Skin Conditions

What is urticaria?

Urticaria, commonly known as hives, usually strikes suddenly. First the skin itches, then it erupts into red welts. The itching may be severe, keeping people from working or sleeping. It’s a distressing disorder which affects an estimated 20 percent of the population at one time or another in their lives.

Most cases of urticaria are acute, lasting from a few hours to less than six weeks. Some cases are chronic, lasting more than six weeks. The welts may appear in one place, disappear after a short time, then erupt at another spot, then another. They are made worse by scratching. Each individual hive lasts no more than 24 hours.

What kinds of things can trigger attacks of urticaria?

Bouts of urticaria have been traced to such triggers as certain foods and additives, infections, drugs (including aspirin), cold, insect stings, alcohol, exercise, endocrine disorders and emotional stress. In some people, pressure caused by belts and constricting clothing causes hives. Urticaria may be a response to infection including the common cold, strep throat and infectious mononucleosis.

In the urticaria-prone person, these triggers cause the body to release chemical mediators, including histamine, from cells. Histamine (which causes itchy, runny noses and watery eyes in hay fever sufferers) dilates the walls of blood vessels, allowing fluids to leak out into the surrounding tissues. Swelling and itching are the result.

How are urticaria “triggers” identified?

In some cases, the trigger is obvious – a person eats strawberries or shrimp, then develops urticaria within a short time. But because there are so many possible causes for urticaria, other cases require determined detective work on the part of the physician and sometimes, forbearance on the part of the patient.

To unravel the urticaria puzzle, your allergist-immunologist will take a detailed history, looking for clues in your lifestyle that will help pinpoint the cause of your symptoms. You’ll be asked about the frequency and severity of your symptoms, your family’s medical history, medications you’re taking, your work and home environment, and miscellaneous matters.

In some cases you may require blood tests to try and determine the cause. Allergy skin tests are usually performed, as they often provide useful information. Your allergist-immunologist will decide which tests to order based on your history and the suspected cause.

What are the different types of urticaria?

They can be classified into two categories: immunologic (allergic) and non-immunologic. Immunologic urticaria is the least common form. It is caused by the immune’s system’s over-reaction to foods, drugs, infection, insect stings, blood transfusions or other substances.

Foods such as eggs, nuts, and shellfish, and drugs such as penicillin and sulfa are common causes of allergic or immunologic urticaria. Recent studies also suggest that some cases of chronic urticaria are caused by autoimmune mechanisms, when the patient develops immune reactions to components of his or her skin.

Non-immunologic urticaria are those types of urticaria where a clear-cut allergic basis cannot be proven. These take many forms:

  • Dermographism is urticaria that develops when the skin is stroked with a firm object.
  • Cold-induced urticaria appears after a person is exposed to low temperatures – for example, after a plunge into a swimming pool or when an ice cube is placed against the skin.
  • Cholinergic urticaria, which is associated with exercise, hot showers and/or anxiety, is a form of hives that is related to release of certain chemicals from parts of the nervous system.
  • Pressure urticaria develops from the constant pressure of constricting clothing such as sock bands, bra straps, belts or other tight clothing.

Some cases of non-immunologic urticaria may be caused by certain food additives such as artificial and natural colors, sulfites, preservatives and others. In many cases, particularly in chronic urticaria, the trigger for the problem can’t be found; in this instance it is called idiopathic urticaria.

If you have any more questions, your allergist-immunologist will be happy to answer them.

Hive Diet

Allergy skin testing is highly reliable for food allergies related to milk, eggs, nuts, fish and other “whole” foods. However, with few exceptions, there is no available allergy testing for food colors, preservatives, and artificial flavors.

In order to evaluate the possibility that your hives are related to a “hidden” food allergy, the only practical way is to proceed with an elimination diet. This involves not eating most “processed” foods including most deli items.

You will need to read labels so you can avoid eating foods that contain any artificial colors, artificial flavors, preservatives especially citric acid, BHA and BHT, and nitrates or nitrites often found in deli meats.

It is generally best to spend at least 1 day reviewing what you commonly eat at home to determine which foods will need to be “eliminated”. Then spend another day shopping for foods that are “safe” to eat. While on the elimination diet you should not eat out. This diet should be strictly followed for a minimum of 5 days.

If after 5 days there has been no improvement in the hives, then a “hidden” food allergy is not the underlying cause. If your hives did dramatically improve, then there indeed may be a “hidden” food allergy. At this point we would slowly add back one food at a time to narrow down the cause.

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Rosacea

Rosacea, often called "adult acne," which it resembles, usually begins as a subtle reddening of the skin of the cheeks, nose, forehead, and/or chin that may come and go. Untreated, the reddening eventually becomes more prominent; small dilated blood vessels may appear, and bumps and pimples may form. Rosacea can also affect the eyes, resulting in a gritty feeling and making them bloodshot and watery.

Can you get rosacea from drinking too much?

Many people associate the ruddy appearance and sometimes bulbous nose of rosacea with excessive drinking. W. C. Fields had rosacea and was known to drink a lot, but alcohol does not cause rosacea. It may worsen it, however, by causing flushing. Once you have it, rosacea may be triggered by anything that flushes the face. Hot or cold weather (including sun and wind exposure), spicy foods, hot beverages, emotional stress, heavy exercise, niacin, and other medications that cause flushing are well-known triggers.

The cause of rosacea is unknown. There may be a genetic component-more than a third of sufferers have relatives with it.

What is the best way to treat it? Will supplements help?

Rosacea can be controlled by antibiotics-topically applied, or even taken orally for severe flare-ups. You can also use an antibiotic cream long-term to keep rosacea at bay. Metronidazole lotion (1% formulation) is effective. No dietary supplements are known to help. Certain foods such as chocolate, yogurt, citrus fruits, and spicy foods can aggravate rosacea. Keeping a food diary can help you avoid triggers.

How should I care for my skin?

Wash your face gently with mild soap and lukewarm water-avoid hot water-and pat dry for a few minutes before applying your medication. Then wait 5 to 10 minutes before putting on any moisturizer or makeup. Men should avoid dull blades when shaving and aftershave lotions that bum or sting. Don't use alcohol, witch hazel, or astringents. Minimize sun exposure by wearing a broad-brimmed hat and sunscreen with an SPF of 15 or higher. In the cold, use a moisturizer to prevent drying and cover your face with a scarf. Standard acne medications are no help and may make matters worse.

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