Urticaria (Hives) Urticaria is a very common skin irritation causing intensely itchy and stinging swellings called hives, or occasionally as a ringed wheal with central-sparing. It tends to be recurrent, and can be extensive; and when it affects the face (eyelids and lips), it can be disfiguring, adversely affecting one’s concentration and social participation at school and at work. What causes Urticaria? More importantly, urticaria can be a manifestation of an allergy, or an underlying autoimmune disease. Allergies can be mild, causing skin-limited symptoms, but can involve multiple organs such as the lungs (breathlessness and wheezing), the circulatory system (dizziness and fainting spells), and the gut (tummy pain and bloating). Such a condition is termed anaphylaxis, which may be fatal if medical treatment is delayed. Allergies to food, drug, insect stings, and inhaled particles (eg dust mites, vape, pollen) are common triggers for anaphylaxis and allergy. These allergies commonly get triggered during viral illness, fever, or with exercise. Persons with asthma, eczema, and chronic rhinosinusitis are often more prone to developing such allergies, and manifest more severe symptoms. Allergies ought to be diagnosed and managed promptly; apart from potentially acute life-threatening catastrophies, and rapidly worsening attacks with every subsequent allergen exposure, the longer term detrimental impact on one’s quality of life can be devastating: sleep quality, work performance, social stigmatisation, and mental health. Non-allergic causes of urticaria include infection, autoimmune, and idiopathic (unknown cause). In autoimmune urticaria, it is important to rule out systemic illnesses such as Lupus, Sjögren, and Graves disease. What tests are needed? At the initial consultation, the allergist will take a detailed history of the symptoms, the circumstances and possible triggers of the allergy, and assess other contributing risk factors. A physical examination is essential to ascertain whether it is a true allergy or a mimic, the extent and severity of the involvement, and if there is an underlying cause. A diagnosis can often be made based on the history and physical examination. Skin and laboratory tests can be employed to affirm the diagnosis. Skin prick testing is also instrumental in ascertaining the exact allergen when there are multiple suspects. A challenge or provocation test is performed to rule out suspected allergies, especially in the setting of the use of an essential medicine. Blood tests for key markers of inflammation and autoantibodies may be performed if an autoimmune disease is suspected. How can chronic urticaria be controlled? In allergic urticaria, allergen avoidance is the cornerstone in management. For life-threatening anaphylaxis, an action plan includes the use of an Epipen on standby. If patients have urticaria occurring on most days of the week for 6 weeks or more, regular antihistamines use is recommended. In persistent urticaria in spite of antihistamines, immunomodulatory medications (eg IgE or IL4 blockade) have demonstrated superb efficacy and safety. Effective immunotherapy (“desensitisation”) is available for some allergens (eg dust mites, animal fur). We employ cutting-edge yet cost-effective & innovative treatment strategies Let us Cure Your Pain Book an Appointment