A Perspective on Food Allergies

A food allergy is a type 1 hypersensitivity reaction which occurs in 6% to 8% of children and about 2 % of the adult population.

Arm RashThis ailment is considered to arise in those who have genetic predispositions together with sudden exposures to allergens during the early years of their life as an effect of suffering from gastrointestinal, respiratory tract or nasal mucosa.  It has certainly been proven to be caused by the proteins found in some foods.  Once ingested and during the digestion process, the immune system incorrectly identifies the protein as a foreign body.  There are some proteins in food that are not absorbed correctly during the process of digestion or absorbed into the body, and they are marked by the immunoglobulin E (IgE).

IgE is an antibody which is formed plasma cells and lymphocytes which respond to the stimulus created by the immunoglobulin.  This antibody is solely involved in the allergic reactions or disorders and even some parasitic functions from which we suffer.  Through ongoing research a second type of food allergy has also been identified one which is classed as a non-IgE syndrome.  This is one in which the T-cells play a vital role.

There are many foods around these days which can trigger allergic symptoms or reactions.

Woman With LobsterAny food can contain an allergen that results in anaphylaxis (a severe, whole-body allergic reaction). There are however some more common offenders such as seafood (lobster, shrimp, crabs, clams, some types of fish), legumes (beans, peanuts, licorice and peas), seeds (sunflower, sesame, caraway, cottonseed, flaxseed and mustard), berries, tree nuts, milk, buckwheat, egg white, and chocolate. Tree nuts and peanuts (e.g. cashew, walnut) allergies are responsible for most severe food allergy reactions. Some 70% of children with peanut allergies, their symptoms develop right from their very first exposure to the food, which has tended to suggest unknown exposure through breast milk or another source.

Pregnant women as well as those breast-feeding who are known to have a family history of allergies, namely mother, father, or sibling of the unborn infant with asthma, eczema or hay fever should steer clear of peanuts and foods which contain peanut traces whilst pregnant as a precautionary measure. One of the dangers of food allergy is that they may be hidden in other foods and not apparent to people who are susceptible to the allergen. For example, peanuts and peanut butter are often used in salad dressings and Asian, African, and Mexican cooing and may result in severe allergic reactions, including anaphylaxis. Previous contamination of equipment with allergens (e.g. peanuts) during preparation of another food product (e.g. chocolate cake) is enough to produce anaphylaxis in people with severe allergy.

Peanut and Medi-TagPeanut allergy is the most frequent cause of anaphylaxis, and allergic reactions to peanuts can include swelling of the throat, making it difficult to breathe, constriction of the airways, hypotension or decrease in blood pressure leading to shock, rapid pulse, dizziness and loss of consciousness. Some people are also allergic to wheat. Unlike peanuts, wheat allergy is rare.

It normally presents itself as a food allergy but it can also be a type of contact allergy following an exposure to wheat. Like all types of allergies, wheat allergy involves the immunoglobulin E, and it has several types as well.  Some of these include gluten allergy, wheat pollen and grass allergy, and albumin and globulin allergy.  Wheat allergy symptoms consist of eczema, hives, asthma, hay fever, angioedema or swelling of tissue due to leakage of fluid from the blood vessels), nausea, abdominal cramps and vomiting. The symptoms of allergies may vary from person to person as well as the amount of food ingested to cause the reaction.

Cocoa Powder and SpoonChocolate is by far the most well-loved food for everybody, but it can be a cause for allergy and anaphylaxis.  Like wheat allergies, a cocoa allergy or an allergic reaction to the cocoa bean is very rare. Since chocolate product contains many ingredients such as peanuts, soy, milk and wheat, most chocolate allergic symptoms are caused by these add-on ingredients. After ingestion of the chocolate, classic clinical symptoms will follow which includes: hives, pruritus (itching), eczema, wheezing, coughing, laryngeal edema and gastrointestinal symptoms (itching, swelling of the tongue, abdominal pain, nausea and vomiting, and diarrhea).

