Myra's Newbie Guide

1. Urticaria is a manifestation of many conditions and illnesses.

2. Chronic Idiopathic Urticaira is a diagnoses by exclusion. You can only be called idiopathic if everything else is ruled out. How much a Dr rules out will depend on his personal diagnostic talent, knowledge and willingness to test.

3. The mechanics behind hiving is called mast cell degranulation. Which means certain little white blood cells are going bonkers and firing histamine. Mast cells fire because of antigens (invaders, real or "perceived") which come into your body either by contact (skin), inhalation or digestion. Or by antigens which are produced within the body by other factors, such as inflamation or systemic illness such as cancer, thyroid or lupus. Besides histamine, mast cells also "fire" heparin, chrondrotin sulfates, neutral proteases, acid hydrolases and other enzemes. On the surface of these mast cells are little receptors for IgE (immunoglobulin E antibody). Think "velcro". When an antigen comes into the body it "sticks" to the velcro, when the mast cell gets loaded it starts "firing" its weapons (degranulation) and it encourages other mast cells as well as other inflamatory cells (basophils and leukotrines) to fire also. Degranulation causes hives because the contents of the mast cell causes vaso-dialation ( the capillaries increase in diameter) and leak fluid into the surrounding tissues which produces swelling and the histamine infusion into the tissues produce hives. The principal approach is to control mast cells, by either controlling the IgE stimulation or control the histamine being leaked. Granted this is treating the symptom not the cause, but until a cause is determined it is in your best interest to try to gain some control over the symptoms.

4. Mast cells in the skin carry receptors for both kinds of histamine, H1 and H2. H1 histamine is generally thought of as respiratory and H2 as gastro-intestinal. But since skin mast cells carry both, the most effective treatment is taking both an H1 and H2 antihistamine. Zyrtec (cetirizine) is a 2nd generation H1 which has been found to be superior in supression of the wheal and flare of urticaria. The H2 that works well with it is Zantac (raniditine).

5. Since no Dr can be with you 24/7 you are going to have to be your own best detective. This brings me to the not so popular but very necessary diary. Try keeping a diary of everything you do, touch and eat for at least three months. I know, I know, you hope not to be with us for three months and I hope you are right and won't be, but if you are, this tool can help you eliminate the possibilities which are endless.

6. Everytime you see your Dr ask for a photocopy of every test and his notes. This is your right as a patient and if you have to change Drs, get a second opinion or try to keep the facts straight, having your own file will help.

7. If you find a med journal article about a kind of hiving you think might be the same as yours, copy it and take it to your Dr. He has to include it in your medical file, if you request him to do so, another one of your rights as a patient.

antagonist : a drug that neutralizes the effect of another drug

arthralgia : a painful joint

antigen : a substance which stimulates the formation of an antibody

anaphylaxis : a state of shock, or a extreme allergic reaction

basophil : a type of a white blood cell involved in mast cell degranulation

cutaneous : relating to the skin

degranulation : discharge of the contents of a cell

dermographia : condition in which the skin becomes red and raised, when the skin is scratched lightly or irritated

eosinophils : red staining white cells that usually increase in allergic reactions

epipen: an injected rescue med for anaphylaxis containing epinephrine

flush : to blush; to become red

erythema : a patch of redness of the skin

heparin : a blood thinner, released into the body by degranulation

histamine : a mediator released by mast cells

H1 : a class of antihisamines which reduce respiratory histamine

H2 : a class of antihistamines which reduce gastro-intestinal histamine

lesion : a change in tissue structure caused by injury or disease

leukotrine : a type of white blood cell involved in mast cell degranulation

Mast Cell : a type of white blood cell whcih release histamine, heparin etc. when it degranulates.

NSAID : Non-Steroid Anti-inflamatory Drug

PGD2: a by-product of mast cell degranulation, which can cause joint pain and hormone problems

prostaglandin : fatty acid that affects many body functions

pruritus : itching

purpura : a purplish or brownish-reddish discoloration of the skin's outer layer caused by blood vessel fragility

systemic : affecting the entire body

tachycardia : rapid heart rate

urticaria : hives, nettle rash

urtication : a burning or itching sensation

vasculitis : an inflamation of the blood vessels