Brief Answer:
Daily antihistamines, review drugs, more details

Detailed Answer:
Hello,

Thank you for asking at HCM.

I went through your query and would like to know more about you like:

a. How exactly your skin allergy started? Are they urticaria (hives) or dermatitis (as told by your dermatologist)? Can you please upload a picture of your skin lesions on follow-up? (From your history, I am assuming they are hives, but I want to confirm)

b. How long do the skin lesions last? a few hours or more than 24 hours? Do they subside with drugs such as Allergra or levocetirizine or montelukast? Do you get any side effects like sedation, drowsiness, etc from these drugs?

c. Do the skin lesions itch or cause burning pain? Do you have fevers or joint pains associated with them?

d. How frequently you have the skin lesions in a week? I there a particular season when they are more frequent?

e. Are your skin lesions aggravated by any particular foods, if you have observed anytime?

f. How is your skin in general? Is it dry or you have excessive sweating?

g. What is the frequency of your consumption of analgesics (pain killers)? Have you ever noted worsening of skin lesions with consumption analgesics?

h. Apart from bone-muscle-tendon and back pains, do you have any other medical condition?

i. Since when are you taking Yasmin?

j. I want to specifically ask why you need to take injection Avil? Does it work better than oral drugs in relieving hives?

k. Have you ever been investigated for these skin allergies? If yes, what are the reports? Can you please upload them?

l. Do you have any of the complaints from - weight gain, constipation, feeling excessive cold, dry skin, menstrual disturbances?

Please provide me above details on your follow-up. They will help me a lot to know more about your problem and therefore to help you in a better way.

From your given history, I would make following suggestions to you at present:

1. I usually suggest my such patients an antihistamine like fexofenadine (Allegra) or levocetirizine regularly. If they have more itching at night, I suggest them an additional hydroxyzine before going to bed.

2. In my opinion, there would not be an additional advantage of injection (such as Avil) over tablets. Of course, Avil is more powerful in relieving itching as compared to others, you can take Avil in tablet form or even you can take Hydroxyzine.

3. I would like to mention that all the above drugs will "control" the symptoms of your kin allergies. They do not treat the "cause". So you need to take them daily as long as you are having symptoms of skin allergies.

4. I usually suggest my patients with long-term urticaria (hives) investigations like complete blood counts, ESR, CRP, serum SGPT, urine & stool examination. If one has symptoms suggestive of thyroid abnormality (as asked in point "l" above), I also suggest thyroid function testing - serum TSH, T3 & T4.

5. However, for you, most important thing seems to be your drug intake.

Unfortunately most of the drugs that you are taking - Hifenac-P (aceclofenac component), Ultracet (Tramadol component) and XXXXXXX - all the three can cause skin urticaria (hives).

So please try to correlate your symptoms with consumption of above drugs, there are no tests available for them. In my opinion, paracetamol is the safest pain killer in terms of allergy. Please discuss possibility of these drugs causing hives with your respective doctors and decide accordingly.

In case, if you cannot withhold above drugs, I would suggest you to take daily montelukast (Montair that you have already taken) in addition to an antihistamine.

6. In general, I would suggest you to avoid activities causing excessive sweating and hot/spicy foods. I would also suggest you to avoid late night awakenings and heavy meals at night.

7. Stress is an important aggravating factor for skin allergies (hives). If it is an important factor for you, I would suggest you regular stress reducing activities like relaxation and meditation.

8. I also prescribe my such patients a multivitamin for 3 months, especially vitamin D, vitamin E, zinc and selenium.

9. I would also suggest you to apply a moisturizing lotion such as calamine over itchy areas and areas of dry skin regularly, especially immediately after bathing in order to preserve moisture in skin.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask on follow-up. It will be my humble pleasure to help you with best of my knowledge and efforts.

Wish you the best of the health.

Thank you & Regards,

Dr. Parin N. Parmar

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Brief Answer:
Regular antihistamines, discuss about XXXXXXX

Detailed Answer:
Hello.

Thank you for your follow-up and details.

From your updated details, I would like to make suggestions for you as follows:

1. At present, I would suggest you to take montelukast-levocetirizine (combination is available) in morning and hydroxyzine before going to bed.

2. Please continue application of derma calm caloe lotion.

3. I would suggest you an multivitamin containing especially vitamin D, E, B6, zinc & selenium for 3 months.

4. As you have started XXXXXXX for last 5 years and you are having hives for last 4 years, it is highly likely that XXXXXXX may be causing your skin symptoms. Please discuss this this possibility with your gynecologist and decide further regarding XXXXXXX and its alternatives.

5. My rest of the suggestions would be same as mentioned in previous answer.

Wish you best of the health.

Thank you & Regards,

Dr. Parin N. Parmar

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Brief Answer:
Oral drugs only in my opinion

Detailed Answer:
Hello.

Thank you for your follow-up and further details.

I went through your details and would like to make suggestions for you as follows:

1. I have seen many patients who start urticaria/skin allergies after any major surgery. Usually the cause cannot be found out, but their allergies stay for some months, even some years and subside by themselves. Usually they have to take antihistamines as long as they have symptoms.

2. Of course, in your case, I am suspecting XXXXXXX also, which may be contributing additionally.

3. As long as your blood sugar is controlled, it is not a problem. High blood sugars can contribute to itching, dry skin and skin infections but not especially hives.

4. In my opinion, tablet is better option than injection. Taking regular injections is not a good option because every time your will need to puncture a vein. There are also chances of entering infection through veins into body.

