Treatment and prevention of urticaria: 8 questions for a dermatologist

Histamine-containing products.

Histamine is the most important universal mediator of vital physiological and pathological processes, obtained from the amino acid histidine. However, its excess leads to the launch of an indirect inflammatory reaction with allergic manifestations. Histamine is a kind of stimulant of the immune system, warning of danger. When an allergen or toxin enters the body, due to histamine, the blood vessels expand and swell and an immediate allergic reaction is triggered.

Unprocessed fresh foods contain very small amounts of histamine, but the longer the food is stored or ripened, the more histamine it accumulates.

Foods high in histamine include: pickles, vinegar, beer, champagne, wine, tomato ketchup, canned food (especially fish), yeast products, aged cheeses, soybeans, bananas, avocados.

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But not only foods can be stimulators of histamine release, but also exogenous factors, which include:

• allergic reactions;
• various diseases;
• injuries;
• hypoxia;
• radiation exposure;
• stress;
• taking certain medications.

Foods that show signs of spoilage should not be consumed, since bacteria that contaminate them are capable of producing histamine from histidine in large quantities.
Pay special attention to the proper storage of fish, in particular the mackerel family, and seafood. It is these foods that can cause severe histamine poisoning.

Urticaria: first aid

As soon as the first signs appear, immediate action must be taken. First you need to stop the allergen if its source is known, and also avoid taking NSAIDs, opioids, aspirin and calm down.

Pharmacotherapy for allergies is based on taking antihistamines. Only in cases of urticaria that are resistant to this treatment will other drugs be used. Everyone should have medications for allergic reactions, regardless of their medical history, because they are also used for insect bites, from which no one is immune.

A sudden rash does not appear the first time you encounter an allergen, but only the second time. To form a reaction, the presence of antigens to triggers is necessary. It could be anything, because few people know in detail the entire list of compounds to which they are hypersensitive.

Scheme for emergency care for urticaria

1. Take an antihistamine orally and cutaneously: Fenistil, Loratadine, Dimetindene, Erius. The dosage form of remedies for urticaria can be different - tablets, sprays, drops, gels, ointments, injection solutions. Roller applicators are convenient for external use.
2. Take a calcium gluconate tablet for faster relief of symptoms.
3. If after taking the medicine there is no improvement, then after 15-20 minutes there is a reason to call an ambulance.

To prevent similar episodes of hives in the future, it is necessary to undergo allergy tests. Sometimes testing does not help clarify the cause, because each panel is designed for a specific set of allergens, which may not include the one you are interested in. But if the rash appears rarely and is easily eliminated with medications, then it is enough to simply have antihistamines for such a case.

A hypoallergenic diet is an important component in the prevention of urticaria, angioedema and other anaphylactic manifestations. What is allowed for allergy sufferers:

• Lean meat, steamed or boiled.
• The soup should be prepared only with the second broth (the first one must be drained).
• Oatmeal, buckwheat, rice.
• Low-fat dairy products, fruits, and vegetables are welcome.

You should not eat raisins, whole grain bread, brightly colored fruits, citrus fruits, eggs, chocolate, coffee, fish, seafood, store-bought sausages and baked goods - they often cause allergies. These recommendations are not for lifelong implementation, but only for the first time after the appearance of the rash. If you are aware of a specific allergen, you should avoid it as much as possible.

If it is difficult to establish, then the first suspicions of doctors fall on new care products, cosmetics, washing powder, or a product tried for the first time.

Treatment of urticaria, which is combined with other manifestations of allergies, must necessarily consult a doctor to prescribe a course of therapy.

Other drugs for urticaria

If antihistamines do not provide relief, a course of corticosteroids (injections or tablets) is prescribed. The selection of medications is made exclusively by doctors after a full examination and assessment of existing diseases. The prescribed dosage must be observed, since it is calculated based on the complexity of the disease and the patient’s body weight.

If the drug use regimen is violated, the desired therapeutic effect may not be achieved. How long does it take to clear up hives?

There are acute and chronic course of the disease. The first is when the rash lasts no more than 6 weeks. If it takes longer, we are talking about a protracted illness. When the period of exacerbation gives way to a short remission, and then blisters appear on the skin again, consult a therapist and allergist.

Without treatment, there is a risk of developing severe consequences, including autoimmune ones, which are even more difficult to correct.

Follow all medical advice to get better faster and not make your allergies worse. This will significantly improve your quality of life and give you greater freedom.

The second group is histamine liberators

Histamine liberators include foods that cause specialized immune response cells (mast cells) to release histamine.

This happens when the product is consumed in large quantities. Even if an allergic reaction has not been observed before.

Most often these products include: citrus fruits, pineapples, tomatoes, cocoa, chocolate, seeds and nuts, legumes (in particular soybeans), honey, spices and ester-rich products (horseradish, radish, radishes, mustard) and, of course, fast foods -food stuffed with dyes, flavors and preservatives.

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Fully or partially limited products

The diet for acute/chronic urticaria involves the complete exclusion of such products as fatty red meats, strong meat and fish broths, as well as first courses based on them, duck, goose, smoked meats, most sausages, whole milk, chicken eggs, fish, especially , “red” fish of all kinds.

Citrus fruits, chocolate, seafood (shrimp, mussels, squid), flour products and sweets, honey and honey products (propolis, bee jelly, wax), any salty foods, canned food, pickled vegetables, animal and cooking fats, salty and fatty are prohibited. cheeses, cream, sweet curds, sour cream.

