Cure For Urticaria

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cure for urticaria
I suffer from hives and angieodema (deep swelling in the tissues). Can someone please help me find a cure?

I'm on day antihisthamine (1 in the morning and two at night), but the suffering continues. Although doctors and skin specialists, prescriptions, no relief. Have been screened for allergies – no! When the floods are bad, my eyes swell and close. My face is swollen, lips and chin (I look like Desperate Dan or the Elephant Man. Also I have to take steroids that reduce the symptoms but not cure the long term. When the throat or tongue swells is Epi-Pen injection and outside the hospital. All this began with a duel, and although it does many years, these problems continue to appear without apparent cause, other than the stress or tiredness, or sometimes nothing at all. When the worst case, can not go out and face the world, has affected my work and I'm at the end of my rope. Please help if you can.

Avoidance of triggers urticaria Many patients assume that a causal agent can identify and avoid the trigger to cure his ailment. This may be possible in acute urticaria, but is unfortunately not possible in most cases Chronic urticaria due to the idiopathic nature of the disease. General education on the hives and avoidance of triggers can help patients understand their condition and reach an agreement with him. In general, patients should avoid medications known to cause or exacerbate urticaria or, like aspirin, NSAIDs, opioids, and ACE inhibitors. (Alcohol also should be avoided.) Acetaminophen can be a replacement therapy for pain control. Several studies have shown that COX-2 inhibitors such as rofecoxib and celecoxib, are safely tolerated in these patients (7,8). The recent withdrawal of rofecoxib (Vioxx) and valdecoxib (Bextra) leave celecoxib (Celebrex) as currently COX-2 inhibitor available in the United States. ACE inhibitors should be discontinued in any person experiencing angioedema. Can angiotensin II receptor blockers (BRA) used in these patients? A recent study (10) showed that a small percentage of patients with angioedema that was induced by the use of ACE inhibitors is having symptoms when treatment is changed to an ARB. Therefore, caution should be exercised (16). Pharmacotherapy for hives pharmacotherapeutic options are listed in Table 2. What is the first line treatment? Antihistamines Antihistamines Antihistamines! New generation H1 antihistamines are generally quite effective in controlling the condition and have a side effect profile of the mucous membranes or minimal sedation and not dry. Antihistamines first generation, such as hydroxyzine (Atarax, Vistaril), diphenhydramine hydrochloride and cyproheptadine hydrochloride, can be a complementary therapy. Cyproheptadine is treatment of choice for cold urticaria and cholinergic urticaria (3). Taking antihistamines on a schedule and not as a necessary foundation is the key to achieve disease control. The dose may need to be adjusted upwards depending on the severity of the disease. The relative potency of these agents is necessary to consider for example, 10 mg cetirizine (Zyrtec) is approximately equivalent to 30 mg of hydroxyzine (3.11). In a study of the effects on the central nervous system of higher doses of non-sedating antihistamine fexofenadine, Hindmarch and colleagues (17) found that doses of 360 mg caused no psychomotor or cognitive dysfunction. If symptoms are not optimally controlled with H1 antihistamines, the addition of an H2 blocker should be considered. Another option is to add doxepin hydrochloride (Sinequan) a tricyclic antidepressant with potent H1 and H2 antihistamine properties and strong antipruritic action. Unfortunately, sedation and dry mouth associated with severe medicine tends to limit its use. Leukotriene receptor blockers used as adjunctive therapy to H1 antihistamines have been shown to provide some benefit (18,19). However, as individual therapy, have not been found to be effective (20). Glucocorticoids are usually not necessary and should be avoided, if possible, because to their associated side effects and the tendency for lesions to recur after discontinuation of these drugs. What are the options for patients with severe, unremitting urticaria who have had a poor response to standard therapy? To ensure that the diagnosis is correct, a biopsy and a reference to an allergist must be considered. Non-standard therapy such as cyclosporine (Gengraf, Neoral, Sandimmune) has been used with some efficacy (21). Other therapies include non-standard intravenous immunoglobulin, plasmapheresis, methotrexate (Rheumatrex, Trexall), colchicine, dapsone, sulfasalazine (Azulfidine), hydroxychloroquine sulfate (Plaquenil) and warfarin sodium (Coumadin) (21). Management Administration angioedema angioedema is more difficult than the hives angioedema, because it tends to take its own time to resolve, regardless of what treatment is started. Although treatment with antihistamines, epinephrine (adrenaline chloride, EpiPen), and steroids is a practice common in emergency care and emergency services, no controlled studies demonstrating the efficacy of these treatments in angioedema. However, they can reduce the duration of minimal inflammation. Undoubtedly, an EpiPen should be prescribed for any patient with a history suggestive of anaphylaxis or angioedema involving the tongue, pharynx or larynx. Supportive care and maintenance of the airway in the emergency care or emergency department are the mainstay of treatment for acute epi-sode of this type. Conclusion If one of the causes of acute urticaria is recognized by thorough history taking, resolution can be avoided by following the trigger. Chronic urticaria remains a challenge however, because most cases are idiopathic. However, the evaluation of an associated underlying medical condition should be part of the routine. Excellent control of the disease can be achieved with appropriate use of antihistamines until the disease resolves spontaneously over time. Referral to an allergist is appropriate when skin testing is needed to identify a cause or confirm a suspected causative agent or when injuries become chronic or refractory to standard treatment. Prognosis varies with chronic urticaria. Although the average duration is 3-5 years, 20% of patients still have the disease after 20 years. (2) Patients should be aware that their disease can appear and disappear with time and exacerbations often develop after exposure to various triggers. Also should be informed that these features require that your medications will be adjusted accordingly to maintain control of the disease.

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This entry was posted on Sunday, May 16th, 2010 at 10:43 am and is filed under Hives. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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