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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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May is Allergy and Asthma Awareness Month

Breathe Better with Asthma, Wherever You Are

If you have asthma, you know that symptoms can come on quickly, then worsen. The things that make them do that are called triggers. An important part of managing asthma is knowing what your triggers are — at home, work, school, or while you’re outdoors. A healthcare provider can help you figure that out, then you can take steps to avoid those triggers and breathe easier.

At home

Because asthma is usually due to allergies, triggers are often allergens, or things that cause allergic reactions. Allergens such as pet dander, dust mites, pests, and smoke can make asthma symptoms worse in some people, and for others, even trigger an asthma attack. The National Heart, Lung, and Blood Institute (NHLBI) suggests that it may be helpful to combine a few different strategies to help reduce exposure to triggers. People sensitive to dust can clean with a high-efficiency particulate air (HEPA) filtration vacuum and use mattress and pillow covers that prevent exposure to dust mites. If you’re sensitive to pests like cockroaches and rodents, consider integrated pest management, which involves removing and controlling pests through methods such as traps or poison. Avoiding tobacco smoke, including secondhand smoke, can be especially helpful for some people with asthma.

At school

Asthma is one of the leading reasons children miss school. At school, kids may be exposed to dust mites, pests, and mold, which may be asthma triggers for some children. Because children spend lots of time at school, it can be helpful for teachers, school nurses, or coaches to know what to do if your child’s symptoms flare up. Team up with a healthcare provider to develop an asthma action plan and share it with trusted adults at your child’s school.

At work

The workplace can have hundreds of potential triggers, like chlorine-based cleaning products, bleaches, hair dyes, and metal dust. Repeated exposures in the workplace can also lead to new triggers. Report new or worsening symptoms that occur at work to your healthcare provider and your workplace supervisor.

Outdoors

Everyday weather like cold, dry air can set off breathing problems. Air pollution can affect asthma, too. It may be helpful to avoid some of the worst pollution by adjusting when and where you exercise. Try to avoid exercising near busy roads or industrial areas. Visit airnow.gov to check your local air quality so you can plan to avoid outdoor activities when pollution is highest.

Managing your triggers is just one part of keeping your asthma under control. Work with a healthcare provider to develop an asthma treatment plan that includes taking medicines as prescribed and keeping track of your symptoms and where you are when they occur. That way, you can know what’s making your asthma worse or better.

Want to learn more about asthma? Visit NHLBI’s Learn More Breathe Better® program at nhlbi.nih.gov/BreatheBetter. Or make an appointment to meet with one of our asthma specialists at Oklahoma Allergy & Asthma Clinic 405-235-0040.

The post May is Allergy and Asthma Awareness Month appeared first on Oklahoma Allergy and Asthma Clinic.

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