Urticaria cause by Ray Sahelian, M.D. Urticaria treatment

Urticaria is the medical name for hives. Urticaria leads to pale red swellings that occur in groups on any part of the skin. Each hive lasts a few hours before fading without a trace. New areas may develop as old areas fade. They can vary in size from as small as a pencil eraser to as large as a dinner plate and may join together to form larger swellings. Urticaria is usually itchy, but may also burn or sting.

Urticaria is a vexing problem for countless people who have this acute or chronic condition. The most important part of the diagnostic evaluation remains a comprehensive and detailed history and physical examination, supplemented with limited laboratory testing. Although acute urticaria has been relatively well understood for some time, significant and important recent advances in under-standing the pathogenesis of chronic urticaria are beginning to provide insight in this challenging field, notably the identification of many of these patients with an autoimmune etiology. Antihistamines of various types continue to represent the keystone of symptomatic treatment, with adjunctive support from medications of other classes, such as antileukotrienes, adrenergics, and immunosuppressive and anti-inflammatory agents (including steroids and cyclosporine). Although some progress has been made at improving symptomatic control of urticaria, further research and discovery are necessary before there can yet be an effective impact on the underlying course and natural history of this condition.

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Royal Jelly and Urticaria
Royal jelly consumption and hypersensitivity in the community.
Clin Exp Allergy. 1997 Mar;27(3):333-6.
Royal jelly consumption has recently been linked with acute asthma, anaphylaxis and death. A cross-sectional survey was conducted to determine the prevalence of and the relationship between royal jelly consumption and hypersensitivity reactions. 1472 hospital employees of a teaching hospital in Hong Kong completed a questionnaire on royal jelly consumption and related allergic symptoms, and 176 questionnaire respondents and 300 consecutive asthma clinic patients were skin tested to royal jelly. Royal jelly consumption was high, with 461 out of 1472 subjects (31.3%) having taken royal jelly in the past. A total of nine subjects reported 14 adverse reactions to royal jelly, including urticaria, eczema, rhinitis and acute asthma. Thirteen out of 176 questionnaire respondents (7.4%) and 23 out of 300 consecutive asthma clinic attendees (7%) had positive skin test to pure royal jelly. All but one of the 36 subjects with positive royal jelly skin test were atopic to other common allergens. CONCLUSION: Royal jelly consumption is high in the community of Hong Kong. Atopic individuals are at high risk of sensitization to royal jelly but the precise relationship between royal jelly use, positive royal jelly skin test and clinical manifestations of adverse reactions to royal jelly, remains to be defined.

Urticaria and Gluten Sensitivity
Chronic urticaria: a cutaneous manifestation of celiac disease.
Can J Gastroenterol. 2006 Apr;20(4):291-3. Haussmann J, Sekar A. Ottawa Hospital, Ottawa, Ontario.
Celiac disease, or gluten-sensitive enteropathy, is an immune-mediated disease of the small bowel that results in malabsorption. It classically presents with gastrointestinal symptoms including chronic diarrhea, weight loss, abdominal bloating and anorexia. It is becoming more frequently identified in asymptomatic patients with a diagnosis of deficiencies related to malabsorption of iron, folic acid, vitamin B12 and vitamin D. It is increasingly identified as a cause for early or refractory osteoporosis. Occasionally, celiac disease presents with cutaneous manifestations alone. Dermatitis herpetiformis is a well-recognized cutaneous manifestation of celiac disease. Other cutaneous manifestations include alopecia, angular stomatitis and aphthous ulcerations. Described here is a case of a 24-year-old woman who presented with intermittent urticaria and gastrointestinal complaints. She was found to have celiac disease on small-bowel biopsy. Both her gastrointestinal symptoms and urticaria resolved when she was put on a gluten-free diet, suggesting that her urticaria was a cutaneous manifestation of celiac disease.

Urticaria Cause
There are many factors that can cause urticaria.

Urticaria Cause

Food allergens: Milk, cheese, egg, protein products, wheat, cereals, certain daals as used in India, peas, orange, fish, chicken, etc. Synthetic and natural food additives and artificially-flavored food articles. Non-allergic food reactions, from salicylates in fruit, azo dye food coloring agents, benzoate preservatives and other food additives, or from histamine due to bacterial decomposition e.g. scombroid fish poisoning.

Urticaria and alcohol: Most reactions to ingested alcoholic beverages are secondary to other chemicals in the beverage such as metabisulfite, papain, dyes or yeasts. However, there are reports of true allergic reactions in which the offending agent was shown to be the ethanol itself.

Exposure to pollen, house-dust, buffalo dander, fungi, change in temperature, etc. are known exciting factors. Extreme cold, heat, pressure may also induce urticaria.

Drugs: The major cause for urticaria are man-made drugs such as antibiotics (Penicillin), anti-inflammatory drugs (aspirin, indomethacin), quinine, ipecac, vaccinations, hormonal preparations, contraceptive pills, etc.

