Skin Allergies

Urticaria/Swelling/Redness/Itching/Rashes

Erythema multiforme (EM) can occur as primary skin disorder or as skin manifestation of systemic infection or chronic inflammatory disease; often a manifestation of hypersensitivity to drugs (penicillin, barbiturates); vaccinia, BCG, and poliomyelitis vaccines, herpes simplex, food allergens, and infectious organisms can induce EM; hypersensitivity is a common factor.

Possible Causes of Urticaria:

Physical : resulting from reactions to physical stimuli: from simple contact with furniture, garters, bracelets, watch bands, towels, or bedding. Leisons usually start with 1-2 minutes of contact and erythema, replaced within 3-5 minutes by edema and surrounding reflex urticaria; maximal edema within 10-15 mins; erythema regresses within an hour, edema persists up to 3h.

Associated with other diseases: parasotosis, insect bites, neuropsychiatric disorders, hormonal changes, thyroid disorders, pregnancy, menopause, diabetes, immunulogical alternations, other urticarias, during or following drug therapy, candida albicans, angioedema, hypereosinophilia.

Heat reflex : Urticaria that involves stimulation of sweat gland, lesions are pinpoint wheals surrounded by reflex erythema; wheals arise at or between follicles preferentially on upper trunk and arms.

Drugs: leading cause of urticaria in adults; in children – due to foods, food additives, or infections. Many drugs produce urticaria; most common are penicillin and aspirin.

Food Allergy : IgE-mediated urticaria occurs upon ingestion of specific reaginic antigen: most common are milk, fish, meat, eggs, beans, and nuts; atopic patient experiences urticaria due to IgE mechanisms, basic requirement for food allergy is absorption of allergen through intestinal mucosa.

• • Factors increasing gut permeability – possibly caused by bacterial action, anti-inflammatories, anti-biotics, contraceptive pill, asprin, and food additives.
• • Alterations in gastric acidity, intestinal motility, and function of the small intestine and biliary tract in 85% of patients with chronic urticaria – selective IgA deficiency , gastroenteritis, hypochlorhydria, achlorhydria, etc. may alter barrier and immune function of gut wall.
• • IgG reactions may cause most adverse food reactions – anaphylatoxins

Food additives: are a major factor in chronic urticaria in children; colorants (azo dyes), flavorings (salicylates, aspartame), preservatives (benzoates, nitrites, sorbic acid), antioxidants (hydroxytoleune, sulfite, gallate), and emulsifiers/stabilizers (polysorbates, vegetable gums) produce urticaria in sensitive people. Tartrazine (azo dye FD&C yellow): first food dye reported to induce urticaria.

Food flavorings: Salicylates acid used to flavor foods – cake mixes, puddings, ice cream, chewing gum, and soft drinks. Dietary sources are fruit (berries, dried fruit) – raisins and prunes have highest amounts; also licorice and peppermint candies, moderate levels – nuts and seeds, salicylate is very high in some herbs and condiments – curry powder, paprika, thyme, dill, oregano and tumeric. Other flavoring agents: cinnamon, vanilla, menthol, and other volatile compounds may produce urticaria; also artificial sweetener aspartame.

Food preservatives:

Benzoates: benzoic acid and benzoates are the most common food preservatives; fish and shrimps may have very high levels of benzoates.

Butylated hydroxytoluene (BHT) and butylated hydroxyanisol (BHA): primary anti-oxidants in prepared and packaged foods.

Sulphites: induce asthma, urticaria, and angioedema in sensitive persons: ever-present in foods and drugs.
Food emulsifiers and stabilizers: many foods containing these also contain antioxidants, preservatives, and dyes; polysorbate icecream induces urticaria; vegetable gums (acacia, gum Arabic, tragacanth, quince, carrageenin) induce urticaria in susceptible individuals.

Infections : major causes of urticaria in children; in adults, immune tolerance occurs to many microbes-repeated exposure.

Bacterial infections: contribute to urticaria in two settings:

• - acute strep tonsillitis in children; acute urticaria predominates
• - chronic dental infections in adults; chronic urticaria predominates

Viruses: hepatitis B is the most frequent cause of viral-induced urticaria; also linked to infectious mononucleosis and many develop several weeks before clinical manifestation.

Candida albicans: very common with patients suffering from chronic urticaria. Oral provocation using foods prepared with yeasts, elimination of organism can cure some individuals, patients also responded to ‘yeast free’ diet. This diet excludes bread, buns, sausage, wine, beer, cider, grapes, sultanas, marmite, Bovril, vinegar, tomato, ketchup, pickles and prepared foods containing food yeasts.

Psychological Stress: is also known to trigger urticaria in some individuals. Relaxation therapy and hypnosis may be beneficial in some patients. Stress is known to decrease intestinal secretory IgA.

Therapeutic Considerations suggested by ICIM Medics

- Try to identify the initiating factor

- Food Allergy : elimination diet with monitored re-introduction of suspected foods.

- Medications: identify and coordinate cessation of offending agent. Cease all unnecessary medications. Consult your GP before doing so.

- Environmental exposure : arrange patient disengagement from offending agent.

- Underlying infection : immune support and indicated anti-microbial therapy.

- Initiate anti-inflammatory program e.g. potassium iodide

- Herpetic infection: zinc sulfate locally.

- Ultraviolet light therapy: some benefit is chronic urticaria; both ultraviolet A (UVA) and B (UVB) have been used to treat urticaria linked to physical stimuli.

- B12 supplements reported value in treatment of acute and chronic urticaria.

- Quercetin – 250mg 20 mins before meals has offered stabilization and inhibits many pathways of inflammation.

- Vitamin C has also been found to provide assistance.

- Relaxation techniques conducted daily are also recommended.

For more information on this topic please call ICIM Medics on +353 45 844 819 or email us at info@icim.ie

Tags: Allergy, Rashes, Skin Conditions