Urticaria, chronic

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.

An order once placed, cannot be cancelled. For exceptional circumstances (e.g. sudden death of patient), we need to get our medicines returned in good and usable condition, after which a refund will be effected after deducting 30 % administrative expenses. Return will be at the cost of the client. Capsules and powders do not qualify for a refund. Local courier charges, international shipping costs incurred, and documentation and handling charges also will not be refunded.Even in case of exceptional circumstances, a refund will be considered only within 10 days from delivery of the medicines. The decision taken by staff of Mundewadi Ayurvedic Clinic in this respect will be final and binding on all clients.

The treatment package includes shipping costs for domestic clients who are ordering within India. Shipping charges are extra for international clients. In addition, international clients will have to select a minimum of 2 months' order since this will be the most cost effective and practical option.

With a full course of treatment, most patients with mild or moderate disease get complete relief with oral treatment itself ; patients with severe urticaria may require additional Panchkarma procedures for a complete remission. Diet and lifestyle modifications may be required to prevent a relapse or recurrence.