Medical Notes - Hives (Tagulabay)

What causes tagulabay? My brother, who is now 35 years old, has been having this condition although on and off for many years now. What is the treatment for this problem? � Joanne A., Cebu City

Tagulabay is the Filipino word for hives, a skin condition which the medical professional calls urticaria. Hives are clearly defined, pale swellings surrounded by an area of redness ("pantal" in Filipino) that occur in groups on any part of the skin. The swellings vary in size from less than a quarter of an inch to huge ones that are more than a food in diameter. Often, the individual swellings coalesced to form larger lesions.

Hives is a form of allergic or hypersensitivity reaction � an overwhelming response of the body�s immune defense system to an essentially harmless substance or physical agent. Why the immune system reacts violently to an innocuous substance or agent is unknown.

What is known is that in response to the presence of the causative material or agent, cells known as "mast cells" that are present in the connective tissue in and under the skin release a chemical called histamine.

When histamine is released, it causes the surrounding small blood vessels to dilate and become more permeable. This allows blood plasma to leak out and form the elevated swellings that typify hives.

Hives are usually itchy, but sometimes they give rise to a burning or stinging sensation. Crops of hives can appear in any part of the body. Typically, the swellings appear suddenly and disappear even without treatment after several hours. They do not cause any permanent damage to the skin unless the skin is scratched so violently that it breaks and gets infected.

When hives form in skin areas close to mucous membranes like the lips, eyes or genitals, the mucous membranes may likewise swell excessively, but as a rule, this swelling also subsides spontaneously after a few hours. Hives become life-threatening only if it is accompanied by angiodema, i.e., excessive swelling of the mucous membrane in the throat that results in difficulty of breathing or swallowing. Thus, people with hives who develop difficulty of breathing or swallowing should seek medical attention immediately.

A variety of substances and conditions can trigger the formation of hives. Common causes of hives include foods, drugs, infection and insect bites.

Any food item is a potential trigger for formation of hives, but the most common are shellfish, eggs, nuts and milk. Food preservatives and additives are likewise known to trigger hives.

Any drug, whether over-the-counter or prescription, is also a potential trigger for hives, but the most notorious are the antibiotics.

Hives sometimes appear with or after a viral infection such as the common cold, hepatitis or German measles.

Physical agents such as heat, cold, sunlight and pressure are occasional causes of hives. Of these agents, the most common culprit is cold. Exposure of the skin to a cold environment triggers hives formation in some people.

Hives is fairly common. Experts estimate that 10 to 20 percent of the population will develop hives at least once in their lifetime. But most attacks of hives last only a few days to weeks and do not recur. Often, the offending substance is identified and easily avoided.

However, as in the case of your brother, hives becomes a chronic condition that keeps recurring for many years. The offending agent in chronic hives is usually difficult to identify. In fact, sometimes, it is never discovered, in which case the hives is labeled chronic idiopathic urticaria.

The cure for hives is finding and avoiding the cause, but often, this is easier said than done. To provide relief, especially from the itchiness, antihistamines are the standard drugs prescribed by doctors. Most antihistamines, however, cause drowsiness and people taking them should be cautioned against driving or operating machineries.

People with acute episodes of hives may need to take antihistamines for just a few days, but those with chronic hives may have to take them for prolonged periods of time. In severe cases, corticosteroids, either orally or by injection, are sometimes administered. Corticosteriods should however be given for a limited period of time only, because they lead to serious adverse effects if taken for prolonged periods.

Reference:

http://www.mb.com.ph/issues/2005/01/24/HLTH2005012427031.html