Dear Readers

Jay B is a 26-year-old mechanic from Harbour View, St Andrew, who reads Lifeline regularly. His problem is he has been experiencing an itchy rash which recurs over several weeks on and off. It may go away and weeks later recurs. His trunk, arms, and limbs are covered with a blotching reddish rash at this time. The itching can be really intense. Jay B works in the hot sun and gets real sweaty. He wonders if the heat could be causing his condition. He visited a doctor who thought he was experiencing an allergic rash after a meal of corn pork, but Jay B says the rash keeps coming back. He asks Lifeline for an opinion.

From Jay B's description, this rash could be urticaria, which is a really common allergic skin condition. Urticaria is associated with an itchy rash where weals of varying sizes are seen over the skin. This rash can last from minutes to over 24 hours. Some people also experience swelling of the eyelids, lips, tongue and larynx, which is referred to as angio-oedema. The rash and itching (and swelling) is due to release of histamine and other vasoactive agents like leukotrienes, kinins and prostaglandins.

Urticaria can be acute or chronic. Attacks can be brought on by exposure to various foods, drugs, infections or insect bites. Ingesting foods containing large amounts of histamine like mackerel or frozen tuna fish, or ingestion of shell fish can bring on an attack. Ingestion of drugs like aspirin and non-steroidal anti-inflammatory drugs (eg Advil, Indocid, Voltorin, Cataflam etc.) can also result in urticaria.

For most people, treatment of urticaria depends on the symptoms. Applications of topical steroids won't help and topical antihistamines are only a bit better. Calamine lotion does have a cooling, anti-itch effect while topical anaesthic creams, (eg Emla), will also lessen the itching sensation over the skin when applied. For most people antihistamines are the main drugs used in treatment. When attacks are infrequent, they are best treated with antihistamines (eg DPH, Erolin, Claritine, Zyrtec, Cetrine, Allegra, Aeries, Histal and many others) which are H1-receptor blockers. Relief is usually experienced within an hour of receiving treatment. If uticaria occurs frequently, then antihistamines should be taken regularly.

Most cell stabilisers such as Zaditein and anti-leukotrines like Singular can also be used (orally) to prevent or lessen attacks. Sometimes using H2-receptors blockers like Tagamet or Ranitidine (Zantac) can have significant effect on the treatment of urticaria. These latter drugs are primarily used in the treatment of peptic ulcer diseases and acid reflux disorders. Severe attacks will require treatment with oral prednicone (steroid) for a few days. Steroids should not be used long term.

Sometimes dietary management helps in the prevention of chronic urticaria or at least immunises symptoms although it is not always easy to determine all the food types which may be associated with urticaria.

Some people experience urticaria when in cold conditions (cold urticaria). These individuals should avoid sudden change in temperature, eg the change from an air-conditioned environment to sudden outside heat or emersion in cold water as this can bring on itching, rashes or even fainting.

Popular urticaria often occurs after insect bites and mainly affects children.

Management would involve the use of insect repellents, oral antihistamine and in this situation, the topical application of an antiseptic (or antibiotic) mild steroid cream combination.

If Jay B's condition persists he should return for reassessment by his physician.

Write to: Lifeline

PO Box 1731

Kingston 8