Brief Answer:
"Urticaria" : Kindly provide important details

Detailed Answer:
Hello,

Welcome and thanks for posing your query to the forum.

I can understand your concern for the skin issues. After analyzing the picture I can get that you have the problem known as "Urticaria or commonly known as hives" in yourself.

I require important part of history to guide you for best suggestions and possibilities of complete remission.

I request you to provide important details:

- How often in a week you have these hives or these appears on daily basis.

- Any specific time of occurrence or appear randomly any time of day.

- How long these persists- for few hours or longer than 12 hours.

- Are these hives appear on all over body non-specifically or appear on certain areas of body.

- What is the size of lesions- smaller thumb print type or larger palm sized.

-Severity of itching in urticaria- mild/ moderate/ severe/ very severe.

Any other specific thing which you want to mention or any related illness or any other health issues or medications.

Waiting for your reply so that I can guide you further.

Regards,

Dr Sanjay Kumar Kanodia
MD (Dermatology)

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Brief Answer:
Urticaria: Loratadine with levocetrizine

Detailed Answer:
Hello young lady,

Welcome again to the forum and thanks for posting important details so that I can now guide you best regarding your present condition.

I have gone though the previous query answered by Dr. Albana Sejdini General & Family Physician on 11 August 2014.

After analyzing the complete details and the previous query with diligence let me guide you for the condition which is known as "urticaria" or simply known as "hives".

Before I proceed further let you understand about your problem. To tell you medically - Our blood contains multiple type cells with red blood cells and white blood cells. Particularly these white blood cells provide immunity to our body which are of further multiple types.

Whenever anything in body is not appropriate or anything is offending to body then the number of white blood cells increases transiently. Particularly these cells which increase are eosinophils and basophils which are also known as mast cells. These cells contain granules which have a specific chemical known as histamine.

So as soon as any offending factors come in contact there is bursting of the mast cells. Therefore this histamine is released and we experience variable degree of itching and the kind of bumps which we can see in yourself.

The bumps can remain for a very transient period to upto multiple hours. It can remain for more than 12 -24 hours depending on the intensity of the offending factor or more than 24 hours too in certain cases.

Now the type of offending factor are innumerable including our internal hypersensitivity to anything including environmental factors including temperature variation, food, worm infestation, heat, humidity, cold, dust and even simple of fragrances in air and multiple of other related things and very importantly stress too.

In your case as most probably it may be related to internal factors as is generalized. In your case as I can get a history of giardia infestation so can be correlated with same. It may be related to internal factors as is generalized. You check out for any change in all the factors during preceding last two hours before the bumps.

Let us weight for stool examination report and then we can act accordingly. But overall you should not think this condition as serious one as it is just over expression of immunity to combat anything unusual in our body.

For the treatment part - it is quite simple and treated with drugs which inhibits the histamine release also known as Antihistamines. I myself prefer combination of Loratadine ( Dazit or Alaspan or Lorfast) and levocetrizine (vozet) in my patients. These are very simple medicine without any side effects of sedation. In my patients I start with 2-3 tablets/day, as soon as good effect is maintained then reduce to one to two in few weeks and then alternate days in next few weeks. At night time I prefer to give levocetrizine.

Once there are no lesions/bumps for few weeks then taper off to 2-3 tablets per week for few months and then stop it.

I can see that you have been prescribed phenergan 25mg which is basically sedative and can cause morning drowsiness. I suggest you to discuss antihistamines suggested by me which are not sedating and can be taken for long period of time.

In general urticaria may remain as long as the offending factor is present in our body. In most of the cases as our immune system and body get adjusted to that particular offending factor so it then self subsides.

I hope these information will help you in dealing the condition better. If you have any further queries I will be glad to help you.

With good health wishes,
Dr Sanjay Kumar Kanodia
MD - Dermatology

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