Chronic urticaria and Cough for the past 4 yrs - #11347
21 yr old female facing this problem from more 4 years sometimes I am completely fine but sometimes I face a lot of this. Case Summary: Recurrent Urticaria with Intermittent Cough Chief Concerns Recurrent skin welts/rashes and itching, often appearing after bathing or where clothing rubs/presses. Intermittent cough Both skin rash and cough episodes improve with cetirizine. Pattern & Triggers (Patient-Reported) Skin: Raised red lines/welts where clothes press or scratch → consistent with dermographism/pressure urticaria. Rashes sometimes after bathing and on hot days or mild exercise → suggests cholinergic (heat/sweat) urticaria. Episodes last hours to a day; swelling/itch varies; respond reliably to cetirizine. Cough: Occurs in phases; often with throat or nasal irritation. Improves with cetirizine, suggesting histamine-mediated mechanism (allergic rhinitis/post-nasal drip). Relief noted: Cetirizine helps both cough and rash. Moisturizer helps itch. Possible aggravators: Dust at home, bathing, clothing pressure, heat/sweat. Past/Relevant Data Total IgE: 163.7 (mildly elevated) → consistent with allergic tendency. Vitamin D: Previously 18 ng/mL (deficient). Lifestyle: Vegetarian, sedentary, >8 h sleep, no known chronic diseases. Medications tried: Cetirizine PRN, occasional cough syrup. Symptom Behavior Cough and rashes appear in an alternating pattern: when one flares, the other subsides. Both improve with cetirizine, but recur once the effect wears off. Current Concern Despite temporary relief with cetirizine, symptoms recur repeatedly. I want to understand the underlying cause of this alternating pattern of cough and rashes, and why antihistamines are the only thing that consistentlly working on this? Why amIfacing this problem how can I better
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Doctors’ responses
Recurrent urticaria and intermittent cough can be quite challenging, particularly when they persist over a long period. This pattern of symptoms you’re experiencing suggests a strong allergic component. The fact that cetirizine, an antihistamine, provides relief indicates that histamine release likely plays a significant role in both your skin and respiratory symptoms. In such cases, especially with a raised IgE level, which indicates an atopic or allergic tendency, identifying and avoiding triggers becomes crucial.
Your symptoms after bathing, sweating, and due to clothing pressure suggest types of physical urticaria, such as cholinergic and dermographic urticaria. Avoiding hot showers, wearing loose-fitting clothing, and maintaining a cool environment can help minimize these triggers. Dust and possibly other allergens in your living space might be exacerbating your symptoms, so it’s worth exploring steps to reduce dust exposure, like regular cleaning, using allergen-proof covers on pillows and mattresses, and perhaps considering an air purifier.
The cough suggests post-nasal drip or an allergic rhinitis component, which aligns with your response to cetirizine. Maintaining good hydration and using saline nasal sprays might help reduce mucous build-up and throat irritation. Ensuring that Vitamin D levels are optimal, considering your deficiency, might not directly alleviate allergic symptoms but can support your immune system overall.
Long-term management might benefit from daily antihistamine use rather than as needed if your doctor agrees. Additionally, exploring other medications like leukotriene receptor antagonists or considering allergen immunotherapy could be worthwhile, depending on more detailed allergy testing results.
However, given the chronic nature and complexity, it might be valuable to work with an allergist or dermatologist who can conduct specific allergy testing, like skin prick tests, to pinpoint particular allergens contributing to your symptoms. They can also help tailor a precise and comprehensive management plan.
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