A careful diagnostic workup is required in any person with suspected food hypersensitivity.

Included in the diagnostic workup will be a detailed allergy history, a physical examination, and pertinent diagnostic tests. Skin testing is use to identify the source of symptoms and is useful in identifying specific food causative agents.

Therapy for food hypersensitivity includes elimination of the food responsible for the hypersensitivity. Pharmacologic therapy must be undertaken for those who cannot are not able to avoid exposure to the foods which set off the reaction and also for those individuals with numerous food sensitivities and who are not responsive to any of the avoidance measures available.

Medication therapy involves the use of histamine blockers, antihistamines, corticosteroids, and cromolyn sodium. Another essential aspect of management is teaching the person how to identify and cope with the early stages of a severe anaphylactic response. There are quite a few food allergies which will dissipate over time and this appears to be more the case with children. Approximately a third of the proven allergic reactions will disappear within a period of between 1 to 2 years provided the individuals are carefully and avoid the foods which set it off in the first place.

Peanut ButterHowever, a peanut allergy has been known to continue throughout adulthood in some individual cases. The individual suffering with the allergy should also be extremely aware of the importance of assessing the foods that are prepared by other people for the obvious, as well as hidden sources of food allergens and must pay particular attention to the avoidance of locations and facilities where those allergens are likely to be present.

Food PreparationCareful note should also be taken to read food labels and monitor the preparation of foods by others to be sure that exposure to even smallest amounts of allergenic food is circumvented. Most importantly, the person, along with his family must know the signs and symptoms of an allergic reaction and must be proficient in emergency administration of first aid medication and treatments.

Understanding Hives Better

The human body is menaced by a host of potential invaders-allergens as well as microbial organisms- that constantly threatens its defenses.

The Human BodyOnce the defenses have been penetrated the organisms and allergens, if left to carry on their path of destruction and not treated, they can disrupt the enzyme system in the body and destroy some of the most vital tissues.  In order to guard against these types of agents, the human body is prepared with an elaborate resistance mechanism. One of the most effective defense mechanisms is the body’s capacity to equip itself rapidly with weapons, namely the antibodies.

Antibodies react with antigens (foreign bodies) in a variety of ways. The antibodies prepare the antigens so that the phagocytic cells (cells that eats or ingests microorganism and foreign particles) of the blood and the tissues can dispose of them. However, although this system is normally reasonably protective, in some cases the body can produce an overstressed reaction to specific antigens.  This over-reaction leads to hypersensitivity or an allergic episode.

Somewhat a great number of allergic reactions are literally a materialization of tissue injury which comes from an interaction between antibodies and the antigen. Allergy is an inappropriate and often harmful response of the immune system to a normal harmless substance or substances. In this case, the substance is referred to as an allergen. Allergy is a hypersensitive reaction to a specific antigen that is initiated by immunological mechanisms and is usually mediated by the immunoglobulin E (IgE) antibodies, which are produced in response to the allergen. Once the human body meets an antigen, generally a protein which the body’s defense system recognizes as foreign, a chain of events occur in order to attempt to make the foreign element harmless.  It follows that it will then be destroyed and remove from the body completely. When lymphocytes (white blood cells which provide means for specific and nonspecific immunity against antigens) respond to the antigens, antibodies are produced.

Allergice Reaction on LipsMost allergic reactions, well at least the more common ones, are triggered when a susceptible person’s immune system reacts to a particular substance, one which is usually harmless to other people, but for someone who suffers hives can kick off an attack, things such as dust particles, plants, flower pollen, and sometimes pet hair. Internal body system inhibitors release a particular type of chemical into the body which will either result in a mild form of hives appearing or possibly even a life threatening episode – this can vary dramatically.  The numerous cells and organs which go to make up a person’s immune system secrete various substances which are vitally important and need to work collectively to make sure that there are sufficient defenses against inflections.  This needs to work in such a way so that there is no destruction of the body’s tissues due to an overly aggressive reaction.