So personally, I would suggest you daily levocetirizine-montelukast in morning and hydroxyzine in evening.

You can increase the duration if you are free from symptoms in between and find your minimum requirement.

5. It's good that you are not eating outside food. It has many unknown substances & spices that may increase symptoms.

6. Personally I also suggest to consult a good alternative medical practitioner (such as Ayurveda or Homeopathy). They have their own way of looking at what's wrong and may suggest you some other life-style changes, herbal remedies, etc.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask at HCM.

Wish you the best of the health.

Thank you & Regards.

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Brief Answer:
Please read the information

Detailed Answer:
Hello.

Thank you for asking at HCM.

I would reply to your queries as follows:

1. Regarding Avil injection, as mentioned earlier, neither Avil injection nor tablet antihistamines can "cure" hives, they can only temporarily suppress the symptoms.

As you are already having hives for last 4 years, there is chance that you may have them for a few more months as the basic cause of hives is not yet clear.

It would mean you will need many intravenous injections of Avil.

Taking many intravenous injections is not a good option because every time a vein is punctured, the inner walls of veins may get damaged and there is a risk of entering an infection via punctured vein also.

Injection Avil may give you a relief for a longer period, but still you would need them at least twice to thrice in a week. So it is not desirable in my opinion.

Avil or for that matter any antihistamine is not a drug which is more effective in injection form as compared to tablet form. So in my opinion, repeated injections are not a good option.

2. A true Ayurveda practice does not consist of prescribing herbs/Ayurvedic medicines only. A true Ayurveda is diagnosing patient's condition after identifying patient's constitution, suggest life-style changes as well as diet changes, prescribing some herbs and suggest some therapies like Panchkarma etc. These type of practice is usually available at specialized Ayurveda centers/institutions only.

3. Personally I would again suggest you to discuss the possibility of contraceptive causing hives with your gynecologist. If it is the cause, you could be free from all the suffering without medications.

Hope above information will help you to understand why I made the suggestions.

Should you have any further query, please feel free to ask at HCM.

Wish you the best of the health.

Thank you & Regards.

Dr. Parin N. Parmar

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Brief Answer:
Please discuss my suggestions with your doctors

Detailed Answer:
Hello.

Thank you for your follow-up.

I can understand you are having multiple physical problems but it is really good that you are already having a good life-style by implementing regular Yoga & exercises as well as by eating nutritious home-based food.

As I had mentioned earlier in my very first answer, there are many investigations which need to be carried out in a patient with long-standing hives. (I usually suggest may patients complete blood counts, ESR, CRP, serum SGPT, urine and stool examination - these are minimum investigations).

Hope with patience and regular treatment under your doctor's guidance, you would be gradually come out of your health problems.

At present, I would like to summarize my suggestions as follows:

a. Montelukast-levocetirizine in morning and hydroxyzine in evening

b. Application of moisturizer over itchy and dry skin areas

c. Multivitamin-multimineral supplements as suggested previously

d. Consulting gynecologist regarding XXXXXXX

e. Investigate further if no improvement

f. Continue life style measures as you are already implementing currently

Please discuss all the suggestions made by me with your current treating doctor and decide further medicines accordingly.

Wish you the best of the health.

May God bless you with the best of the health.

Thank you and Regards,

Dr. Parin N. Parmar

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Brief Answer:
long-term oral antihistamines

Detailed Answer:
Hello.

Thank you for the follow-up.

I went through your reports and my opinion is as follows:

1. Liver and thyroid functions are normal.

2. I would suggest you supplementation with vitamin D.

3. ESR, CRP and Total leukocytes are high, suggestive of some chronic disease/long standing disease or infections or anything.

As long as urticaria is concerned, from above reports I can only suggest that you may need long term antihistamines, may be for a few years overall.

I have not seen any patients with liver/kidney damage even after long-term use of tablet Avil. Frankly, I have not come across any patient regularly taking injection avil and I always avoid unnecessary injections in my practice.

Hope above suggestions will be helpful to you.

Wish you the best of the health.

Thank you & Regards,

Dr. Parin N. Parmar

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Brief Answer:
Only with uncontrolled diabetes, treat dry skin

Detailed Answer:
Hello,

Thank you for follow-up.

I went through your query and would like to reply as follows:

1. I haven't said that diabetes can cause "allergies". Only uncontrolled diabetes (means sugar levels remain high despite taking drugs) can worsen itching. This type itching is also associated with dry skin. Hence I always ask about diabetes in my allergic patients, however, diabetes itself does not cause allergies.

So patients with both uncontrolled diabetes and allergies/hives, itching is more as compared to those with allergies alone. Treatment of dry skin and good control of diabetes is helps but cannot "cure" allergies/hives.

2. So if your mother's diabetes is controlled, your should not worry about allergies. I would suggest her to treat dry skin rather to improve her symptoms.

3. Further suggestions about her would require detailed information as I had already asked to you and cannot be dealt together with this query.

Hope above suggestions and information will be helpful to you.

Wish both you and your mother a very good health.

Thank you & Regards.

Dr. Parin N. Parmar

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Brief Answer:
hydroxyzine, treatment of diabetes and dry skin

Detailed Answer:
Hello XXXXXXX

Thank you for follow-up.

I would suggest her hydroxyzine as she has more night-time itching I assume.

Control of diabetes and treatment of dry skin (with moisturizers and multivitamin-mineral supplements - vitamin D, E, A, selenium, zinc, essential fatty acids) are even important than antihistamine in my opinion.

Hope above suggestions will be helpful to her.

Best regards,

Dr. Parin N Parmar

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