Chronic Urticaria: Causes, Treatment, and Management

Measles

Dear Doctor, since I had a fever last October, I have been experiencing allergic reactions, with red, swollen patches appearing all over my body, resembling mosquito bites, which gradually spread.
It has not improved since then.
I visited a doctor who diagnosed me with urticaria.
After taking medication, the symptoms subsided, but they reoccurred when I stopped taking the medication.
During a visit to Renai Hospital, I mentioned wanting to test for allergens, but the doctor told me that treatment is more important than testing.
Is that true? The medication prescribed needs to be taken continuously; if I stop, the symptoms return.
This has been ongoing for a year now.
What can I do to get better? Am I going to have to rely on medication for the rest of my life? I hope the doctor can help me.
Thank you!

Xiao Xu, 20~29 year old female. Ask Date: 2000/11/10

Dr. Zheng Lizhen reply Dermatology

Chronic urticaria can indeed be quite challenging to manage.
Allergy testing may not always yield definitive results, which is why doctors at Renai Hospital emphasize that "treatment is more important than testing." The treatment for chronic urticaria needs to be continuous; even when symptoms are not present, medication should still be taken to prevent flare-ups and avoid starting the treatment process over again each time.
Long-term medication can help maintain the body in a low-allergy state, and with gradual dose reduction over six months to a year, there is a possibility of achieving remission.
Dietary considerations are also important; research suggests that reducing the intake of foods containing additives (such as spices and preservatives), like canned foods, can effectively decrease the frequency of acute flare-ups and reduce the amount of medication needed.

Reply Date: 2000/11/10

More Info

Chronic urticaria, commonly known as chronic hives, is a condition characterized by the recurrent appearance of itchy, red welts on the skin. These welts can vary in size and can appear anywhere on the body. The condition can be quite distressing, as it often leads to discomfort and can significantly impact a person's quality of life. Understanding the causes, treatment options, and management strategies is essential for those affected by this condition.

Causes of Chronic Urticaria
Chronic urticaria can be classified into two main categories: chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU).
1. Chronic Spontaneous Urticaria (CSU): This form occurs without any identifiable trigger. The exact cause is often unknown, but it is believed to involve an autoimmune response where the body mistakenly attacks its own mast cells, leading to the release of histamine and other inflammatory mediators.

2. Chronic Inducible Urticaria (CIndU): This type is triggered by specific stimuli, such as pressure, temperature changes, sunlight, or exercise. Identifying these triggers can help in managing the condition effectively.

Treatment Options
The treatment of chronic urticaria typically involves a combination of medications and lifestyle adjustments. Here are some common approaches:
1. Antihistamines: These are the first-line treatment for chronic urticaria. Non-sedating antihistamines, such as cetirizine or loratadine, are often prescribed to help reduce itching and the appearance of hives. In some cases, higher doses may be necessary for effective control.

2. Corticosteroids: For severe cases, short courses of corticosteroids may be prescribed to reduce inflammation and control symptoms. However, long-term use is generally avoided due to potential side effects.

3. Leukotriene Receptor Antagonists: Medications like montelukast may be added to antihistamines for additional relief.

4. Omalizumab: This is a monoclonal antibody that targets IgE and is used for patients with chronic spontaneous urticaria who do not respond to antihistamines. It has been shown to be effective in reducing symptoms and improving quality of life.

5. Immunosuppressants: In refractory cases, medications such as cyclosporine may be considered.

Management Strategies
1. Avoiding Triggers: If specific triggers are identified, avoiding them can significantly reduce the frequency and severity of outbreaks. Keeping a diary to track symptoms and potential triggers can be helpful.

2. Lifestyle Modifications: Stress management techniques, such as mindfulness, yoga, or meditation, can help alleviate symptoms, as stress can exacerbate urticaria.

3. Regular Follow-ups: Continuous communication with a healthcare provider is crucial for adjusting treatment plans and monitoring the condition.

4. Education and Support: Understanding the condition and connecting with support groups can help patients cope with the emotional and psychological aspects of chronic urticaria.

Conclusion
Chronic urticaria can be a challenging condition to manage, especially when it persists for an extended period. While it may feel daunting to rely on medication, many patients find that with the right treatment plan, they can achieve significant relief from symptoms. It is essential to work closely with a healthcare provider to tailor a management strategy that suits your specific needs. Regular follow-ups and open communication about your symptoms and treatment efficacy will be key in navigating this condition. Remember, while chronic urticaria can be persistent, it is manageable, and many patients experience periods of remission.

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