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I am suffering from Acute Urticaria and am on Allegra together with Betnesol for the past 1 year. I also have Hypothyroidism. As a result I have gained a lot of wieght.

PAST HISTORY : I am suffering from Acute Urticaria and am on Allegra together with Betnesol for the past 1 year. I also have Hypothyroidism. As a result I have gained a lot of wieght.

2 Answers

Dr. Vivek Nair answered : 11 years ago

Hi,

What dose of Betnesol are you on? Do you take it daily?

Have any blood tests been done for you besides thyroid testing for the Urticaria?

Patient asked followup Question: 11 years ago

I take alegra and betnesol one tablet thrice a day. I have done Allergy test. I am allergic mainly to the following: 1. Milk 2. Bringal 3. Dust 4. Cock roaches 5. Pollens

Dr. Vivek Nair answered : 11 years ago

Thank you for the information. Your history qualifies as Chronic Urticaria. This can have many underlying causes and management consists of trying to find an underlying cause along with treating the patient symptomatically.

Hypothyroidism and in particular thyroid auto-antibodies are an important cause of Chronic Urticaria. So this could well be the case with you given your history of hypothyroidism. Still other causes need to be ruled out.

Other common causes include Infection anywhere in the body (e.g dental infection, bladder or bowel complaints etc), autoimmune disease and certain prescription drugs.

A complete hemogram (blood count) with peripheral smear, lymph node examination, liver and kidney function tests also form part of the basic workup. More detailed tests require a chest X ray, abdominal ultrasound, dental checkup, sinus X-rays, serum IgE levels, ANA, VDRL, RA Factor, HBsAg, Anti-HCV, Serum Complement levels, urine and stool examination and an allergy screen (contact/inhaled/ingested). If a patient has symptoms of gastritis sometimes an endoscopy with biopsy to check for H Pylori infection can be useful. H Pylori is a bacteria that lives in the stomach and causes gastritis. It has recently been shown to be a hidden cause of chronic urticaria in some patients.

About 50% cases of chronic urticaria turn out to have no underlying cause even after exhaustive investigations and this type is called Chronic Idiopathic Urticaria and can be diagnosed by the Autologous Serum Skin Test (ASST). This is proposed to be caused by antibodies being made in the body that cause the symptoms, and hence is an autoimmune type of urticaria. This kind of urticaria can be very chronic.

Antihistamines form the standard management for urticaria and these may need to be taken in 3-4 times the usual dose during acute episodes. If one does not work on its own then two even three can be combined. Options include Tablet Atarax 25-50 mg three times a day, Tablet Loratadine 10-20 mg twice a day and Tablet Levocetrizine 5-10 mg twice a day. All of these are safe to take on a prolonged basis if required.

Betnesol however is not safe to take for beyond 2-3 months without supervision and you really need to discuss stopping it with your doctor. If the urticaria cannot be controlled by antihistamines along then a short course of Prednisolone (a short acting oral steroid) followed by an immuno-suppresant drug like azathioprine may be required for 3-6 months.

Please feel free to ask if you have any queries.

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