Hives (Urticaria)

When you suddenly develop extreme itchiness together with swelling of your body in patches or lumps, chances are you have hives (or in medical terms, urticaria).

This condition can progress further to swelling of the eyes and face and worse still, go to a very dangerous condition of the patient collapsing within minutes with difficulty in breathing. This is called anaphylaxis or allergic shock.

Fortunately for most patients, they only have transient hives but unfortunately, most do not know the cause.

Generally, most hives are caused by various drug reactions but some are caused by food, in particular seafoods of various kinds, colour additives and eggs.

There is also a kind of hives caused by PHYSICAL means, such as cold, heat or even physical contact. This condition is called Physical Urticaria.

The treatment of urticaria includes the avoidance of the causative factors and the treatment of a superficial fungus which causing the condition.

Lesson: HIVES TREATMENT INCLUDES TREATMENT OF A SUPERFICIAL FUNGAL INFECTION

And my learning continues.

Egg Allergy and Avoidance

Lets say you (or your child) has been diagnosed with egg allergy and you have been told to totally avoid eggs, as ingestion of eggs will cause your allergy to worsen.

It is very easy to say, "avoid eggs at all cost" but in practice, it takes a lot of effort to do so.

Lets examine what type of food has eggs:

• All fried food that contains batters (flour with eggs added) e.g. goreng pisang (banana fritters)
• Most pastries and bread contains eggs
• Most types of biscuits in its content or they are glazed with eggs
• Mee noodles (egg noodles - the yellow ones) especially those instant ones
• Ice cream, chocolates, cakes and the list goes on and on

I am still learning from my patients which foods contain eggs and which do not. Reading labels on the food packet usually does not help (as there is no law on strict labelling in Malaysia, but your country may have it) and as such imported food need not state all the ingredients. So if you are unsure whether a particular food has egg or not, avoid it!

Lession: FOOD AVOIDANCE IS NO EASY TASK BUT ABSOLUTELY NECESSARY

and my learning continues...

Multiple Allergies and Growing Up

This young man first saw me at the age of 12 with very severe eczema and he was feeling terrible and really, who can blame him?

He was first diagnosed to have house dust mite, egg and milk allery and later with the help of his mum and himself, we gradually realised that he also had chrome, nickel, alcohol, detergent and mint allergy. That's quite a number.

His condition improved with time but he was not happy as he was the smallest boy in class and by 15 had not attained puberty. I assured him that with the elimination of his allergies, he would grow. Of course, being the awkward age of 15, I wasn't sure if he believed me.

Imagine my pride that he is now grown and training for a triathron! In fact when I met him at the park where I have my weekly walks, he challenged me for a race (with handicap of course... I'm past my prime) with the bet that if he won, further medical fees would be waived. Clever boy.

Because he was getting better in the course of his treatment, he also mentioned that he wanted me to stay alive as long as he lives so that he would always be well. What a compliment, I thought.

Allergies May Have Multiple Causes. Doctor and Patient Detective Collaboration Helps.

My learning continues.

The Extremes of Allergies

An allergy can present as two extreme manifestations; I had two cases today to demonstrate my point.

One young man came to see me for a patch of thickened skin rash at the back of his neck, about the size of a ten-cent coin. He was diagnosed to have chromium allergy (i.e. allergy to chrome). It was due to a chain he was wearing for some time, a gift from his girlfriend.

The other patient had seen me 5 years ago and was diagnosed as having egg allergy and has actually got well after treatment by me. This time, he had a scaly rash all over his scalp, his face and his whole body. His condition is known as exfoliative dermatitis, a severe allergic reaction. His present severe manifestation is in contrast with what he experienced 5 years ago - only a mild skin rash. This illustrates the unpredictability of allergy.

I can remember some other cases I've had of extreme allergic manifestations.

Many years ago, one patient of mine had an allergy to yellow dye additive (as found in certain foods) and was admitted to a hospital for an anaphylactic reaction (i.e. allergic shock) in Sydney after taking some butter for breakfast. After that incident, she kept an Epipen (Epinephrine Auto-Injector) with her. She had another attack in Kuala Lumpur when she was back in Malaysia but after I prescribed her with probiotic, she has never had another attack since. 

Another patient is the daughter of a squash buddy of mine who had peanut-induced anaphylactic shock, which can cause death very rapidly, like 5 minutes. He brought her to see me, and after treatment, she has not had an attack since.

Allergy can range from the very mild to very life treatening

My learning continues...