Tuesday, June 9, 2020

Lifestyle recommendations in management of chronic hives

The previous section discussed the role of medications in management of chronic hives. Medications are effective, but life style changes also impact chronic urticaria.

In 2013, Omalizumab (Xolair) injection trial worked in patients failing high dose antihistamines. In the study, Omalizumab  improved hive and  itch symptoms. Similarly, the placebo group also showed significant  (30-33%) reduction in symptoms  but less than Omalizumab. So what might be the cause  of this placebo benefit?
It is my hypotheses that,

"The  patients knew their adversary and had a greater understanding of the disease process. They were ‘at peace’ with their hives. Their anxiety was less. They were also likely not attributing their hives to 'being allergic to everything'. The exhaustion and stress of hyper-vigilance (being super aware of all actions) reduced."

This brings us to lifestyle recommendations:

1. Take actions to reduce stress. Identify any personal, professional or physical stressors. Once identified, take steps to reduce them.
2. Yoga, meditation and mindfulness help. Anything that can help take your mind off the itching can help the medications help you better
3. Take control of your anxiety. Recognize the contribution of the  positive feed-forward loop where anxiety can  worsen hives.  Worse hives, lead to more anxiety. You get  the picture.


The feed forward loop between anxiety and hives

4. Try to get as much of restful sleep as possible. Sleep is an  unrecognized victim of chronic hives. People with uncontrolled hives do not sleep well for many reasons. Waking up several times a  night to scratch all over is an obvious cause. Medications necessary  to control hives (antihistamines in high  doses) can affect sleep quality.



The feed forward loop between poor sleep and hives

5. Weight can have an adverse impact. The documentary ‘fat, sick and nearly dead’, is about a person whose hives resolve with weight loss. It could be worth  trying since there is not much to lose (except weight). High dose  antihistamines stimulate appetite contributing to weight gain. Corticosteroids (e.g. prednisone) can also cause weight gain. This weight - hives relation could be the third positive feed forward loop.


The feed forward loop between weight gain and hives

6. Take your medications of time!

The steps above should be complementary to the medication regimen as prescribed by your physician.

To jump directly to other sections on this topic
  1. Why do I get hives all the time with seemingly no cause?
  2. What if my hives bruise, blister, scar or heal with marks on skin?
  3. What is happening in skin that leads to chronic hives? 
  4. How to effectively manage hives and why do antihistamines work in most cases?

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