Even though the human immune system protects against many infectious and foreign antigens, immune reactions can themselves cause injury or disease.  An immune response to an antigen may result in sensitivity when challenged with that antigen: hypersensitivity is a manifestation of unwarranted or uncharacteristic immune responses (from Abbas and Lichtman 2004). A hypersensitivity reaction is an atypical, heightened response to any type of stimulus. It usually does not occur with the first exposure to an allergen. Rather, the response follows re-exposure after sensitization (exposure to allergen that results in hypersensitivity) in a predisposed person. Sensitization initiates the humoral response or buildup of the antibodies.  Hypersensitivity has been classified into specific types of reactions. The most common are identified as either type I or type IV hypersensitivity reactions.

The most severe form of hypersensitivity reaction and the most severe immune-mediated reaction is anaphylaxis.

PollenAn un-anticipated severe allergic reaction that is often explosive in onset, anaphylaxis is characterized by swelling within a number of tissues which can include the throat, and is often accompanied by bronchospasm, hypo tension and cardiovascular collapse in the more severe cases. Type I is an immediate reaction beginning within minutes of exposure to the antigen.

This reaction is mediate by the IgE antibodies. IT typically occurs on re-exposure to a specific antigen and requires the release of pro-inflammatory mediators.  During re-exposure, the antibodies attach themselves to receptors of the membrane cells which are found in connective tissues.  This primary chemical mediators are responsible for the symptoms of type I hypersensitivity because of their effects on the skin, lungs, and gastrointestinal tract. Clinical symptoms are determined by the amount of the allergen, the amount of mediator released and the sensitivity of the target organ, and the route of allergen entry. Type I hypersensitivity reactions may include both local and systemic anaphylaxis.

Urticaria or commonly known as hives, is a form of hypersensitive allergic reaction (Type I) on the upper layer of skin which can be distinguished by an immediate appearance of pink bumps or elevations which can vary  in size and shape are likely to itch, and can generally cause discomfort to that area. They may involve any part of the body, including the mucous membranes (especially those of the mouth), the larynx (sporadically causing severe breathing complications), and the gastrointestinal tract. If left untreated, this can progress to a more serious type of allergic reaction, and urticarial rash, which entails the more profound layers of skin.  This then results in more distributed distensions as opposed to the discrete lesions characterized with hives. On occasions, this reaction can literally cover a person’s entire back. The skin over the reaction may appear normal but often has a reddish hue. The skin also does not stay depressed when pressure is applied, as ordinary swelling does.

HivesThe areas which are more often affected are the cheeks, hands, feet, eyelids, lips, tongue and genitalia; the mucous membranes of the larynx, the bronchi, and the gastrointestinal canal may also be affected however this is more particularized in the genetic form. Swelling may appear suddenly within a few seconds, or minutes, or in some cases much more slowly, for example after one or two hours. In the latter case, their appearance is often preceded by itching or burning sensations. Seldom does more than a single swelling appear at any one time, although one may develop while another is disappearing. Infrequently, swelling recurs in the same region. Individual lesions usually last from between 24 to 36 hours. On rare occasions, swelling may recur with remarkable regularity at intervals of 3 to 4 weeks.

Hereditary Urticaria, although not an immunologic disorder in the usual sense, is incorporated due to its similarity to type I Urticaria and because of its potential to cause serious harm to the immune system. Symptoms are caused by swelling of the skin, the respiratory tract or the digestive tract. Attacks may be precipitated by trauma, or they may seem to occur spontaneously.

