arbital H)
c. what are her all investigations
d. whether she has any digestion/stomach related complaints
e. whether she has more itching during day or night time
f. whether she has any respiratory problems like frequent cold, allergies, cough, etc
g. whether stress is an important factor in his life as some urticaria are worsened by stress

Hope above suggestions will be helpful to you.

Please provide remaining details on follow-up. It will help me to understand your wife's problem better and therefore the make suggestions more specifically.

Please feel free to ask any other questions/concerns regarding diagnosis/drugs, etc on follow-up.

Wish your wife the best of the health ahead.

Thank you & Regards,

Dr Parin N Parmar

---

Brief Answer:
Not related to urticaria, please consult a gynecologist

Detailed Answer:
Hello Mr XXXXXX,

Thank you for your follow-up.

I would suggest you to consult a Gynecologist for breast secretions. He/she would examine her breast and then decide accordingly cause of secretions after reviewing your detailed medical & gynecological history. Sometimes some hormonal/endocrinal causes can also cause such secretions.

As an Allergist-Immunologist, I would like to mention that medications for urticaria (Fexofenadine, Montelukast, Hydroxyzine) do not commonly cause breast secretions or any such other complaints.

Hope this will help you.

Wish your wife the best of the health.

Thank you & Regards,

Dr Parin N Parmar

---