What the first 10,000 patients with chronic urticaria have taught me: A personal journey

  • Allen P. Kaplan
    Reprint requests: Allen P. Kaplan, MD, Department of Medicine, Division of Pulmonary Critical Care Medicine and Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC-29425.
    Department of Medicine, Medical University of South Carolina, and the National Allergy, Asthma, and Urticaria Centers of Charleston, Charleston, SC
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Published:December 11, 2008DOI:
      Chronic urticaria remains one of the disorders treated by allergists with which there is (and has been throughout my lifetime) associated myths regarding the cause of the disorder and its treatment that are extremely difficult to dispel. In this brief article I would like to address some of these beliefs, review the literature where it exists, point out where there are gaps in our understanding, and convey some of my own conclusions that will, hopefully, become hypotheses for future investigation. Table I lists the beliefs that I think are false and potentially detrimental to the care of patients. I will expand on each of these.
      Table IMyths about the cause and treatment of chronic urticaria
      Myths about cause
       1. Chronic urticaria is a psychosomatic disorder, with hives as a cutaneous manifestation of an emotional problem.
       2. Chronic urticaria is caused by food additives or is exacerbated by pseudoallergens contained in foods.
       3. Helicobacter pylori causes hives.
      Myths about treatment
       1. Nonsedating antihistamines in recommended doses are as efficacious as sedating antihistamines with much less toxicity.
       2. Data demonstrating sedation with antihistamines as tested in healthy subjects or patients with allergic rhinitis can be extrapolated to the treatment of chronic urticaria.
       3. Thyroid hormone can be used to treat chronic urticaria if thyroid antibodies are present.

      Key words

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