How to Treat and Manage Urticaria

Urticaria is a common condition affecting approximately 25% of the population at some time. It has many causes. Urticaria is unpredictable and results in a great deal of distress because of the intense pruritis, and the interference it causes to sleep and daily life. The fundamental step in managing a patient with urticaria is to try and classify the nature of the condition. This will determine which, if any, investigations are necessary. Antihistamines remain the mainstay of treatment, but in some cases other strategies are necessary.

In approximately 50% of patients, urticaria and angioedema coexist, while 40% experience urticaria alone and 10% will have isolated angioedema. The hallmark of urticaria is transient (less than 24 hours duration) pruritic wheals. Angioedema is a deep dermal, subcutaneous or submucosal oedema resulting in swelling which generally lasts 24 hours and sometimes longer.

Management 

Treatment begins with an attempt at classifying the nature of the patient’s urticaria.

Management of the patient with a physical urticaria begins with an explanation of how the physical factor(s) provoke the reaction. No laboratory investigations are necessary. Avoidance measures can be very effective in limiting the number of episodes. Antihistamines may have a useful role in some cases although they are typically ineffective in patients with delayed pressure urticaria.

Those patients who have suffered an acute, severe episode, usually with other features of an acute allergic reaction, require careful assessment, including skin testing with appropriate allergens. Most cases of urticaria and angioedema of less than six weeks duration will settle with symptomatic measures and rarely require investigation.

In patients with chronic urticaria, an explanation of the condition and its tendency to be a long-lived problem is essential if they are to come to terms with a very distressing situation and learn to manage it. Reassurance that the problem is not a sign of cancer or any other severe disease is important. Extensive laboratory investigation is unnecessary and rarely yields useful results, but appropriate investigation should follow any clues from a careful history and physical examination.

Patients with chronic urticaria and angioedema require counselling about the avoidance of non-specific aggravating factors such as overheating, overexertion, alcohol excess, and the use of aspirin and related compounds. Simple measures such as tepid showers, oatmeal baths and ice packs can give some temporary relief.

Baking Soda :-

Baking soda helps relieve the itching and inflammation associated with hives. In addition, it prevents further irritation.

• Prepare a mixture with 1 part baking soda and 3 parts water. Apply it on the affected area for 1 to 2 minutes, then rinse it off with lukewarm water. Do this once a day until your condition improves.
• Alternatively, add ½ to 1 cup of baking soda to a bathtub filled with lukewarm water. Mix it well, then soak in this water for 10 minutes once a day.

Oatmeal :-

Oatmeal contains anti-irritating, anti-inflammatory and soothing properties that can relieve itching and swelling. It can even help your skin heal quickly.

• Add 1 to 2 cups of finely ground oatmeal to a bathtub filled with lukewarm water. Soak in it for at least 15 to 20 minutes. Enjoy this soothing bath once or twice a day.
• Alternatively, add a little water to ½ cup of oatmeal. Set it aside until it turns into a paste-like consistency. Apply it on the affected skin, leave it on for 30 minutes and then rinse it off with lukewarm water. Do this once daily.

Aloe Vera :-

Aloe vera is another effective remedy due to its anti-inflammatory and antimicrobial properties. The gel of aloe vera helps reduce redness, swelling and itching when applied topically. In addition, it is very soothing to the skin.

• Extract fresh aloe vera gel from an aloe leaf.
• Apply it on the affected area and allow it to sit for 20 to 30 minutes.
• Rinse it off with lukewarm water.
• Repeat 2 or 3 times a day until the symptoms clear.

Apple Cider Vinegar :- 

Apple cider vinegar is another effective remedy due to its antihistamine and other medicinal properties. Moreover, it can help fight bacterial or viral infections that could be causing or aggravating the problem.

• • Add 1 to 2 cups of raw, unfiltered apple cider vinegar to a bathtub filled with warm water. Soak in it for 15 to 20 minutes once daily.
  • Alternatively, dilute apple cider vinegar with an equal amount of water and use it to wash the affected area a few times a day.

• Another option is to add 1 teaspoon of raw, unfiltered apple cider vinegar to a glass of water. Add a little honey for taste. Drink this twice daily.

Doxepin :-

• In troublesome cases, doxepin is certainly worth a trial.
•  Doxepin is a tricyclic antidepressant, which possesses both H1and H2 antagonist properties.
• Its sedative action may be beneficial when sleep disturbance is troublesome.
• The mild anxiolytic effects may also be an advantage if the patient has a lot of psychological distress.
• A dosage of 25-50 mg at night is usually effective.

Leukotriene antagonists :-

• The leukotrienes are important products of mast cell activation and degranulation.
• Inhibition of these mediators may play a useful role in the management of chronic urticaria.
• With the advent of the leukotriene receptor antagonists, there is the opportunity for exploring this possibility.