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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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Back to School with Asthma and Allergies

Back to School

Where did the summer go? It’s almost back to school time for thousands of Oklahoma children. Is your family ready? Are your children starting a new school? Was your child recently diagnosed with an allergy, a food allergy and/or asthma? OAAC will help you be prepared for back to school!

First, if you need birth certificates, they can be ordered online oklahoma.gov/health/services/birth-and-death-certificates.html or by calling 877-817-7364. The cost is $15. Additional copies $15. There is an online/phone convenience fee of $5.

Need immunization records? You can access them online through the Oklahoma Immunization Information System Portal - shotrecords.health.ok.gov

Children with Asthma
Talk to your OAAC provider especially if your child’s asthma is not in control. Update or complete an Asthma Action plan to use at home and at school. You can download a plan from the OAAC website oklahomaallergy.com/wp-content/uploads/521-ASTHMA-ACTION-PLAN.pdf Update any medication orders. If your child is going to a new school, make an appointment to have a conversation with the school staff. Review when your child should take his/her asthma medications. Ensure your child or teen is using daily controller medications on schedule and quick-relief medication as needed.

Visit with the school’s nurse or school administrator about your child’s asthma. Take the medication, forms and supplies to school before or by the first day. For those with children who use a nebulizer, check with the school to see if you need to provide tubing and a face mask and/or the nebulizer itself.

Develop a healthy schedule which includes eating regular, nutritious meals and a set sleep routine.

Check with your child at the end of school day to see if he/she experienced any issues maintaining their asthma at school.

Children with exercise-induced bronchoconstriction may complain about participating in physical activities. However, it is very important for children to stay active, so work with school staff to develop strategies to keep your child symptom-free while exercising. These may include:
•    Using a short-acting inhaler 15 minutes prior to exercise
•    Drinking plenty of water before, during and after exercise
•    Choosing sports that are less likely to trigger symptoms.

Allergies at School

Depending on your child’s allergic condition, you may want to:
•    Tour the school to identify potential allergy triggers
•    Talk with your child’s teacher(s) and other relevant school personnel (such as sports coaches) about your child’s condition and treatment plan
•    If your child is at risk for life-threatening reactions, such as those to food or insect stings, complete an Anaphlyaxis Action Plan and show school staff how to administer autoinjectable epinephrine.

In the Classroom
There are many potential allergy and asthma triggers in schools. It is very important that your child’s allergies have been accurately diagnosed in order to determine what allergens to avoid. If your child has not been tested, make an appointment with the OAAC for testing.

Common asthma and allergy triggers in the classroom include:
•    Dust mites
•    Mold
•    Chalk dust
•    Animal dander

At Recess, Gym Class and After-School Sports
Recess may be the favorite time of the school day for many children, but for those with allergies or asthma, it can be a minefield of potential triggers.

If your child has allergic rhinitis (hay fever), you can view the daily pollen and mold counts (Monday-Friday) on the OAAC website and on social media. When levels are very high, plan accordingly if your child takes medication to control symptoms. When indoors, ask staff to keep windows closed to keep pollen out.

Insect bites can cause severe reactions in children with stinging insect allergy. Explain the symptoms to school staff and make sure your child always carries auto injectable epinephrine in case of an emergency.

Working as a team with your OAAC provider, your school staff and your family, back to school can be an easy transition with proper preplanning.

The post Back to School with Asthma and Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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