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Suggest treatment for skin allergy

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Dermatologist
Practicing since : 2005
Answered : 1919 Questions
Question
my wife is suffering from skin allergy and taking Lukotas Fx tablets regularly. But it does not help much.
Posted Tue, 5 Aug 2014 in Skin Hair and Nails
 
 
Answered by Dr. Johny Chacko 22 minutes later
Brief Answer:
Please provide more details

Detailed Answer:
Hello,

Welcome to healthcare magic.

I understand from your query that your wife is having skin allergy.

From your brief history, I feel that she may be having a condition called urticaria. This is a common type of allergy in which the patient will have raised rashes ( hives) which will last for a few minutes to hours and disappear.

However, allergy is a broad term which could include contact dermatitis, eczema,etc.

Could you provide more details so that I can assess better?

1. From how many days or months id she having this problem?

2. Does she have raised rashes which disappear and reappear or are the rashes continuously present at the same site?

3. Does she have any thyroid abnormality?

4. With the above mentioned medication, do the rashes completely go away and come back again when medicine is stopped? Or is it that the rashes do not disappear even when she takes the medicine.

You have a feature to upload the images by yourself at the right side of the query page, please utilize that if possible so that I can answer your query better. You can also send the image as attachment to YYYY@YYYY , with the subject as 'Attn: Dr. Johny Chacko'

Please revert back with details so that I can assess and give a treatment outline.

Regards,
Dr. Johny Chacko
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for skin allergy 46 hours later
She is having this problem since 18 months.
The rashes disappear & reappear.
Thyroid problem she had previously. But within limits. Report attached.
The rashes disappear after 2 hrs of takingLukotas FX and reappear after about 8 to 10 hrs. Photograph attached.
 
 
Answered by Dr. Johny Chacko 19 hours later
Brief Answer:
Chronic idiopathic urticaria

Detailed Answer:
Hello,

Greetings.

Sorry for the delay in replying. Your reports and images were not uploaded in my dashboard and I had to request the customer care to look into the problem.

I have seen the clinical picture and the reports you have attached.

I would consider the diagnosis of Chronic Idiopathic Urticaria.

This is a type of skin allergy, as I mentioned above, which presents with hives lasting for few hours.

It seems that she has been evaluated thoroughly. I have seen the allergy test reports that you have attached.

In more than 90% of the cases, it is not possible to find a specific cause for the allergy. That is the reason it is called " Idiopathic" ( meaning no reason found).

This is more common in individuals with other auto immune problem like thyroid abnormalities. Even though the thyroid problem is under control, the allergy ill take time to completely subside.

Eliminating the highlighted food items may provide relief in some patients. However, in my experience, even eliminating food items to which the test has come positive will not be of much use.

I would suggest to you the following -

1. Medications- Lukotas fx has 120 mg Fexofenadine and 10 mg montelukast. This is not the ideal dose of Fexofenadine for adults with urticaria. This is usually the dose for nasal allergies. This may be the reason for the rashes coming back in 8-10 hours. I would suggest that you could give her 180 mg of Fexofenadine orally in the morning. You could give her another antihistamine like Levocetrizine 5 mg orally at bedtime.
This combination will usually keep her symptom free for 24 hours. You could continue the medication regime for 1 month and then stop the morning tablet and continue only the night tablet for another 1 month.
After this, you could make the night tablet every alternate day and see if the rashes appear.
Generally, most patients will be symptom free with alternate day medication.

It is safe to take levocetrizine for 2-3 years without any major side effects.

2. Diet- Avoid foods containing preservatives ( eg , canned food, colas , etc) and those containing food colourants( eg, kebabs at restaurants which have orange colour) as they are potent allergens.
Keep a food diary and write down everything you eat on the day you get rashes. You can look for any common food, which repeats in the diary, eliminate it and see if it helps.

3. Some types of chronic urticaria occur in areas where excessive pressure has been applied - like the waist line ( where one ties the saree or the belt), buttocks ( after prolonged sitting). If you have noticed such triggers, you need to avoid them.

How long the medication should be continued and when the problem will "cure " is difficult for any dermatologist to determine. This differs from person to person and may last from months to years.

Hope this helps you.

If you have any further queries, I will be glad to answer.

Take care.

Regards,
Dr. Johny Chacko

Above answer was peer-reviewed by
 
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