Q: I have been having urticaria (hives) since January last year. I have seen many doctors and traditional Chinese medicine (TCM) practitioners about this problem.
In June last year, doctors at the National Skin Centre did a few blood tests on me. The results showed that my condition was not due to food allergy or hormonal changes.
I was on antihistamines daily but I cut back after I went to see someone who said he practised natural healing. He advised me to control the hives by cutting down on my protein intake rather than by taking medicine.
I am now taking antihistamines once every two days instead of once a day. This medication can control but not cure the hives.
I would like to ask if there is any cure for hives. Are there any other tests that I should go for?
I have also been having quite serious sinus problems ever since I was young.
I also experience excessive sweating. It happens when I wake up, after I change my clothes and before going to work. Once I step out of an air-conditioned room, I will start to sweat. I can cool down only after I sit down or enter an air-conditioned room.
Lately, I have also been experiencing a very dry mouth, even though I drink a lot of water. I suspect coffee may be causing this, so I have cut down my intake of very strong brews.
I am wondering if there is any underlying problem for my hives, sinus problems, excessive sweating and dry mouth.
Are these symptoms linked to thyroid disease or any other underlying illness? Or could they be due to the helicobacter pylori infection I was diagnosed with in 2009? I was cured of this in early 2010 after treatment.
A: Urticaria (hives) is a commonly encountered condition at the dermatologist's clinic.
It shows up as pale or red, raised, itchy bumps and plaques.
These wheals from urticaria are caused by histamine that is released from mast cells in the skin, resulting in fluid leakage from the cutaneous blood vessels.
When urticaria lasts for longer than six weeks, it is known as chronic urticaria, as in your case. Chronic urticaria is difficult to treat.
Long-term antihistamine use is the mainstay of treatment.
There are a variety of non-sedating antihistamines that work effectively on urticaria with minimal or no side effects.
These should be taken on a regular basis in an uninterrupted manner and tapered off by a dermatologist as your symptoms subside.
Going off the antihistamines too rapidly and erratic dosing are the primary causes of a relapse of urticaria.
For extensive outbreaks, prednisolone, a steroid, is sometimes prescribed as a rescue measure for a short duration.
Identification and avoidance of one's trigger factors are also necessary to treat the condition successfully and to prevent it from recurring.
This can be challenging as there may not be any clear triggers.
There is no known cause in the majority of patients and there is no underlying illness or allergy.
In some cases, chronic urticaria can be triggered by sun exposure, heat, cold, pressure, exercise and certain drugs.
The condition has also been reported to be associated with autoimmune thyroid disease, recurrent sinusitis and helicobacter pylori infection.
The thyroid is located in front of the neck and it makes hormones that control metabolism.
One type of thyroid disease is called hyperthyroidism. This is due to an overactive thyroid gland, which results in the gland making and releasing too much thyroid hormone.
In the majority of cases, hyperthyroidism is caused by an autoimmune disorder called Graves' disease.
Normally, antibodies produced by the immune system help to protect the body against viruses and bacteria.
In Graves' disease, antibodies produced by the immune system inadvertently stimulate the thyroid, making it release too much thyroid hormone.
Some of the symptoms of hyperthyroidism are increased sweatiness and sensitivity to heat, nervousness, weight loss, fast heartbeat, hand tremors, difficulty in sleeping and irregular menstruation.
Other than hyperthyroidism, excessive sweating can also be due to menopause, pregnancy, heart disease, excessive alcohol intake and diabetes.
Chronic sinusitis, which is an infection of the hollow cavities in the nose, can sometimes result in fever, sweating and a dry mouth.
Helicobacter pylori infection is a bacterial infection of the stomach lining.
It is associated with stomach inflammation or gastritis, and stimulates stomach acid secretion. It can cause burning stomach pain, bloatedness, burping, nausea and, occasionally, a dry mouth.
But a dry mouth is a non-specific symptom. It can be due to many other causes such as diabetes, salivary gland disorder, dehydration, smoking and the side effects of certain medication.
There are many possibilities which could account for your symptoms, which you are clearly disturbed by. It is difficult to interpret them without a proper face-to-face clinical assessment.
Many of the conditions mentioned earlier can be easily diagnosed by simple tests. I would suggest that you see your doctor instead of worrying. Anxiety and stress can worsen your sweatiness, among other things.
Dr Stanley Liew
Consultant endocrinologist at Raffles Hospital
Dr Harneet Rany Eriksson.
Consultant dermatologist at Raffles Skin Centre at Raffles Hospital
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