Continue treatment, avoid hot-spicy-packed foods
Thank you for asking at HCM.
I went through your history and your reports.
I would like to summarize as an Allergist as - you are having frequent urticaria, with joint pains, endometriosis
with excessive bleeding during menses and chronic fatigue
. Investigations mainly suggest elevated ESR, CRP, borderline ANA, with possibility of autoimmune disorder.
With above history, I would like to make following suggestions to you:
1. When urticaria occur frequently over a period longer than 6 weeks, it is known as "Chronic urticaria". And in contrast of common belief, chronic urticaria are less likely to be "allergic" by nature. Please do not think your urticaria are surely due to allergies.
2. I would like to know your last reports of complete blood counts, serum SGPT, serum proteins, serum creatinine
, blood urea, urine and stool examination. You need not to get these reports done right now. You can let me know the report on follow-up with the dates they were done.
3. Have you observed aggravation of urticaria within 1-2 hours of consuming any food? This is the best way to suspect a food you may be allergic to. Allergy testing for variety of foods is not very helpful in identifying food allergies. Please let me know if you suspect any food. If you suspect any food related to your urticaria, specific testing for that particular food can be performed. However, as I mentioned earlier, I would not think of allergies first for your urticaria.
4. Have you had any signs of thyroid disorder
like - weight gain or weight loss, constipation or diarrhea, cold intolerance or heat intolerance, dry cold skin, etc.? Have you ever been tested for thyroid function?
Were I treating you, I would suggest you following tests for thyroid: serum T3, T4, TSH, anti-thyroperoxidase antibodies, anti-thyroglobulin
I suggest every female chronic urticaria patient to get above test done because thyroid disorder is very commonly associated with chronic urticaria and especially females. Sometimes treatment of thyroid dysfunction
can help treating urticaria also.
Above 4 points will be helpful to you to know what your urticaria can be due to. Please discuss above things with your treating physician and he will be helpful to you to make further decisions.
For treatment part, I would make following suggestion to you:
1. You are already taking Montek (montelukast), I would agree with that.
2. I would also agree that Allegra (Fexofenadine) can be taken on as-and-when-needed basis. However, if you have frequent urticaria, you can take it daily/regularly which will reduce frequency of urticaria.
3. If you have more symptoms during night (which may disturb your sleep) than daytime, I would suggest you hydroxyzine before going to sleep.
4. Personally I would suggest you to avoid wearing tight-fitting or woolen or synthetic material clothes as much as possible. Loose-fitting, cotton clothes are best option in my opinion.
5. I would also suggest you activities which may cause excessive sweating
. This may aggravate urticaria.
6. Multivitamins and minerals may help. As you are already taking vitamins, please continue taking them as per your doctor's advice.
7. Please avoid medications which may aggravate urticaria like - pain killers (except paracetamol). Paracetamol is the safest analgesic for urticaria.
8. Please do not scratch at the itchy areas, it will aggravate urticaria. I would suggest application of lotion like calamine over the itchy areas to reduce itch.
9. As you have specifically asked for food, I would like to make suggestions for foods as follows:
a. As mentioned above, unless you can specifically observe a close relation between your food and urticaria, you may not be allergic to any food.
b. In general, excessive hot & spicy (and sometimes excessive sour) foods can aggravate any urticaria. So these foods may be avoided in my opinion.
c. Sometimes foods like tomato, spinach, brinjal, cheese, chinese foods, chocolates, some types of fish, etc can aggravate urticaria in some patients. You can observe these food's relation with your own urticaria symptoms and you can avoid them only if you find any correlation.
d. In general, I also suggest my urticaria patients to avoid packed foods, junk foods, etc in order to avoid preservatives, coloring agents and other chemicals. There are no laboratory tests to identify allergies to these chemical additives. If one cannot avoid, one can at least cautiously minimize consumption.
e. In Ayurveda, much emphasis is given on Turmeric for treatment of urticaria. So I generally advise my urticaria patients to consume more turmeric than usual and some of them are benefitted. However, please take an Ayurvedic practitioner's opinion to be on safer side.
Hope above suggestions and answer will be helpful to you.
Should you have any further query, please feel free to ask on follow-up. I will try with best of my knowledge and efforts to be helpful to you.
I would be thankful to you if you could give me your feedback on follow-up.
Wish you the best of the health.
Thank you & Regards.
Dr. Parin N. Parmar