Pruritus, though and independent symptom, is the leading symptom of urticaria (Hives, Rashes or Nettle rash). Urticaria could be acute or chronic and is an allergic reaction to some allergen in which red and round wheels develop on the skin, ranging in size from small spots to several inches across. In some cases there may be red pimple-like confluences which itch intensely and, as the patient scratches, there is awful burning and restivity, thirst for cold water, fever appearing very rarely. Urticaria could be induced by:
□ Some food item like shell fish, oysters, strawberries, spices, drinks, nuts, seeds, chicken.
□ Sudden changes in weather conditions.
□ Either after entering onto a bed or while leaving the bed (state of exposure).
□ After removal of clothes.
□ Living in underground damp cells.
□ Drug reaction or contact with an allergen.
In some patients eruptive rashes appear and disappear suddenly while, in others, they may stay for longer time. Eruptions are generally on the exposed parts or covered parts of the body. Cold, heat and perspiration are also the usual causes. If urticarial swelling spreads to lips, mouth, tongue, hands and feet, it is a very serious symptom which requires immediate treatment. This variety is known as angio-oedema.
□ Bites and stings of insects.
□ Use of synthetic/nylon clothes.
□ Unknown causes (and majority of cases fall under this category).
□ Inhalation of pollens.
□ Presence of parasites and stools.
□ Constipation.
TREATMENT
Skin tests are not of much significance in urticarea because area of investigations is too wide. First of all get stool and blood tested and if there is any abnormalcy, try to correct the same by way of food adjustments or proper medicines. If any food allergy is the cause, the offending food item should be eliminated from diet. If there are intestinal worms, take suitable drugs.
No laxative or purgative should be given to remove constipation, rather constipation should be removed by prescribing suitable food items. There are a number of antihistamine tablets available in the market and it is a matter of chance that the first given medicine may prove effective, otherwise it is an arduous job which can be facilitated by error-and-trial method. In any case, do not subscribe to cortecosteroids which must not be managed by the patient himself but by can be used for pruritus also.