Urticaria – allergy – my story.

Diagnosis: Idiopathic Urticaria. (Idiopathic = unknown cause).

Note: This article is not professional medical advice. I am not trained in medicine, nor qualified to give medical advice. You should consult medically or otherwise trained and qualified health care professionals about your situation. My experiences however may help in some way.

Urticaria is a nasty skin condition and can make some people depressed – a double whammy. Hopefully my experience will help others.

Nearly three weeks ago now I developed an itchy rash. Some still remains, however the overall situation is improving. Because the timeline is less than 6 weeks my condition is officially termed acute urticaria. Were it to go on beyond 6 weeks, then it would be known as chronic urticaria. Acute urticaria is usually allergy related.

To make things easier for people to follow, here are links to some earlier blog posts which mention my situation with Urticaria/allergy.

On this blog.

On my Personal Development blog.

Here are some personal case notes that I wrote, prior to a visit to the Doctor on Wednesday 28th January. Following the notes I have outlined further developments. My notes are as is – a bit ‘rough and ready’, and were written when my hands were somewhat disabled with the condition. 

Urticaria Time Line. 2009.

Notes: Urticaria hereinafter referred to as ‘Allergy”.                                

Condition: Diagnosed as likely Chronic Idiopathic Urticaria in the evening of Thursday 22 January.

Case notes:

Monday 12th January.
Moderate itching behind both ears. Had a shower using anti dandruff shampoo earlier in the day which was at the time believed to be the cause.                                

Tuesday, 13 January
On the awaking discovered two fingers with reddish itchy patches. Thought that patches were some sort of moderate dermatitis or similar, which I have had in the past. Used Lamisil cream which I had in the fridge – itching subsided for a while, however more skin patches occurred gradually during the day.

Wednesday 14 January
I awoke with even more allergy patches. Tried paw-paw ointment to no avail. Attended pharmacy where pharmacist advice was to use Hydrocortisone acetate 1% cream and a soap free hand wash.

Thursday 15 January
Conditions steadily worsened and symptoms included pain.

Friday 16 January
Attended regular doctor  with urine sample for checking for absence of pre-Christmas UTI which had been treated with 10 days of antibiotics (Cephalexin - finished course on Weds 31 Dec). Still awaiting results of urine check, though initial dip stick test done by Doctor suggested no obvious problem.
Discussed allergy with Doctor, who advised to continue using Hydrocortisone acetate and to take Loratadine – an antihistamine.
( I was disappointed to learn that the Pharmacist I spoke with on Wednesday, 14 January had not suggested Loratadine for an allergy).

Saturday 17 January
Condition started to improve, moderately markedly.

Sunday 18 January
Condition still improving.

Monday 19 January through Thursday 22nd January
Condition worsened

Thursday 22nd January
Attended Doctor M late in the evening.
Doctor M diagnosed likely Chronic Idiopathic Urticaria. Prescribed Prednisolone 50mg once per day for five days.
Ate meal at home and then took Prednisolone at 22.30. Note: Continued taking still only in the evening for the five days – partly because that way I could get an extra 12 hours out of it, bearing in mind that started on Thursday night, and also because on Sunday 25th I started fasting during the day; partly to assist my body detox. I took Prednisolone after the evening meal every night at around 18.00.

Friday 23rd of January through Sunday 25th of January
Condition improved dramatically – lesions and itches disappeared.

Sunday 25th of January evening – took Pantoprazole 40mg.
Note: first started taking Pantoprazole in 2001 when I was diagnosed with an internal lesion. Took regularly for quite a long time, but in recent years changed to episodic as as reflux/heartburn decreased markedly. In 2007 had gastroscopy which showed that lesion was healed. Specialist advised to continue Pantoprazole episodically.

Monday 26 January – allergies started to reappear in small patches on my hands. Present when I woke up in the morning.