All products containing easily digestible carbohydrates are excluded - sugar and products containing it, honey, jams, preserves, sweets, confectionery, ice cream. Semolina, rice and pasta, and soy are subject to restrictions.

Red and orange fruits/vegetables (tangerines, red apples, oranges, tomatoes, radishes, beets, radishes, carrots, strawberries, strawberries), nuts (especially peanuts and hazelnuts) are excluded from the diet; coffee; vinegar, all seasonings (mustard, ketchup, horseradish, mayonnaise), mushrooms, eggplant, pineapple, melon, butter dough.

The hypoallergenic menu should not include products containing food additives (dyes, preservatives), fruit tea, fruit/vegetable juices from prohibited berries, vegetables and fruits, sweet carbonated drinks and any alcohol-containing drinks.

Table of prohibited products

Blockers of important enzymes that break down histamine (diaminoxidase)

Often, histamine intolerance in the body occurs when it accumulates excessively and the enzymatic system is unable to break it down in a timely and effective manner. In the digestive tract, histamine taken with food is destroyed by diamine oxidase (DAO). The effect of this enzyme is reduced in case of various intestinal diseases, microflora disorders, alcohol abuse, celiac disease and gluten intolerance, as well as deficiency of certain vitamins and minerals.

A deficiency of this enzyme is also caused by taking certain medications (in particular, non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, immunomodulators, antihistamines, antiarrhythmics). The main difference between food intolerance is that it does not participate in the immune system response.

Based on the experience of German colleagues, according to a 2017 study, it is recommended to approach the diet in stages. At the first stage, abstain from histamine products for 10-14 days; at the second stage, under supervision, the product is reintroduced, thus determining histamine tolerance.1 A monthly low-histamine diet can reduce the symptoms of urticaria in adults.2

Diagnosis of urticaria in children

A preliminary diagnosis is made by the doctor after an initial examination of the skin.
The doctor knows exactly what urticaria looks like in a child, so he will not confuse it with manifestations of other diseases. For allergies, the following tests are prescribed:

• general blood test to exclude immune and inflammatory processes;
• allergy tests to identify the allergen.

In some situations, a biochemical blood test and examination for helminthic and parasitic diseases are performed. If necessary, a thyroid examination is prescribed to identify hyper- and hypothyroidism.

What is an allergy?

If you ate one tangerine and there was no reaction, but a box of tangerines was sprinkled on it, then, as we said above, this is food intolerance. Histamine liberators worked.

Since a true food allergy does not depend on quantity, there will be a reaction even from one tangerine slice, and such an allergy can be detected by simple allergy tests. There is an exception in the form of cross food allergies, where a seasonal allergy, say an allergy to pollen, can manifest an allergy to citrus fruits.

A good illustration of an allergic reaction and its difference from a pseudo-allergic reaction is shown in Fig. 1

Figure 1 - Classification of allergic reactions according to A.D. Ado, 1978

Food allergies are most often first identified in childhood. Nutritional disorders in women during pregnancy and lactation play a leading role in the formation of food allergies in a child. Provoking factors include:

• early transfer of the child to artificial nutrition,
• improper introduction of complementary foods,
• diseases of the gastrointestinal tract and hepatobiliary system (diseases of the liver and biliary tract),
• irrational approach to child nutrition, deficiency of essential nutrients.

The causes of allergies in adults most often include diseases of the digestive system, microbiota disorders, disturbances in the functioning of enzymatic organs (bilious, pancreatic), disrupted food intake, independent transition to strict eating styles (fruit-eating, fasting, keto, etc.) without approval with a specialist.

Menu options for the day

Article on the topic

Allergies: causes, symptoms and treatment in case of an acute reaction Breakfast: wheat porridge, tea, green apple

Snack: cottage cheese

Lunch: vegetable soup, meatballs, pasta and dried apple compote

Dinner: vinaigrette, tea with a bun

Breakfast: buckwheat porridge, tea, apple

Snack: coffee with milk, cookies

Lunch: Minced chicken soup, boiled beef stroganoff and mashed potatoes, compote

Dinner: curd pudding, jelly

Breakfast: semolina porridge, tea, apple

Snack: Cabbage and carrot salad

Lunch: vegetarian cabbage soup, baked rabbit leg, stewed carrots, compote

Dinner: milk noodles

Hypoallergenic diet: menu

As you understand, the only way to treat food allergies is to completely eliminate the allergen. No allergen - no problem.

It is recommended to exclude from the diet in case of food allergies:

• citrus,
• seafood,
• rich broths,
• processed meat products,
• mayonnaise, vinegar, mustard,
• radish, horseradish, radish,
• spices,
• whole whey,
• honey,
• alcohol,
• strawberries,
• a pineapple,
• melon,
• sweet carbonated drinks.

What products should you form your diet from in order to reduce the immunological load?

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Reviews and results

A hypoallergenic diet, according to reviews from most patients, minimizes the frequency of exacerbations of food allergies and the severity of clinical manifestations.

• “...I have suffered from food problems since childhood. Since I don’t know exactly what you can and can’t eat, and what product I’m allergic to, I try to stick to a hypoallergenic diet and periodically take Enterosgel”;
• “... A diet combined with antihistamines helps a lot. At the first reaction, I take treatment, start with an adsorbent and go on a diet.”