New Guidelines to Evaluate and Treat Hives Antihistamines
- Sunday, August 23, 2009, 23:46
- Allergy
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- Andrew:
- So, there are people listening, and I hate to pick on middle-aged women – I’m a middle-aged man – but you talked about them as a big group of people who could face this. So, if their history in discussion with their gynecologist or their primary care doctor indicates, they might end up with a specialist – an allergist perhaps – and it would lead to this approach of using a non-sedating antihistamine over an extended period of time.
- Dr. Goodman:
- That’s correct. In fact, that’s the way we wind up seeing patients. They’ve worked through their problem with a concerned and empathic primary care or OB/GYN physician. And we see them when it’s time to really plan a long-term approach to control.
- Andrew:
- Okay. So, here we are. You’ve announced these guidelines. For our listeners who may be treated by a primary care physician of one sort or another, what action would you recommend if they’ve been dealing with this problem and have had episodic treatment over time – bit it’s [still] a big discomfort in their life?
- Dr. Goodman:
- Well, the first thing I would recommend is that the patient [use] the knowledge that they’re hopefully gaining from this conversation and take it to their primary care physician and say, “Doc, have you heard about the new guidelines for how to evaluate and treat chronic hives?” And use that as a stimulus. And you may be providing a [way] for patients to get on the Web and look at these kinds of guidelines. [Editor's note: This article is available on the Annals of Allergy, Asthma and Immunology's Web site, http://www.annallergy.org/. It is a Supplement to Volume 85 Number 6 December 2000, and is titled "The Diagnosis and Management of Urticaria: a Practice Parameter."] [Then], have a good dialogue with their primary care physician. If the primary care provider has exhausted their skills or knowledge base or attempts at treatment, [the next step] would [be a] referral to someone who specializes in chronic hives.
- Andrew:
- And that’s a key point. Some people, depending upon their health plan, [can] self-refer. So, would [they] typically call an allergist and ask, “Does this allergist specialize in the treatment of chronic hives?”
- Dr. Goodman:
- Exactly, and most allergists that are board-trained and board-certified allergists in this country do see hives as a challenge to be addressed. Some dermatologists have a good comfort level with chronic hives, but the field of dermatology is changing somewhat in that regard as well. Certainly, self-referral for an intensive look [by] someone who specializes in hives to go through an extensive history and try to get to the root of it. That’s an appropriate way of entering the health care system to address this vexing problem.
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