Urticaria & its Homoeopathic Approach

By

Dr.. Pawan S. Chandak BHMS

Email: pavanchandak498@gmail.com

Parbhani, Maharashtra, India

Urticaria:

Basic Medical Consideration:

Definition: Urticaria (or hives) is a skin condition, commonly caused by an allergic reaction, that is characterized by raised red skin welts. It is also known as nettle rash or uredo.

Welts from hives can appear anywhere on the body, including the face, lips, tongue, throat, and ears. Welts may vary in size from about 5 mm (0.2 inches) in diameter to the size of a dinner plate; they typically itch severely, sting, or burn, and often have a pale border.

Aetiology:

       Urticaria is generally caused by direct contact with an allergenic substance, or an immune response to food or some other allergen, but can also appear for other reasons, notably emotional stress.

       The rash can be triggered by quite innocent events, such as mere rubbing or exposure to cold.

Pathophysiology & Causes of Urticaria:

       The skin lesions of urticarial disease are caused by an inflammatory reaction in the skin, causing leakage of capillaries in the dermis, and resulting in an oedema which persists until the interstitial fluid is absorbed into the surrounding cells.

       Urticarial disease is thought to be caused by the release of histamine and other mediators of inflammation (cytokines) from cells in the skin. This process can be the result of an allergic or non-allergic reaction, differing in the eliciting mechanism of histamine release.

Allergic urticaria : Histamine and other pro-inflammatory substances are released from mast cells in the skin and tissues in response to the binding of allergen-bound IgE antibodies to high affinity cell surface receptors. Basophils and other inflammatory cells are also seen to release histamine and other mediators, and are thought to play an important role, especially in chronic urticarial diseases.

Non-allergic urticaria: Mechanisms other than allergen-antibody interactions are known to cause histamine release from mast cells.

Neuropeptides have been found to be involved in emotionally induced urticaria.

Dominantly inherited cutaneous and neurocutaneous porphyrias (porphyria cutanea tarda, hereditary coproporphyria, variegate porphyria and erythropoietic protoporphyria) have been associated with solar urticaria.

Drug-induced solar urticaria should be investigated for porphyrias. Caused by IgG binding not IgE

Types of Urticaria:

       Acute urticaria usually show up a few minutes after contact with the allergen and can last a few hours to several weeks. Food allergic reactions typically fit in this category. Common causes of reaction include consumption of shellfish, nuts, eggs, fish, acid derivatives, dye, or a combination of these.

       Chronic urticaria refers to hives that persists for 6 weeks or more. There are no visual differences between acute and chronic urticaria. Some of the more severe chronic cases have lasted more than 20 years. A survey indicated that chronic urticaria lasted a year or more in more than 50% of sufferers and 20 years or more in 20% of them. Of course this does mean that in almost half the people it clears up within a year and in 80% it clears up within 20 years or less (Champion and others, British Journal of Dermatology 1969).

       Drug-induced urticaria has been known to result in severe cardiorespiratory failure. The anti-diabetic sulphonylurea glimepiride (trade name Amaryl®), in particular, has been documented to induce allergic reactions manifesting as urticaria. Other cases include dextroamphetamine, aspirin, penicillin, clotrimazole, sulfonamides and anticonvulsants.

Physical urticarias are often categorized into the following.

       Aquagenic: Reaction to water (rare)

       Cholinergic: Reaction to body heat, such as when exercising or after a hot shower

       Cold (Chronic cold urticaria): Reaction to cold, such as ice, cold air or water

       Delayed Pressure: Reaction to standing for long periods, bra-straps, panty or thong bands, belts

       Dermatographic: Reaction when skin is scratched (very common)

       Heat: Reaction to hot food or objects (rare)

       Solar: Reaction to direct sunlight (rare)

       Vibration: Reaction to vibration (rare)

       Adrenergic: Reaction to adrenaline / noradrenaline (extremely rare)

Related conditions of Urticaria:

Angioedema is related to urticaria. In angioedema, the swelling occurs in a lower layer of the dermis than it does in urticaria. This swelling can occur around the mouth, in the throat, in the abdomen, or in other locations. Urticaria and angioedema sometimes occur together in response to an allergen and is a concern in severe cases as angioedema of the throat can be fatal.

Treatment & Management:

Urticarias can be very difficult to treat. Most treatment plans for urticaria involve being aware of one's triggers, but this can be difficult since there are several different forms of urticaria and people often exhibit more than one type. Also, since symptoms are often idiopathic there might not be any clear trigger. If one's triggers can be identified then outbreaks can often be managed by limiting one's exposure to these situations.

While the disease is obviously physiological in origin, psychological treatments such as stress management can sometimes lessen severity and occurrence. Additionally, methods similar to psychological pain management can be used to shift focus away from the uncomfortably and itchiness during an attack.

Homoeopathic Management:

Homoeopathy offer an effective & permanent solution to Urticaria. Treatment is directed towards signs & Symptoms, total symptomatology, Constitution of Patient, his physical & mental make up. Many times as Allopath we concentrate on therapeutics of Urticaria & try with specific remedy sometimes it works but sometimes we have to face failures.

