Urticaria, Itchy Rash, Hives Treatment | Chronic Idiopathic Urticaria Diagnosis | Chet Tharpe MD

Hi, my name is Dr. Chet Tharpe, and I'm a board certified allergy specialist in South Carolina.
Just to ensure we are all on the same page, urticaria is just the big medical word for hives or raised, red, itchy patches on the skin.
And, this video is in reference to a post on the chronic idiopathic urticaria support group on Facebook. It's from a member who reports that she's new to the page and that this is really her first chronic idiopathic urticaria or CIU experience.
She’s been dealing with Chronic Idiopathic Urticaria for about six months and basically she's asking about others' experiences and insights into the condition. She is confused with all the various treatment options she’s read about and her physicians' evaluations. She also wonders if her condition could be autoimmune.
She said she recently had blood work done but does not have the results yet. Her medicines currently are double doses of antihistamines that do not seem to be helping much.
She reports she has bad side effects with hydroxyzine so is also leery about new meds.
So, a lot is going on there.
But in summary, you've got a patient who's new to the group with six months of horrible chronic idiopathic urticaria, and just is seeking whatever knowledge and insight she can get.
I think it’s very admirable she’s reaching out for any information and advice and if you or a loved one has CIU, you can probably relate.
Chronic idiopathic urticaria, or ciu is one of the most difficult diagnoses I deal with as an allergist. And the obvious main reason is that it is “idiopathic” which means we do not know what the cause is. I often like to joke that idiopathic means the doctor is an idiot and can't figure it out.
All joking aside, believe it or not, the general medical consensus is not to perform any testing unless there is a good history to suggest testing is needed such as allergy testing, or bloodwork for medical conditions such as a thyroid abnormality or autoimmune condition.
Please make no mistake that this statement means we should not look for a cause.
Obviously, it is likely tough for you as the patient to hear that the recommendation is not to test at all. It may make you feel like nothing is getting done and a cause is not being explored. In my early years of treating CIU, I felt the same and ordered blood work or other tests on the vast majority of my patients. And I just know this from experience from seeing 1000s of CIU patients that 99.9% of the test results and bloodwork comes back either normal or just does not assist in the treatment and management of the CIU. Only rarely have I picked up a thyroid issue or similar medical cause that once treated, calmed the CIU. And in these very few instances, the testing was actually predictable as the patient had other clues in the medical history which indicated something was not right. For example a patient with a possible thyroid issue had weight gain, cold spells and constipation and sure enough, her thyroid levels were very low. Allergy testing, which is what we love to do as allergists is usually not helpful either. It can be negative or on the opposite end of the spectrum show lots of positive reactions that have nothing to do with the actual CIU. So again that’s where a good history of triggers that guides the testing is so important.
So the best investigation into a cause is really not the actual tests themselves. In actuality, the best investigation is the thorough history, confirming first we are in fact dealing with CIU and then asking questions about all possible triggers and medical causes. We need to spend time with you by asking a bunch of questions and getting as much information as possible. We shouldn't just rack up several thousands of dollars in testing just to test to make ourselves or you feel as though we are doing something if the testing is likely not to be helpful. And only after this thorough in-depth history is done, testing should only be performed if absolutely indicated.
So let’s briefly discuss how we first confirm this rash is really urticaria and not something else. Urticaria, which again is the big word for hives, are raised red itchy patches that can appear anywhere on your body that typically lasts for no longer than 24 hours in one isolated spot.
After 24 hours, that one isolated hive should go away. For example, let's say you have a hive on your forearm, that one spot you could circle it with a pen, should not last longer than 24 hours. You may have other hives all around it, you may have hives on other areas of the body, but that one hive should go away in about 24 hours.
You will find more details in my blog post from the link below:
https://chettharpemd.com/chronic-idiopathic-urticaria-diagnosis-itchy-rash-hives-treatment
Connect me on:
Facebook: https://www.facebook.com/chettharpeMD
Website: https://chettharpemd.com/
Email: ctharpe1822@gmail.com
Phone: 608-305-4950

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