Treatments for chronic urticaria
Treatments for chronic urticaria
Urticaria is a rash of pimples on the skin, similar to that caused by a nettle bite. When it is chronic, hives repeat for more than 6 consecutive weeks. How to treat and relieve outbreaks with Dr. Nina Roos, a dermatologist.
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What is chronic urticaria?
There are two forms of hives:
Acute urticaria, which usually occurs in isolation, lasting a few hours or even days, and whose cause is usually allergic (food, drugs, insect bites, etc.).
chronic urticaria, which is defined by the appearance of papules repeatedly, every 2-3 days, or permanently for more than 6 consecutive weeks
Contrary to popular belief, in 90% of cases chronic urticaria is not of allergic origin, with some exceptions, but is linked to "immediate" hypersensitivity reactions.
They are triggered by non-specific stimulation of mast cells, cells present in the dermis.
Chronic urticaria presents itself in the same way as acute urticaria, with small raised red spots that appear during several attacks alternating with periods without any symptoms.
These patches are very itchy. They appear suddenly, and disappear just as quickly.
There are many possible causes: cold, pressure on the skin, exertion, contact with water or the sun, parasitism, rubbing of clothes on the skin or wearing clothes that are too tight, taking certain medicines and liver or thyroid-related pathology.
"Certain foods or drinks such as strawberries, seafood, chocolate, cheese or fermented products, alcohol, coffee and tea can also cause these reactions, as well as stress," says Dr. Nina Roos, a dermatologist in Paris.
Drugs with risk of hives
Some medications can cause an attack of chronic urticaria or make it worse.
"These include painkillers, anti-inflammatory drugs such as aspirin, morphine and its derivatives such as codeine, as well as antibiotics, especially those in the penicillin family and beta-lactam antibiotics," says Dr. Roos.
Also involved are iodine-based contrast agents used in X-ray imaging, H1 antihistamines, and certain locally applied drugs such as anti-acne or muscle relaxants.
Therefore, caution is recommended with NSAID or steroid treatments: the use of a single drug is recommended, but when several drugs are essential, the lowest possible doses should be considered, doses should be divided, and drugs should be introduced in stages. Talk to your doctor about this.
What to do when a drug has caused an outbreak? When a drug appears to have caused an outbreak, skin testing may be necessary, especially for antibiotics.
Consult a dermatologist or allergist who is familiar with this practice and then make arrangements to have the medication reintroduced if the tests are negative.
Taking a risk drug such as a beta-lactam antibiotic or penicillin is often associated with other risk factors such as the combination of an antibiotic and NSAID, severe fatigue, a major stress episode, trauma, infection, and high fever or heat stroke.
On the other hand, any surgical or dental procedure can be a risk factor due to the administration of several anesthetic, analgesic and antibiotic treatments in times of stress.
Chronic urticaria is characterized by a rash with red papules and plaques of varying size and shape. The spots are slightly raised and itchy. They can be located anywhere on the body and face.
"Because of its characteristics, it is enough to question the patient to make the diagnosis," says our expert. Additional tests, such as skin tests, make it possible to determine the allergen causing the outbreaks.
Impact on quality of life
A study conducted in England evaluated the impact of chronic urticaria on quality of life: 73% of patients avoid going out, almost 50% have difficulties in their daily and professional life (absenteeism, decreased performance, etc.).
On the other hand, 63% of patients are worried and stressed by their hives and 38% have sleep problems.
Treatment of chronic urticaria
"It combines the avoidance of the phenomenon responsible for the outbreak with the daily intake of one or more antihistamines for several months," says Dr. Roos.
How to mitigate outbreaks?
- Avoid the trigger as much as possible.
- Avoid aspirin and NSAIDs.
- Watch out for hot showers and baths.
- Manage your stress through physical or meditative activity
- Follow your treatment to the end, even if you notice an improvement.
- Avoid covering and overheating your habitat to limit perspiration.
Who to consult?
Dermatologists and allergists are the professionals who know this pathology best.
Even if the allergic origin of chronic hives is quickly eliminated. 40% of these hives evolve beyond one year, 30% beyond 2 years and almost 20% beyond 10 years.