Urticaria, also known commonly as hives, is an allergic
reaction of the skin with characteristic red, itchy patches of various size and
shape. The individual patches usually subside within 24 hours, without any
pigmentation or scaling. This condition is known as chronic urticaria if
lesions recur for more than 6 weeks. A more serious variant of this condition
is known as angioedema, in which the swelling goes much deeper and involves the
mucous membrane, usually in areas like the eyelids, lips and tongue.
Chronic urticaria is usually diagnosed clinically with the
help of a detailed medical history and physical examination. Further
investigations may be required in case of a concurrent history of parasitic
infection, thyroid disorder, or autoimmune disorder. Rarely, a skin biopsy may
be required if the lesions persist for more than 24 hours at a time, or there
are accompanying features of skin bleeds, autoimmunity, fever or arthritis.
Chronic urticaria is usually divided into three subsets: 1)
Physical or inducible urticaria, also known as symptomatic dermatographism,
cholinergic urticaria, and pressure urticaria. About 20 % of patients present
with this subtype, in which the trigger is some consistent, identifiable factor
such as mechanical stimuli (pressure, vibration), temperature changes,
sweating, stress, sun exposure, and water contact.2) Chronic urticaria
secondary to some underlying medical condition; however, this is very rare. 3) The
largest subtype is known as chronic idiopathic urticaria or chronic spontaneous
urticaria. No definite causative factor can be attributed to this subtype;
however, in about 20-45 % of such patients, there may be an underlying
autoimmune process driving the disease.
The standard management of chronic urticaria includes the
use of anti-histamines to reduce the rash as well as itching. Most people with
mild symptoms can be managed well with these medicines itself. For those with
moderately severe symptoms, additional medicines like colchicine, dapsone, and
steroids are given for a limited time period. Those with an autoimmune process
may require immune modulating drugs, while a small percentage may require
anti-thyroid medications.
It is equally important to avoid triggers like mental
stress, overtiredness, tight fitting clothes, alcohol, aspirin and other
non-steroidal anti-inflammatory drugs. Application of soothing ointments can
help relieve itching; night time pruritis can be alleviated by lukewarm baths.
Chronic urticaria may last from months to years; however, about 50 % patients
experience remission within a year with proper treatment. With the exception of
angioedema, this disease is not life threatening; however, it can significantly
affect the quality of life.
Ayurvedic herbal medicines can be used with very good
results in the treatment of chronic urticaria, especially in those patients who
do not respond to conventional therapy. Herbal medicines can be used to reverse
the basic pathology of the disease. Medicines which strengthen the skin tissue,
treat allergy, and prevent recurrence, are used to reduce symptoms. Medicines
useful in this condition are those which act on the skin, subcutaneous tissue, mucus
membranes, capillaries, and blood.
Ayurveda also differentiates the treatment protocol for
chronic urticaria based on the symptoms and specific causes. Urticaria with
predominantly ‘Vata’ dosha symptoms is known as ‘Sheeta-pitta’; with dominant ‘Pitta’ symptoms, it is known
as “Utkotha”; while with dominant ‘Kapha’ symptoms, it is known as ‘Udarda’.
Each of these types of urticaria is treated differently, according to the
clinical presentation, causative factors, and severity. For patients with
refractory symptoms, purification Panchkarma procedures like induced emesis, induced
purgation, and bloodletting are utilized, either as stand-alone procedures, or
as combinations, or even as repeat combination-procedures, if indicated.
Ayurvedic herbal medicines also need to be given to treat
chronic gastro-intestinal symptoms, repeated worm infestations, thyroid
disorders, chronic stress, latent infections, and chronic inflammation. For
patients with an underlying autoimmune process driving chronic urticaria, an
elaborate treatment needs to be planned, which includes detoxification;
treatment of chronic inflammation; healing of damaged organs, tissues and body
systems; rejuvenation using tonifying medicines; provision of specific
nourishment; gradual immune modulation; and providing treatment for the
specific type of chronic urticaria.
With proper and regular treatment, most patients having
chronic urticaria can be fully treated in about 4-8 months. Before commencing
treatment, it is important to do a thorough examination and accurate diagnosis,
in order to achieve a quick remission. Depending upon the severity, patients
with autoimmune disease may require treatment for longer periods. It is equally
important to adopt suitable lifestyle modifications and avoid know triggers.