Infections and infestations: The bites of bedbugs, wasps, bees, mosquitoes, flies, and certain kinds of caterpillars can be a cause of urticaria. Fungal, protozoal, frequent bacterial infections (Urinary tract), viral infections (Hepatitis), helminthiasis (worm infestations such as round worms, tapeworms), etc. are factors known to cause urticaria. One cause of urticaria appears to be infection with H. Pylori. There is some evidence of a relationship between H. pylori infection and both chronic idiopathic urticaria and atopic dermatitis. Treatment of infection demonstrated by reduction in C-urea breath test and anti-H. pylori antibody titers resulted in partial improvement of clinical symptoms in some patients with atopic dermatitis. Domestic contact with the pet animals should be examined as cause for urticaria. Dental abscess and candida (thrush) could be a urticaria cause.

Synthetic products as uritcaria cause : Use of personal products such as deodorant, perfume, and talcum powder, cosmetic products, animal derivatives, and similar synthetic substances may induce this disorder.

Emotional factors: Emotional stresses, such as a fight with a spouse, may directly or indirectly make one susceptible to develop a tendency to urticaria.

Systemic and general disease: Urticaria in some cases may present as a sign of other systemic or general internal disease such as hormonal disorders (hyperthyroidism), lupus, polycythaemia, reticuloses, etc. In certain variety of malignancies (cancer) urticaria may present as a precursor.

Antihistamines for Urticaria
Antihistamines that bind to the histamine 1 receptor (H1) serve as important therapeutic agents to counter the effects of histamine in the skin. Two generations of antihistamines exist; however, second-generation agents are more advantageous because they cause less sedation, have a longer half life and are more selective for the H1 receptor. While H1 antihistamines have proven to be effective at reversing the pruritus and cutaneous lesions of chronic urticaria, their ability to treat pruritus associated with other cutaneous and systemic diseases is unproven.

Pathophysiology of urticaria.
Urticaria is dermal edema resulting from vascular dilatation and leakage of fluid into the skin in response to molecules released from mast cells. Histamine produces a short-lived urticaria. However, the clinical spectrum and pattern of urticaria lesions indicate that other molecules, including prostaglandins, leukotrienes, and cytokines, produced at different times after mast cell activation contribute to the polymorphism of this symptom and the variable evolution of this disease. It is a common practice to distinguish immunological and nonimmunological urticaria. Immunological urticaria is a hypersensitivity reaction mediated by antibodies and/or T-cells that results in mast cell activation. Although immunoglobulin IgE-mediated type I hypersensitivity (HS) was long postulated to be the major immunological pathway associated with mast cell activation, interaction between IgE-bound mast cells and allergens is unlikely to be the mechanism by which urticaria develops in most patients. It is now well established that urticaria may result from the binding of IgG auto-antibodies to IgE and/or to the receptor for IgE molecules on mast cells, thus corresponding to a type II HS reaction. These auto-immune urticarias represent up to 50% of patients with chronic urticaria. Mast cell activation can also result from type III HS through the binding of circulating immune complexes to mast cell-expressing Fc receptors for IgG and IgM. Finally, under certain circumstances, T-cells can induce activation of mast cells, as well as histamine release (type IV HS). Nonimmunological urticarias result from mast cell activation through membrane receptors involved in innate immunity (e.g., complement, Toll-like, cytokine / chemokine, opioid) or by direct toxicity of xenobiotics (haptens, drugs).

Chronic urticaria treatment
Treatment with cyclosporine A is beneficial for maintaining remission in severe cases of chronic urticaria where all other options have failed. Cyclosporine prevents the need for chronic use of corticosteroids.

Cold Urticaria cause
Histamine, But Not Leukotriene C4, is an Essential Mediator in Cold Urticaria Wheals.
Acta Derm Venereol. 2007;87(1):9-13. Nuutinen P, Harvima IT, Ackermann L. Hospital for Skin and Allergic Diseases, Helsinki University Central Hospital.
In addition to histamine, leukotriene C4 might also play a role in mediating cold urticaria wheals. To study the significance of leukotriene C4 vs. histamine, 6 patients with cold urticaria were challenged with the ice cube test before and after ingestion of 10 mg cetirizine (antihistamine), 10 mg montelukast (leukotriene antagonist) or a combination of both drugs. Cetirizine diminished the cold-induced wheal by 50+/- 42%. Montelukast had no significant effect, and the combination of both drugs diminished the wheal by 37+/- 33%. Furthermore, a skin microdialysis technique detected the release of histamine in the cold-induced wheal, whereas no leukotriene C4 release was detected. In conclusion, the antihistamine is effective and histamine is released, whereas the leukotriene antagonist is not effective and leukotriene C4 is not released in the cold urticaria wheal.
 

Urticaria emails
Q. Please can you give me some suggeestions on what to take for urticaria seems every time i get stressed or upset i break out in small itchy or painful bumps on my neck and face is there any thing you could suggest ? i take doxycycline but it does not keep the urticaria from attacking whenever !!
   A. At this time we are not aware of a natural treatment for urticaria. Rest, relaxation, meditation, yoga, less stress, avoiding foods that cause allergy are all good options.

Q. I want to use mangosteen, but before I do I wanted to know if mangosteen product is going to help me with urticaria hives that I've had been bothered by for 5 month now. I am using regular antihistamines and need a strong natural replacement. What do you recommend that would really help my urticaria and for once get rid of the cause of this skin problem?
   A. There are countless causes for urticaria or hives and mangosteen is not likely to be the answer. We have not seen any human studies regarding the use of mangosteen for urticaria.

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