Own Experience:

I will give you my own experience. I was suffering from Allergic cold & cough with breathlessness & cough < at midnight & after midnight. There was sudden change in weather with rain during winter on 31/10/2007 and I was wet in the rain when returning from Clinic. Since Midnight I was having itching with urticarial rashes. In morning I had tried Rhus Tox 1 M single dose with no results till evening then tried specific remedy Urtica urens 200 every 3 hourly till evening no results. As I have seen in Repertory & Theraps Urtica urens is very important medicine for Urticaria. In evening due to exposed to wet I have tried Dulcamara with no result. Same day at 11 pm I started severe itching, burning, redness of eyes, breathlessness, cough . Symptoms severity was very high. On considering the above symptoms similarity I consulted Dr. Vijay Vaishnav and as per his Scientific approach in studying Homoeopathy We can fried symptoms Urticaria with asthmatic or cold cough  symptoms alternating, midnight aggravations etc Arsenic Album 200 three times a day has taken & cured speedily.

Hence in studying Homoeopathy an particular disease or condition importance has been given to patient as a whole. We can not rely just on its therapeutics or specific remedy.

Urticaria is not just an superficial condition which can be managed with local applications or anti-histamines. We need an Internal malady which will help to act through its deeper layers of manifestation & cures the person as a whole.

Repertorial Approach

Skin – Urticaria – Common remedies are Ant –c, Apis, Antip, Ars, Bombyx, Bov,Camph, Chlora, Cim, Cop, Dulc, Frag, Icth, Nat P, Puls, Rhus tox, Sulph, Trios, Urt.

Chronic: Anac, Ant-c, Ars, Astac, Bov, Dulc, Lyc, Rhus tox, Sul, Urt urens etc.

Nodosa: Bov, Urt.

Tuberosa: Anac.

Causes:

from emotion: Anac, Bov, Ign, Kali-br.

From exertion: Con, Nat-m, Pso, Urt-u.

With oedema: Apis.

From menstrual condition: Cim, Dulc, Kali-c, Puls.

From shellfish, roe: Camph.

From suppressed malaria: Elat.

From Sweat: Apis, Rhus-t.

With Catarrh: Cepa, Dulc.

With Constipation, fever: Cop.

With Croup, alternating: Ars.

Alternating with Asthma: Calad.

Alternating with rheumatism: Urt-u.

Asthmatic troubles in : Apis.

With erosion on toes: Sulph.

With itching, burning, often scratching, no fever: Dulc.

With Liver Disturbance: Astac.

With Petechial disturbance or erysipelatous eruption: Fragar.

With rheumatic lameness, palpitation, diarrhea: Bov, Dulc.

With sequel from suppressed hives: Apis, Urt.

With coming sudden & going: Antipy

Wine from: Chlol.

Modalities:

Aggravation:

At Climacteric – Morph, Ustil.

At menstrual periord: Cim, Dulc, Kali-c, Mag-c.

At night: Ant-c, Ars.

From bathing, walking in A.M. : Bov.

From cold: Ars, Dulc, Rhus –t, Rum, Sep.

From exertion, exercise: Con, Nat-m, Psor, Urt-u.

From Open air: Nit . acid, Sep.

From wine: Chlol.

In Children: Cop.

Periodical – every year: Urt- u.

Amelioration:

Cold water : Apis, Dulc.

Hot drinks: Chloral.

From Open air: Calc .

From warmth: Ars, Chloral,

Materia Medica:

Antim Crud: Excessive irritability and fretfulness together with a thickly coated white tongue are truly guiding symptoms of Antim Crud. It is indicated for Urticaria in which itching when warm in bed. Skin symptoms with Gastric derangements. Skin is sensitive to cold bath.

< heat & cold bathing, evening, acids.

>  open air, rest, moist air.          

Antipyrinum: It acts especially on the Vaso-motor centers causing dilatation of capillaries of skin & consequent circumscribed patches of hyperemia & swelling. It is useful for acute erythema multiforme, intense itching. Urticaria  which appears & disappears suddenly with internal coldness. Angioneurotic oedema. Dark blotches on skin sometimes with oedema.

Apis Mellifica: Acts on cellular tissues causing oedema of skin and mucous membranes. Ailments from bee stings. Swelling or puffing up of various parts, oedema, red rosy hue, stinging pains, soreness, intolerance of heat, and slightest touch, and afternoon aggravation are general guiding symptoms of apis. There is extreme sensitiveness to touch and general soreness is marked. Erysipelatous inflammations, dropsical effusions  are characteristic pathological states corresponding to Apis. Useful for Urticaris, Hives with intolerable itching, oedematous swellings. Netle rash after perspiration.

< by heat in any form; touch, pressure; late in afternoon; after sleeping; in closed and heated rooms, Right side.

> in open air, uncovering, and cold bathing.

Bovista: It has modified affects on skin producing ertion line eczema. Urticaria on excitement with rheumatic lameness, palpitation and diarrhea. Blunt instrument leave deep impression on the skin.

< walking in morning, from bathing.

