Chronic Urticaria (hives) is a particularly frustrating disease, usually of unknown cause, although certain recognized factors may influence its course. When thousands of dollars are spent on individual patients in order to determine the causative agent, success occurs only 10% of the time, and in many of these cases the causative agent was already recognized by the patient.
Urticaria is usually the result of an immune system disorder, although other systems may be at fault. Its manifestations are due to fluids leaking from blood vessels into the tissues of the skin. Such a problem can even occur along the gastrointestinal and respiratory tract, causing further complications. Also, Urticaria can be the initial manifestation of a more serious disease, although this occurs only rarely.
Specific triggers of Urticaria include foods, preservatives, medications, infections, aspirin, alcohol, chemicals, and exercise. There is even a category of "Physical Urticaria" which includes hives that occur after exposure to the sun, heat, or cold, pressure, and vibrations. Also, anxiety usually worsens the symptoms in most patients.
The evaluation of Chronic Urticaria is tedious and usually not fruitful. Several months of diagnostics tests and procedures may elapse without discovering any helpful clues in controlling the disorder, other than prescription medications which control the symptoms without curing the problem. The type of medical treatment given is based on the frequency and severity of the illness. Daily episodes require daily therapy and so forth.
Depending upon the wishes of the patient, and abbreviated or extensive work-up is accomplished. Some people are so miserable with even an occasional occurrence that they are willing to undergo a more elaborate evaluation. It should be mentioned that in patients with very frequent episodes (2 or more weekly) and who are young children, a causative agent is more likely to be identified. It is uncommon to detect food or other allergic causes in patients with infrequent urticarial episodes.
The more extensive work-up is outlined below:
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Blood and urine tests: identify specific disease states noted to be associated with Chronic Urticaria (as mentioned above) |
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X-ray of sinuses: hidden or occult sinus infection has been discovered in many patients with chronic urticaria |
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Specific tests for diagnosis: carrying weights, application of hot or cold stimuli, or other tests as indicated. These tests define specific types of Urticaria which influence the treatment plan |
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Skin tests: evaluates the potential of certain specific foods, animals, pollens or molds to induce symptoms |
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Diet calendar and/or a select diet for 3 - 4 weeks as a trial |
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Specific challenges with unlabelled capsules containing dyes, preservatives and foods. This type of testing is useful before recommending major changes in lifestyle |
For more on the Urticaria Diet, click
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