Thursday, December 22, 2005

Chronic Urticaria

man...just read this article about hives ( also known as nettlerash or hives):

People often say that someone with urticaria has 'an allergy'. This may well be true if the urticaria comes on just for a matter of days after a food or medicine which often causes allergic reactions, but is rarely if ever true of urticaria which lasts for months.

Chronic Urticaria
If urticaria lasts six weeks or more, it is called 'chronic urticaria'. The word 'chronic' simply means that it lasts a long time.

But how long is long? In a survey, it lasted a year or more in more than 50% of sufferers and 20 years or more in 20% of them. Of course this does mean that in almost half the people it clears up within a year and in 80% it clears up within 20 years or less (Champion and others, British Journal of Dermatology 1969). So don't count on it clearing up next week (though it may), and get it treated properly.

Chronic urticaria is hardly ever caused by true allergy. In fact we usually can't find the cause, and this regrettable fact causes patients and doctors a vast deal of frustration. In recent years, top researchers have found that quite a lot of people with chronic urticaria have antibodies in their blood which seem to explain the urticaria. But the test for this is too complicated to be used except for research, and the results do not seem to make any difference to the outlook or the choice of treatment. Neither do we know why some people with urticaria make these antibodies.

Chronic 'idiopathic' urticaria: by far the commonest type.
(Long-lasting urticaria with no known cause)

The word 'idiopathic' is a ridiculous word used by doctors to mean that they don't know the cause of something. It means 'self-causing', which is obvious nonsense. But we're stuck with the word because all doctors use it. There is a better word, even if you prefer Latin or Greek words to English ones; it is 'cryptogenic', which means 'hidden cause'. Nobody uses this more sensible word for urticaria with no currently discoverable cause.

Of course there has to be a cause. Every sensible doctor will agree that removing the cause would be the best treatment if only we knew what the cause was, and if only we could remove it without doing you more harm than the urticaria causes. Every patient would rather remove the cause than take treatment all the time.

But most people with chronic (lasting more than six weeks) urticaria have no cause found, no matter how hard everyone tries.

This frustrates everybody no end. Chronic urticaria is no joke, and the itching makes people thoroughly miserable (YES! IT'S SO TRUE!!) ,and for good reasons. But if you are the sort of person who won't accept that the doctor can't do anything else to find a cause, then you and the doctor are going to have a difficult time. More difficult than just having the illness alone.

It's not that your doctor does not care. It is that there are limits to medical science. Perhaps you could help by making your contribution to research, for example by volunteering to help with research tests, or by collecting or donating money for research on urticaria.

There is an idea about the way some chronic urticaria comes about. Research workers in London have found that a few patients have antibodies to their own 'allergy-producing antibodies', i.e. antibodies to their own antibodies. Others, far more numerous, have antibodies to molecules on the surface of the histamine-producing cells (mast cells). In either case the result is that these cells release histamine (and other chemicals) into the skin. Histamine in the skin produces urticaria, though evidently it is not the only substance which can do so. This discovery seems to apply to quite a lot of patients in a clinic so specialised that other experts send their especially puzzling urticaria patients there. Whether it applies just as often among all urticaria patients is something which remains to be found out, as far as I know.

Unfortunately this discovery makes no difference to treatment, even for those people who have these antibodies. There are treatments which can be used to remove the antibodies or to interfere with this mechanism, but at the moment these have too many disadvantages to be worth using except for research.

So mostly the treatment is just the same as for most kinds of urticaria, and relies mainly on antihistamine tablets.

You can also avoid aggravating factors. Almost certainly hot conditions will make you worse, and cool conditions will make you better. So, for example, using a minimum of bedclothes, so that you are no warmer than necessary, will help quite a lot of people.

The good news is that the treatment usually works, or can be made to work by skilled choice of medicines. But there are a very few sufferers for whom the usual specialist treatments do not work. They need to find a specialist, usually a dermatologist, who takes a special interest in urticaria.

The other good news is that sooner or later the urticaria nearly always clears up. But this may happen in weeks or after decades, and is totally unpredictable ( man...this is tough!

sigh...looks like that my 'allergy' will clear up in one year if i'm lucky...but if i'm will take decades!!! that's bad..can't imagine myself scratching my body for the next 20 years (?)

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