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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

 

Recent News

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Ragweed Season is HERE

Ragweed Season

Ragweed Plants Packed with Pollen

Summer fun can turn to fall misery for millions of people who suffer from seasonal allergic rhinitis (hay fever). Sneezing, stuffy or runny nose, itchy eyes, nose and throat, or worsening of asthma symptoms are common in people with undiagnosed or poorly managed hay fever.

The primary culprit of fall allergies is ragweed pollen. A ragweed plant only lives one season, but it packs a powerful punch. A single plant can produce up to 1 billion pollen grains. These grains are very light weight and float easily through the air.

Fall allergy symptoms used to start in mid-August and run through September. In many parts of the country these symptoms now begin in early August and extend through October. Some studies suggest that rising temperatures and higher carbon dioxide levels contribute to longer growth time of allergen-producing plants. In 2023, OAAC reported high ragweed counts beginning in the third week of August. In fact, on August 28, 2023, we had our first ragweed allergy alert day.

Allergies occur when the body’s immune system treats the allergen, in this case ragweed, as a foreign invader. This starts a chemical reaction which produces and sends histamine throughout the blood stream. These chemicals cause allergy symptoms to develop.

Controlling symptoms
Proper diagnosis is the first step in managing your symptoms. An allergist will give a physical exam, ask about your health history and perform allergy testing to determine exactly what you are and are not allergic to.

Although there is no cure, ragweed allergy can be managed to improve the quality of your life.

The best control is to avoid contact with the pollen. This can be difficult, but resources are available. The National Allergy BureauTM (NAB) tracks pollen counts regionally to help you plan when you should avoid spending a lot of time outdoors. Remember to follow the OAAC on social media for the OKC area. Our counts are collected from the top of our main office building Monday-Friday by our certified pollen counters.

Talk to your doctor about medications that may provide temporary relief from symptoms. Your allergist/immunologist may also recommend immunotherapy (allergy shots) or sublingual immunotherapy (SLIT) allergy tablets, treatment. This long-term treatment approach can significantly reduce the frequency and severity of symptoms caused by allergic rhinitis.

Did you know?

  • The tall goldenrod species of ragweed gets blamed for most of the pollen, but a primary cause of allergy symptoms is the tooth-leaved ragweed that lives low in the grass.
    • Ragweed can be found in almost all states in the United States as well as in Canada.
    • An accurate diagnosis is essential for managing symptoms. Allergy testing performed by an allergist can determine what you are and not allergic to.To the point
    Although often associated with hay fever, ragweed can also cause skin conditions such as allergic contact dermatitis and hives.

Source: AAAAI.org

The post Ragweed Season is HERE appeared first on Oklahoma Allergy and Asthma Clinic.

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