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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

Winter Allergies Making Us Miserable
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Winter Allergies Making Us Miserable

If you recently moved to Oklahoma thinking you would be safe from winter allergies, think again. Certain trees have an aggressive blooming season in the winter months. Cedar pollen can cause a myriad of symptoms including headache, conjestion, losing voice, sinus pressure, itchy eyes, post nasal drip, earaches, sore throat, and increased asthma symptoms.
OAAC’s Board-Certified Allergist Dr. Laura Chong says cedar pollen kicks in especially during the December, January and February months.
“It’s kind of an unusual allergen because most people think spring when tree pollen is wafting through the air,” she said. “Cedar pollen pollinates in the winter months catching many people by surprise.”
“Try to stay inside especially during windy days and make sure the pollen is washed off your body before you go to bed,” said Dr. Chong. “Treatments can vary for each person. Typically the first line of defense is to try over the counter antihistamines or discuss with your physician about prescription options.”
If, however, you are still struggling and miserable, it may be time to be allergy tested and a course of action of immunotherapy (allergy shots) may be in order to help build resistance to the allergen.
Ways to Reduce Your Exposure to Cedar Pollen
Dr. Chong suggests a proactive approach in dealing with cedar pollen allergies.
Install a premium, high efficiency particulate air (HEPA) filter to remove bacteria, mold and other allergens and to improve indoor air quality.
Vacuum daily and preferably with a HEPA-filter vacuum cleaner.
White vinegar is your friend (plus very cost effective). Spray air filters, vents and air returns with white vinegar. Wipe with a clean cloth periodically to remove pollen and other allergens.
On these warm Oklahoma winter days; it is tempting to open the windows for fresh air to be let inside your home. Dr. Chong recommends closing windows and doors to keep the pollen out and to drive with your car with its windows up.
Wipe down surfaces that collect pollen such as your furniture and other areas with a clean cloth and don’t forget your pets!
“Give your pets a quick wipe down to remove pollen when coming indoors,” said Dr. Chong.
After spending time outdoors in the pollen, Dr. Chong says after showering, changing clothes to remove any remaining residue will be helpful. She adds to not line-dry clothes outside when pollen counts are high.
“Check the OAAC website and social media for the daily pollen reports,” Dr. Chong said.
Website: Oklahomaallergy.com, Facebook: https://www.facebook.com/oklahomaallergyasthmaclinic/
For more information about cedar allergy, talk to your OAAC allergist.

The post Winter Allergies Making Us Miserable appeared first on Oklahoma Allergy and Asthma Clinic.

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