Tuesday 27 January – the morning after my last dose of Prednisolone (5 Day regime). Allergies looked much better on waking, however started to worsen during the day. I did distinctly notice however, that the time they started worsening was much later than on the 26th. The symptoms were not as bad as those on the 26 either. To my medically uneducated mind, this situation suggests that the cause of my allergy is Pantoprazole, that the product is causing a severe reaction which even 50 mg of Prednisolone had trouble coping with, and that the underlying situation is improving because Tuesday symptoms seemed much better than those of Monday. The Prednisolone dose was of course a constant.
Evening – took one Loratadine (antihistamine). Did not take Prednisolone with evening meal.

Wednesday 28 January
Awoke at 4 AM with severe itching on the hands and more bodily lesions. Applied Hydrocortisone acetate 1% cream all over hands. Itching subsided somewhat and I was able to get back to sleep.
6 AM – I awoke with bad itching again. Notice that lesions were worse, larger and more prevalent. Swelling on lower lip. Hands painful to pressure touch – this aspect was worse than my initial allergy outbreak in the preceding weeks.
As situation appeared to be rapidly worsening, I decided to eat breakfast and at approximately 6:30 AM, I took 50mg of Prednisolone. I realised of course that it was likely going to take around six hours before the Prednisolone kicked in and as I write this at nearly 11 AM, I have a slight impression that’s my hands may be starting to improve.
I went back to bed at 0630 and awoke at around 0900. Redness, itching, lesions, pain and so on were worse than at 0630 both sides of my top lip had started to swell.

Additional Notes:

1. Over recent years I have had very slightly itchy skin, sometimes tingly skin, and occasional reddish outbreaks – but nothing like this. Think that my subconscious is suggesting it was at times I took Pantoprazole.
2. My immune system in general is extremely strong. Apart from a rare inner ear virus which causes giddiness (1998 was last serious outbreak), and which I suspect is related to my deafness and inner ear nerve damage, I cannot remember the last time I caught a viral bug – it may be as long ago as the late 80s. I have known my wife for nine years and she cannot recall me having a cold or any other virus either. I have had the occasional bacterial chest infection, bacterial food poisoning in 2007, and Giardia in 1999.
3. I have racked my brains for possible triggers of this allergy and was only able to come up with anti dandruff shampoo as a possible candidate until this weekend just past when events indicated that Pantoprazole was a likely cause. Research indicates that my urticaria/ allergy can be known side-effect of Pantoprazole.
4. I generally eat very good quality food in a balanced diet; much of it is organic. I have hardly any alcohol; though do suspect that some alcohol I had on the weekend of 17 — 18 January may have exacerbated the situation. I am overweight however I’m making good progress in reducing it.
5. In December 2008, comprehensive blood and urine tests revealed an unexpected UTI (I  had no presenting symptoms and was attending the doctor on another matter). Apart from the urine, all my other results were very good and I have a printout of them. Again, to my uneducated medical mind, this would suggest that my allergy is not related to some other underlying medical condition.
6. Apart from Sunday 25th Jan I cannot recall exactly when I last took Pantoprazole. I think I took some on the weekend of 17/18 January but am unsure. If so, it may explain why condition worsened the following week.

Further developments….

On Wednesday 28th of January at around lunchtime I attended the Doctor and was seen by Dr R. (I attend a multi Doctor practice) Dr R was very thorough and explained that continuing steroids (Prednisolone) carried signifcant additional health risks. He also wanted to be totally sure that I did indeed have Urticaria and not some other condition such as a fungus.

I was given an adrenaline injection into the stomach. For some reason the effect was delayed somewhat and I did not get the racing heart side effect until around an hour after the injection. (Probably due to the layer of fat on my stomach). Within 10-15 minutes of receiving the adrenaline injection however my condition started to improve and after an hour or so virtually all urticaria lesions had disappeared. Besides alleviating my symptoms, the adrenaline provided very strong evidence that my condition was indeed urticaria (an allergy). Had it been fungal then the lesions would have remained visible. Note: my susbsequent inquiries indicated that adrenaline is not a treatment modality for urticaria – it is a diagnostic tool and also provides temporary symptomatic relief for allergies in dire situations.

