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Thursday, September 29, 2016

A Case Of Urticaria (Hives)


A 45 Year old woman presents to her doctor complaining of itching and red patches on her skin of the legs, arms and abdomen. It first appeared 2 weeks back and has been increasing since then. She recalls having similar symptoms in the past at least 4 times . She relates it to start whenever she drinks citrus fruit juice. She was prescribed antihistamines and her symptoms gradually improved. She was advised to avoid food that trigger the allergy.

Case Discussion:

Hives also known as Urticaria is a skin reaction that presents as a red, raised, itchy skin rash. It appears and fades repeatedly. It usually happens due to an allergy.
Chronic hives is defined when the symptoms last more than six weeks or recur over months or years.

Pathophysiology; Whenever there is an allergic reaction triggered by a substance-allergen , body releases histamine . Histamine causes tiny blood vessels t leak fluid which accumulates in the skin causing the rash and swelling.

Causes : Females and young adults are more prone to utricaria. Each individual may develop symptoms due to a particular allergen to which his/her body responds and produces histamine.
Some of the common causes include:


  • Medicines
  • Insect bites
  • Scratching
  • Temperature changes
  • Stress
  • Exercise
  • Sunlight
  • Particular food
Clinical features: Hives appear suddenly as swollen, red bumps, patches or welts on the skin. Hives usually itch but sometimes patients can complain of burning or stinging sensation. 
Some patients may identify the allergen that triggered the rash. 
The rash affects almost any part of the body including face, arms, hands, legs and toes. In most cases a welt will disappear after a few hours only to be replaced by new ones. These welts vary in size and shape. Urticaria itself is not life threatening but it does cause discomfort and interferes with sleep due to itching. Patients daily activities might be effected if it is recurring frequently. 
In severe cases there is swelling of the lips or cheeks and may progress to angioedema which might be life threatening.

Diagnosis: 
In acute cases (symptoms lasting < 6 weeks) generally no laboratory studies are indicated.
For chronic or recurrent cases basic laboratory work like CBC, ESR, Thyroid stimulating hormone (TSH) and antinuclear antibody (ANA) is indicated.

Management: The main stay of therapy for both acute and chronic urticaria is patient education, avoiding triggers and using antihistamines.
Sometimes chronic utricaria becomes difficult to treat and causes considerable discomfort to the patient. The first line of treatment is usually a second generation anti histamine like cetrizine or loratidine which causes less sedation as compared to first generation anti histamines.
Systemic glucocorticoids can be used for episodes of severe disease but should not be used for long term because of side effects.
If patient does not respond to anti histamines the second step is to either increase the dose of current anti histamine or to add another anti histamine or a leukotrine receptor antagonist like monteluekast.
Patient still does not responding are considered as refractory and may need anti inflammatory medications like dapsone or salphasalazine or immunosuppresants like cyclosporine.  


4 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
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