Working With a Specialist to Treat Hives
- Friday, August 21, 2009, 23:43
- Allergy
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- Andrew:
- So, let’s talk about a middle-aged woman. She now finds these welts on her body [that] sheís never [had] before. With your guidelines now, what can the doctor be doing [and] what sort of doctor [should] she [see] to alleviate this condition?
- Dr. Goodman:
- Well, our specific point in formulating the new urticaria guidelines, or parameters, is to point out to the primary care specialist and the generalist specialists – like pediatricians [and] internists – how to approach a patient with chronic hives. For the most part, taking a very careful and comprehensive history is the cornerstone of both their evaluation on the front lines, so to speak, and of our evaluation of chronic hives. Many times we can deduce from a careful history what the cause of the chronic problem is and, by either eliminating it or addressing it, take care of the problem.
- Andrew:
- So, what sort of things might be eliminated? Let’s talk about prevention. Also when you say “take care of the problem,” what other things – [in general] – might happen?
- Dr. Goodman:
- Well, in that history that the generalist or the specialist can take – given the time and opportunity to do so – we look for exposures to medications [such as] antibiotics and other prescription drugs that can often be the triggers for chronic hives. [We also look for] exposures to known, potent food allergens such as peanuts, shellfish, or egg, milk, wheat, corn, soy – those common food allergens that will trigger hives. There are food additives [found in] some of the antioxidant preservatives [that] will trigger hives. Some of the dyes used in processed foods will trigger hives. Other causes, as we alluded to for children, infections – especially respiratory infections.
In middle-aged women, autoimmune diseases – such as autoimmune reactions to thyroid hormone or to progesterone, one of the female hormones – can sometimes trigger chronic urticaria.
And a group that probably comprises the biggest subtype of chronic hives [is] the physical causes of hives such as intense cold exposure, solar or sun exposure, pressure exposure or vibration. Those physical urticarias really are the ones that are most likely to be picked up by just taking a comprehensive history of when and under what circumstances the patient develops hives.
- Andrew:
- You mentioned sun [exposure]. So if somebody goes to Hawaii during the winter, or they’re outside in the summer – heat or sun could bring this on as well.
- Dr. Goodman:
- Exactly, and it’s important that you added heat because sometimes just being out and exercising in heat can trigger hives.
- Andrew:
- And it could happen to someone [even when] those same conditions didn’t [occur] at another time in their life.
- Dr. Goodman:
- These are syndromes that can appear after having been successful in that environment in the past – exactly.
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