When skin is involved, the swelling usually is diffused, does not itch, and usually is not accompanied by urticaria. The gastrointestinal tract swells and may cause abdominal pain, severe enough to suggest surgery. Typically, attacks last 1 to 4 days and are harmless: however, attacks can occasionally affect the subcutaneous and sub-mucosal tissues in the region of the upper airway and can be associated with respiratory obstruction and asphyxiation(dying from lack of oxygen).  Statistics show that there are around about 85% of people who suffer from this complaint – this percentage have one non-productive gene.  The remaining 15% have a gene mutation

Blood Cells and Foreign BodiesDuring an attack of hives, proper management must be established and should be given promptly to avoid suffocation due to asphyxiation  and anaphylactic shock. Attacks usually subside within 3 to 4 days, but during this period of time the person should be observed carefully for signs of laryngeal abstraction, which may necessitate tracheotomy as a life-saving measure. Epinephrine, antihistamines, and corticosteroids are usually used in treatments, but their success is limited. Nonetheless, before anything else, prevention is still the best way to combat an urticarial attack.

Strict avoidance of potential allergens is an important preventive measure for  a person who is at risk for anaphylaxis. For instance, the person at risk for anaphylaxis from insect stings should avoid areas populated by insects and should wear the appropriate clothing, use insect repellent, and take care to avoid further stings.  If avoidance of exposure to allergens is impossible, the person should be instructed to carry and administer epinephrine to prevent an anaphylactic reaction in the event of exposure to the particular allergen. People who are sensitive to insect bites and stings, those who have experienced food or medication reactions, or who have idio-pathic or exercise-induced allergic reactions should always carry an emergency  kit which contains epinephrine.

Screening for allergies before a medication is prescribed is an important preventive measure as well.

A careful history of any sensitivity to suspected antigens must be obtained before administering any medications, particularly in parenteral (oral) form, because this route is associated with the most severe type of anaphylaxis.  The person must be assessed first for risk of any allergic reactions. They are asked about previous exposure to contrast agents used for diagnostic tests and any allergic reactions, as well as reactions to any medications, foods, insect stings, and latex. People who are prone to any type of anaphylaxis should wear some form of identification, such as a medical alert bracelet, which names the certain allergies to medications, food, and other substances.

Dust MitesManagement for urticaria depends on  the  severity of the reaction. Initially, respiratory and cardiovascular functions are evaluated. If the patient is in cardiac arrest, cardiopulmonary resuscitation, or referred to more commonly as CPR is initiated. Oxygen is provided in high concentrations during CPR or if the person is having difficulty in breathing, cyanotic (oxygen deprived), or wheezing. Epinephrine is administered in the upper extremity or the thigh and may be followed by continual intravenous fluid infusion. Antihistamines and corticosteroids may also be administered to prevent recurrences of the reaction and to treat urticaria. In patients with episodes of bronchospasm  or a history of bronchial asthma corticosteroids, it may also be given to improve airway patency and function. If hypo tension is unresponsive to vasopressors, glucagon , a  peptide hormone that decreases blood glucose levels, may be administered intravenously(through the vein) for its fast working effects.

People who have experienced anaphylactic reactions and received epinephrine should be transported to the local emergency department for observation and monitoring because of the risk of a rebound reaction 4 to 10 hours after the initial allergic reaction. Those individuals who suffer reactions are observed closely for between twelve to fourteen hours within a facility which is able to provide any necessary emergency medical administration. Due to the potential for recurrence, patients with even mild reactions must be informed about the risks. Education and proper health advice by a health care provider must be exercised to prevent the attack. More so, individuals who are prone to allergies must be vigilant and REL’s-reliant when it comes to prevention and self-care.

Children and Hives

Child with Severe HivesHives or urticaria is a common disorder causing severe itching of the skin where wheals and swelling may occur.

True causes of the condition have been known to contribute a great deal, resulting in various physiologic immune responses. Sometimes a person may be allergic to certain foods, medicines or even flora and fauna.  Alternatively there are other times when the itching may rise from some focus of infection within the body. Insect bites also produce urticarial receptions in certain people.