Dr R prescribed Promethazine hydrochloride (an antihistamine) 20mg 3 times daily and cautioned that it may make me drowsy. Dr R also referred me to a Dermatologist for further follow up.

On Thursday 29th January my condition worsened again and large areas of urticaria appeared. This time my hands were not so badly affected. I was very tempted to take Prednisolone again and decided to phone a Pharmacist. The Pharmacist explained that it can take 3 days for some antihistamines (Promethazine hydrochloride) to work. He cautioned against taking more Prednisolone without consulting a Doctor. I decided to attend the Doctor again as the evening was getting on and my situation was becoming bad. I saw Dr M again and he explained that I should take Fexofenadine HCI (an antihistamine) in 180g form, and cease taking Promethazine hydrochloride. He seemed convinced that the Fexofenadine HCI would do a much better job. Dr M also prescribed 7.5 to 10mg of Prednisolone per day until the Urticaria disappeared. He suggested tapering the Prednisolone down gradually towards the end in case of wihtdrawl symptoms. This is a low dose of Prednisolone. (High doses of Prednisolone can usually be taken for about a week and stopped without tapering).

I took the Fexofenadine HCI and 10mg of  Prednisolone late on Thursday evening and started to notice an improvement in my condition before bed. This was likely due to the Fexofenadine HCI as the Prednisolone takes around 6 hours to have an effect.

Since then my condition has gradually improved daily and I never took Prednisolone again – just that one 10mg dose. The reason I am not taking Prednisolone is because my condition is improving and manageable without it. My general policy is not to take medications unless I really need them and in any case Prednisolone is a medication with potentially very nasty side effects.

Additional notes:

1) When purchasing the antihistamine Fexofenadine HCI, I asked the Pharmacist why the antihistamine Promethazine hydrochloride did not seem to be having an effect and he advised that antihistamines vary in how well they work on different people.

2) My urine tests referred to in the above notes came back negative. I no longer have a UTI. (Urinary Tract Infection).

3) I purchased an EBook about Urticaria which I found very helpful. In fairness to the author I will not divulge key information here, however it seems that I am very unlikely to have one possible underlying medical condition which can give rise to urticaria. Other advice and information in the EBook was very helpful indeed and I am following some of the recommendations. The book only cost me USD$17 and was available as an instant download. You can find out more and get your own copy here.

4) When researching drug information I read that antacids can interfere with Prednisolone. I do not know whether Pantoprazole (a proton pump inhibitor) intereferes with Prednisolone, however that may explain the worsening symptoms following consumption of Pantoprazole. That said, I think that Pantoprazole is actually responsible for my Urticaria and that I have lost my tolerance for Pantoprazole . Urticaria is a rare side effect of Pantoprazole – under 1% I think. The view that Pantoprazole is the cause of my Urticaria is my own – not that of a medical or healthcare professional.

5) Blended advice from more than one health professional made a better whole.

6) Key drug data is available from here: http://www.drugs.com/

7) I do not smoke and drink hardly any alcohol. (I don’t like the way it fogs my mind which is crystal clear and feels fantastic without alcohol) I do not take illicit drugs either.

8 ) My urticaria was also pressure sensitive. Clothing pressure caused flare ups.

9) I have made some dietary changes, as well as different personal and household care product choices, in the light of this experience.

10) Overall, this has been a very positive experience. I have grown a lot as a person, have greater compassion for the sick, learnt a lot and have much more gratitude across the board. Some more thoughts along these lines are here: (Post also referred to at top of this article).  http://personaldevelopmentmagic.net/2009/01/30/took-time-out-yesterday/

11) Some pictures of my personal symptoms appear here.

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