Clinical Case: Chronic Idiopathic Urticaria

A 27-year-old male is referred to the allergy clinic for symptoms of hives for 2 months. Possible triggers have not been identified.


Figure 1. Urticaria appearing on right arm. Image source: Wikipedia, public domain.

What is the next step?


Figure 2. Mind map diagram of chronic urticaria.

Read more in Chronic Idiopathic Urticaria on AllergyCases.org.

14 comments:

  1. Pathetic. H1 and H2 blockers. Another win for the "flow chart" doctor another loss for a patient. Did the palliative treatment of H1 and H2 blockers resolve the hives? As a long time sufferer, I know the answer is NO. However having a flow chart answer takes the doctor off the hook. A better outcome might have resulted from a more detailed look at what the patient was eating and wearing. Try to figure out what stimulated the hives. Idiopathic urticaria, indeed! It is just another "diagnosis" of ignorance hiding behind a nice sounding Latin phrase that really means "itching I am too idiotic to figure out the cause of." Some "idiopathic" urticaria is autoimmune in nature with autoantibodies attacking and activating mast cells. H1 and H2 blockers would hardly help. Even if they did temporarily relieve the symptoms, the underlying cause still is out there waiting to strike the patient again. Except the next time the "doctor" will find a way to blame the patient for allowing it to happen again. "You must be stressed." or the other refrain "I have never heard of that happening before" therefore you the patient should conclude that what I see before me does not exist. The patient itching and red patches then are imaginary, only in the patient’s mind. No really, the patient's mind is causing it. So send him to a psychiatrist. After all, the nerve of that patient not to get well when I the infallible doctor followed my flow chart to “diagnosis.” Anything so the "doctor" does not have to actually do any thinking or God forbid, research.

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  2. Hello,

    I suffered from chronic idiopathic urticaria followed by anaphylactic shock for over 3-years. After many trips to specialists, I ended up at the Mayo Clinic. Still, undiagnosed, I took matters into my own hands and got healthy. While at Mayo, a Thymoma was indentified above my heart, thought to be benign, we chose to wait and re-scan....not only did my Thymoma shrink, today it is gone; and so are my hives. Mayo, nor any other doctors ever felt that the Thymoma and my condition were realted....

    My Blog contians the comlete story with many images before and after.

    Josh Neimark
    www.joshneimark.com

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  3. Yeah, I like to call most "idiopathic" designations the itchy-head diagnosis. It does, however, happen. You can argue that there is a cause for everthing, but in some cases finding the cause is simply impossible (in theory as well as practicallity). Idiopathic does have a place in diagnosing conditions.

    Oh, and a side note - don't knock the flow charts, knock the doctors who you say are so afraid of thinking outside of the boxes on the chart. Nothing wrong with the flow charts themselves - they've saved my ass a time or two in the pit.

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  4. i've had this problem(if i could call it so)since i came to this place for my higher studies..never had such a thing happened to me wen i was home...i've had two exacerbations since then ,this is third one,its come after a gap of almost two yrs..fist n second were in 2004-5,its so v distresssing,,above all i feel so bugged wen the action of the drugs weans off n i'm forced to take more..it s ridiculous(being a medical student)all my senoirs have to offer to me is a shot of hydrocortisone,wen i go to them wen the itching becomes intolerable..,hope something better comesup in future..for the this misfortune

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  5. i have a 16yr. old daughter who has been seen by an allergy doctor. she is on the antihistamine and steroid. she hsa th chronic case of the hives. within the last 2 months she has been to the hospital 8 times. they give her that steroid shot and send her back home. the hives clears up then comes right back the next day. now the hives are bleeding when she breaks out. please if their is anybody out there that can help me please e-mail me at kiarabaisden@att.net

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  6. i am suffered with chronic idiopathic urticaria for 9years. i take antihistamines all the time, i will not take steroids.is there any new rescearch in this field. please please help
    10/01/09

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  7. The best person to address your condition is your physician. Not an online community or a website.

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  8. Except my physicians havn't helped since this started more than 13 years ago!!! Many many trips to the Dr ofc, many combinations of medications and still absolutely no relief. So tell me. To put my mind at ease...is there just no answer. This is my assumption. I do not have hives because I am stressed! I AM stressed because I have hives!!!

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  9. I too have Chronic Urticaria..anyone know of a support group?

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  10. I have been to a (snotty) allergist who diagnosed me with CIU about 2 years ago. It started about 6 months after I moved into my newly remodeled townhome. This townhome also has a mold problem. I have to clean the mold off the bathroom wall and ceiling. It also collects in the window panes, which I have to clean out every 3 or so months. I've been told the mold may be in the drywall. I can't even prove it's mold that's making me sick because my blood test came back negative for that. Neither of my two kids are sick, just me. What the He.....?

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  11. Same person that posted on 7-5-09. I also am on citerizine and hydroxizine. I'd be lost and breaking out all the time without them. With these meds, at least it's under control. I still itch sometimes though. This seems to be cyclical. It seems every 3 weeks I get itchier (but I don't break out in hives, my skin just gets itchy). My advice to you all: First of all, get on some meds to control this thing--the doctors should know you need zyrtec and things like that for this. Then have an allergy blood test (before you get on zyrtec or whatever, as these drugs may affect the results of your test). This blood test will at least rule out anything that for certain is causing it. Lastly, I would say that chronic hives like I have is caused by an autoimmune disorder. I find it curious why most cases of CIU disappear on their own within 5 years. Hmmm....

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  12. Colette King10/02/2009 6:43 AM

    I am a clinical hypnotherapist and I have been doing some work with people with allergies with some interesting results. People seem to be able to control their histamine reactions by using their brains.I am going to do some further work around this but I just thought it might be of interest to some of the people who have written in.Many people seem to feel very frustrated that a link is being made regarding stress actually causing hives rather than the stress being as a result of the hives.In a sense what matters is not what comes first but how best to control the symptoms so that you can feel as good as want to feel.

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  13. don't laugh out load.my wife and i are starting off trying a remedy which have been tested and tried for many illnesses.we are starting to fast,on water only.giving the body's natural ability to heal a chance to do so.if anybody's interested,we'll keep you up to date.

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  14. I have had CIU for 2 and a half years. They did go away for a few months in 2010 and came back after going to the emergency room for severe stomach ache and as soon as they gave me a painkiller (Dilaudid), they came right back. I have tried every single anthistamine possible, taken some medications for Gout, Malaria, Anti-rejection meds for transplant patients and absolutely nothing has worked for me except for Prednisone. Then I got to try Xolair in February of 2011. It worked like a miracle, hives were completely gone, no more prednisone, I didn't have to take anything at all. Xolair is a drug used for asthma sufferers and is not yet approved for hives but the FDA is working on that. I was so grateful to be able to get Xolair..... until about December of 2011. The hives started coming back slowly and now they are back (not as bad as before... yet, so now I am back on prednisone and trying all of these antihistamines again.
    I was thinking maybe there was a correlation between the hives and hormones, or does anyone else have issues with poor circulation?

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