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Urticaria (Hives)/Angioedema (Tissue Swelling)

Urticaria (Hives)/Angioedema (Tissue Swelling)

Most “hives” are caused by histamine and other mediators “released” in the upper layers of the skin.

Histamine can be released from special cells, mast cells and basophils, which are found in everyone’s skin.

Patients with hives release “too much” histamine when it is not needed and are classified as:

  • “Acute hivers” only when they take in an identifiable “trigger”, i.e., drug, food, etc. or if hives last less than 6 weeks.
  • “Chronic hivers” daily or almost daily without an identifiable “trigger” and lasting for greater than six weeks.

In “chronic” urticaria or persistent hives, a “trigger” is rarely found. A “complete” history is needed to look for identifiable “triggers”.

The etiology for chronic urticaria such as medication, heat, pressure or infection is found in less than 5% of patients.

For most cases of chronic urticaria the etiology will remain idiopathic (cause unknown) although an autoimmune etiology can sometimes be found.

  • Angioedema (tissue swelling), occurs in 90% of patients with chronic urticaria

For chronic urticaria laboratory evaluation can be performed: Thyroid auto-antibody profile, CU Index, complete metabolic profile, complete blood count and autoimmunity tests.

Fortunately, most chronic hives go away with or without treatment:

  • 50% of patients hives go away in 3-12 months
  • 20% of patients hives go away in 12-36 months
  • 20% of patients hives go away in 36-60 months
  • 1.5% of patients can have hives for up to 25 years

60% of “chronic” hivers have recurrences of the hives

Management is directed toward keeping patients “comfortable” with or without some hives being present. This can be achieved with “appropriate” antihistamine therapy, and occasionally with “other” medications. Prednisone (steroid) should be avoided if at all possible.

Remember the potency of:

  • Benadryl 50mg. is considered — a strength of 1
  • Clarinex, Claritin, Allegra — a strength of 2-3
  • Atarax (hydroxyzine 25mg.), Zyrtec, Xyzal — a strength of 88
  • Doxepin (Sinequan) 25mg — a strength of 779

 

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Asthma and COPD: Differences and Similarities

You can't breathe when you exert yourself, and you suffer from episodes of coughing. There are two likely causes for this: you could have asthma, or you could have Chronic Obstructive Pulmonary Disease (COPD), such as emphysema or chronic bronchitis.

Because asthma and COPD have a number of similarities, it can be difficult to distinguish between them. However, after taking into account your symptoms, medical history, a physical examination and results of medical tests, your doctor can determine if either of these chronic diseases are at the root of your poor health.

Symptoms
Both asthma and COPD may cause shortness of breath and cough. A daily morning cough that produces phlegm is particularly characteristic of chronic bronchitis, a type of COPD. Episodes of wheezing and chest tightness (especially at night) is more common with asthma.

In addition, patients with asthma are more likely to have allergies such as allergic rhinitis (hay fever) or atopic dermatitis (eczema).

History of Smoking
COPD is almost always associated with a long history of smoking, while asthma occurs in non-smokers as well as smokers. Smoking can also make asthma worse; and smokers are particularly likely to suffer from a combination of both asthma and COPD.

Differing Treatments
Although it may take some time and effort, it is important to distinguish between asthma and COPD. The treatment for the two conditions is different, and you will greatly benefit from an accurate diagnosis and appropriate treatment plan. Whether you have asthma, COPD, or both, make sure you see your doctor regularly.

Talk to your OAAC provider to discuss diagnosis and treatment. 

The post Asthma and COPD: Differences and Similarities appeared first on Oklahoma Allergy and Asthma Clinic.

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