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Allergies

Chronic idiopathic (spontaneous) urticaria

Chronic idiopathic urticaria is the occurence of recurrent urticaria (nettle-rash, hives or wheals) for at least 6 weeks for which no cause can be identified. Often, angioedema (swelling) of the face can also occur. 

A diagnosis is reached by taking a very careful patient history and excluding other causes causes such as infection, inflammation or autoimmune disease. Most cases of chronic idiopathic urticaria resolve within 6 months but some cases can go on for several years.

No food or drug triggers are identified to these episodes. Quite often these episodes may be exacerbated by heat or pressure; they can be associated with underactive thyroid or underlying infection. More often these can be linked to major stressors in life like bereavements, illness in the family, moving home, changing jobs, and stress at work or in personal life, divorce or marital problems. Chronic spontaneous urticaria is relatively common. There are no specific tests for this condition; the diagnosis is reached by taking a careful history and after excluding other causes such as infection, inflammation or autoimmune disease. This condition tends to last for a few months or for a few years before gradually fading away. However in some cases it may go on for several years.

Treatment

The general advice is to take a daily, non-sedating, long-acting antihistamine. Patients’ often need a higher dose of antihistamines or a combination of antihistamines and other medicines till they are symptom free for a few months before they can gradually taper off their medicines. 

Xolair ( Omalizumab) is an anti-IgE antibody treatment used in severe cases of spontaneous urticaria not responding to high dose anti-histamines and Montelukast. 

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