Arsenic Album: Debility, exhaustion & restlessness with nighty aggravation are most important theme of this remedy. Useful for Urticaria with itching, burning, swelling, oedema worse by cold & scratching. Urticaria with burning & restlessness.

Asthma or Respiratory symptoms alternates with Urticaria.

< wet weather, after midnight, from cold, coold drinks, cold food, cold season.

> from heat, warm drinks.

Anacardium: Skin symptoms f Anacardium are similar to Rhus tox. Useful for Urticaria with intense itching with mental irritability. Itching, swelling in Urticaria, eruption looks like that of Poison Oak.

< application of hot water.

> rubbing.

Caladium: Useful for Urticaria in which Itching rash alternates with Asthma. There is burning sensation and erysipelatous inflammation. Sweet sweat attracts flies in Keynote of Caladium.

< after sweat, after sleep in daytime.

> motion.

Bombyx: Urticaria with caterpillar itching of whole body. This remedy is Relationship of Astagus Fluvia.

Astagus Fluviatilis: Urticaria with nettle rash all over body. There is eysipleua and liver affection with nettle rash all over body. Urticarial symptoms with Liver derangements. Very sensitive to cold air.

< uncovering.

 Camphor: It is useful for Urticaria in which skin is cold, pale, bleed, livid. Can not bear to be covered.

< motion, night, contact, cold air.

> warmth.

 Chloralum: Urticaria worse from Spirituous liquors, hot drinks. Erythema aggravated by alcoholic drinks with palpitation causes pain in tendons & extensions. Intense itching with surface of body cold. Wheal come on from a chill,

< after hot drinks, stimulants, night

> warmth.

Cimicifuga: Urticaria from suppressed menses.

Dulcamara: Hot days & cold nights towards the close of summer are especially favourable to the action of Dulcamara. Urticaria  in which Diarrhoea alternates with skin symptoms. Urticaria from change of weather when weather suddenly becomes cold, damp cold weather, before menses. Urticaria in which red spots brought on by exposure on sour stomach. There are humid eruption on face, genitals, hands etc. Anasarca.

< at night, from cold in general, damp, rainy weather.

> from moving about, external warmth.

Fragaria: Useful for Urticaia rashes just like Strawberry Anaphylaxis. Urticaria from eating strawberry. There are petechial and erysipelatous eruption, swelling of whole body.< strawberry.

Grindelia: Urticaria in which skin rash look like rosacea with severe burning & itching. In poisoning from Poison oak Grindelia could be used locally as wash.

Ictholum: Useful for chronic hives, Urticaria, There is itching, heat and irritation.

Ignatia: Useful for Urticaria from Grief & worry. It is especially adapted to nervous temperament , women of sensitive, easily excited nature, dark, mild disposition, quick to perceive, rapid in execution. Urticaria during fever with itching, nettle rash all over body.  < draft of air, morning, open air.

 Natrum mur: Oversensitive to all sort of influences. Useful for urticaria with itching, burning worse by eating salt, at seashore. Urticaria, wheal, Hives itching after exertion. < at seashore, mental exertion, heat.

> open air, cold bath.

Natrum Phos: Useful for Urticaria in which ithching in various parts especially ankles. Skin is smooth, red, shining.

Burning pain < night.

Pulsatilla: It is an preeminently a female remedy especially for mild, gentle, yielding disposition. Changeability of symptoms are marked.

Useful for Urticaria after eating rich food. Urticaria with Diarrhoea. Urticaria from delayed menses. < undressing.

< from heat, rich fat food, after eating, towards evening, warm room.

> open air, motion, cold application, cold food & drinks.

 Rhus tox: Urticaria from over exertion, getting wet while perspiring. Urticarial eruption are red, swollen, intense itching < during sleep, cold, wet rainy weather, after rain, at night, during rest, drenching when lying on back. > warm, dry weather. 

Sulphur: Sulphur is an great Hahnemannian Anti-psoric. It is having an elective affinity for skin producing heat & burning with itching < heat of bed.

Urticaria with itching, burning < scratching & washing.

< warmth, evening, spring time, damp weather.

> dry, warm weather.

Urtica Urens: Urticaria returns at the same time every year. Violent Itching, blotches, burning heat with formication. Consequence of suppressed nettle rash. Rheumatism alternates with nettle rash.

Useful for Urticaria nodosa. Also for Urticaria with angioneorotic odema. < snow air, water, cool moist air, touch.

References:

       A.P.I. Medicine 6th Edition

       Homoeopathic Materia Medica & Repertory by Willium Boericke

       Homoeopathic Repertory By Dr. Kent

       Allen's Key Notes by H.C. Allen.

        Prescribing Information Dexedrine. GlaxoSmithKline (June 2006).

       Hives (Urticaria and Angioedema) (2006-03-01). Retrieved on 2007-08-24.

       http://en.wikipedia.org/wiki/Urticaria

For more details & Online Homoeopathic Consultation Contact us (Consultation & medicine charges apply)

Dr. Pawan S. Chandak

‘Shradha’ Vishnu nagar,

Basmat Road, Parbhani 431401

Maharashtra, India

Cell: 9422924861

Email: pavanchandak498@gmail.com

Website: http://www.modernhomoeopathy.com