Q: I am a 56 year old housewife with two grown up sons.I had both ceasarian births.I also had hysteroctomy performed in 1996, to remove uterine fibroids and menoeraegia.I have been suffering from Hypothyroid problem since 1996.For the past 3 years I have been suffering periodic attacks of severe upper stomach pain along with allergic reaction of hives (rashes and swellings) all over the body with itching. Only two days back I had the latest of such attacks and was treated by Changi General Hospital here in singapore.I was discharged after 3 hours of observation and administration of oxygen and saline drip.My question is the possible causes of such allergic attacks and what precautions to take to avoid such attacks in future.

A:There are a number of causes for urticaria. Some lines straight lifted frommy book areAetiological factors(5 Is + others ):1.Ingestants:a) Foods - cheese, eggs, nuts, fish, mushrooms, etc.b) Food additives - tartarzine dyes, etc.c) Food preservativesd) Drugs - penicillin, salicylates, sulphonamides, etc.2.Injectants:a) Insect bitesb) Injection - drug, sera, blood, etc.3.Inhalants:- Pollens, animal dander, etc.4.Infestation by parasites:- Amoebiasis- Giardiasis- Hookworm- Round worm5.Infection - focus in teeth, tonsils, sinuses or elsewhere.6.Physical causes/factors (Urticarial attacks are brief lasting for 30 to 60minutes):a) Dermographism (write-on-skin) - stroking the skin with blunt metallicinstrument results in an exaggerated triple response.b) Pressure urticaria - pressurec) Cholinergic urticaria - decrease in core body temperature (smallintensely pruritic papules)d) Cold urticaria - cold air or watere) Heat urticaria - heated objectf) Solar urticaria - sun exposureg) Exercise induced - exerciseh) Aquagenic pruritus/urticaria - contact with wateri) Vibratory urticaria - handling vibratory instruments7.Contact urticaria - On coming in contact with potato, onion, nitrogenmustard etc, develops urticaria at site of contact.8.Rule out underlying collagen vascular disorders, malignancy or anypsychogenic cause.9.Idiopathic - no cause found.Diagnosis and treatment:How to proceed in a case of urticaria?1. Urticaria due to physical causes or drugs excluded by history andexamination.2. Complete food elimination followed by gradual introduction of one dietaryelement at a time helps in detection of food induced urticaria.3. Mask use/nasal filter use/change of place may work for inhalants.4. Stool examination by concentration method on 3 consecutive days -infestations are detected and treated accordingly.5. Look for a focus of infection. If not possible to detect, give a courseof antibiotics. Still no response, change the antibiotic.6. If still getting urticaria, then look for other causes and treatsymptomatically.· Soothing lotion for topical application given during attack of urticaria.· Antihistaminics -H1 antagonists orH2 antagonists orBoth together Old sedative antihistaminics are still better during acute episodes.· Corticosteroids may be required to tide over a crisis· Adrenaline used in anaphylaxis· Other measures like intravenous fluids, oxygen use may be required.Probably a detailed history and examination can find out the cause ofallergic rashes in you. It could be due to same cause which is causinghypothyroidism or due to drugs used for it.