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What are the causes of skin allergy like urticaria?

Prof (Dr) DM Thappa
Associate Professor and Head,
Dermatology and STD Department, JIPMER,
Pondicherry

Q: I am 29 years old, 5’ 9” in height and about 65 kg in weight. For the last 8 years or so I am suffering from a skin allergy during the evening associated with an itchy feeling on my back. Whenever I get this allergy, I take cetrizine hydrochloride, which seems to be working for me. I have been taking this medicine for about 2- 3 years now. Besides this I take finastaride daily for hair loss. Now, apart from this problem I suffer from indigestion and feel full even after taking a small amount of any food. Sometimes I feel as if the food is stuck in my throat. Now, for the past few days I feel as if some pressure is being applied on my chest when I lie down. Is there any relationship between my stomach problem and skin allergy? I have always been an active person and now I feel my life has become sedentary. Please help me.

A:You are probably suffering from chronic urticaria and need to be investigated for various aetiological factors, which may be triggering this reaction like:Aetiological factors (Five Is + others):1. Ingestants:a) Foods - cheese, eggs, nuts, fish, mushrooms, etc.b) Food additives - tartarzine dyes, etc.c) Food preservativesd) Drugs - penicillin, salicylates (Aspirin), sulphonamides (Sulpha antibiotics), 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 a blunt metallicinstrument results in an exaggerated triple response.b) Pressure urticaria c) 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 - urticariah) 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.Consult a dermatologist for a detailed work up and treatment of underlying cause.