 

However, more often than not, the condition is coupled with some form of allergic reaction which can cause an array of symptoms. For the most part, hives are commonly linked to some of these frequent allergens which include, but are not limited to:

  • pollen
  • shellfish
  • tree nuts
  • milk
  • fruits
  • pet hair

It can also be caused by exercise, stress, too much exposure to the sun, infections, applying excessive pressure to the skin, and excessive scratching. Unfortunately, not everyone is immune from this kind of condition and children can be affected with hives too.

Childs FaceChildren who suffer with urticarial attacks or hives usually experience red and swollen skin. Thick welts or inflamed skin can be seen throughout various parts of the body. These generally tend to appear suddenly and remain for several hours, but they do then slowly disappear.

Itching is definitely one of the few symptoms for which there is never any argument during an urticarial attack.

About two hundred years ago it was appropriately described “that disagreeable sensation which excites the desire to scratch.” There couldn’t ever be a better description given than this one. Every human being finds some irritable place on their skin at one point or another, one which they scratch; usually the sensation is so mild that they don’t notice it. The fact still remains that we all scratch, at least occasionally. In the case of hives, there is constant itching which unfortunately is more likely to be a distress signal indicating a more aggressive anaphylactic reaction is taking place.

Generally, the thick red welt of hives within the skin happens when histamine/heparin is released into the blood human stream by the mastocyte (also referred to as a “Mast Cell”).  Histamine is an organic nitrogen type element which plays a very important part in everyone’s immune responses.  The mastocyte, or mast cell releases what is known as “stored granules of histamine” into the blood. Maximum intensity is achieved within about 15 minutes following antigen contact.

Childs BackThe effects of histamine being released includes: redness, localized swelling in the form of wheals; itching; contraction of the bronchial smooth muscles resulting in wheezing and a sudden contraction of the walls of the bronchioles; widening of the small capillaries and contraction of the bigger vessels; increased release of gastric and mucosal cells, which results in diarrhea. The actions caused by the Histamine result in stimulus of histamine 1 and 2 receptors which can be found in different types of which blood cells in our immune systems, and more particularly, the T-white blood cell suppressor cells and basophils.

To stop the abnormal production of histamine, antihistamine drugs are administered which stops the attack.

RASTPrior to any treatment being given, children, just like adults, should have a comprehensive allergy history and a thorough physical examination carried out in order to provide useful data for diagnosis and management.  Diagnostic evaluation of a child, especially if they are suffering with an allergic disorder commonly includes blood tests, smears of body secretions, skin tests, and radioallergosorbent tests or “RAST”. As soon as a diagnosis is ruled out, a treatment plan can be started.
The goal of therapy in children with hives is to provide relief from symptoms and avoiding the progression of the disease to a more chronic condition. These therapies can contain one or sometimes all of the following interventions:

  • immunotherapy
  • avoidance therapy
  • pharmacotherapy

ImmunotherapyIn avoidance therapy, every effort is made to eliminate the allergens that act as precipitating factors. Simple measures and environmental controls are often extremely effective in decreasing the symptoms. Due to multiple allergens which are quite often more complicated, multiple measures to avoid exposures to allergens are often necessary. Many different types of research has been undertaken and it has shown that multiple avoidance strategies tailored for a specific person’s risk factors can certainly reduce the severity symptoms, the number of work or school days missed because of symptoms, and the number of unscheduled health care visits for treatment. In many cases, it is impossible to avoid exposure to absolutely every single environmental allergen, so pharmacologic therapy or immunotherapy is needed.

Antihistamines taken by mouth are easily absorbed into the body and are the most effective when given at the first occurrence of the symptoms because they prevent development of new or other symptoms. The effectiveness of these medications is limited to certain individuals with hay fever and mild asthma, including a more severe case of hives. Antihistamines are the major class of medication prescribed for the symptomatic relief of pretty much all allergies. The major side effect is sedation. Other side effects include nervousness, tremors, dizziness, dry mouth, palpitation, anorexia, nausea and vomiting.

EpiPenOn the other hand, administering Epinephrine is still the most widely used medication, both in children and adults, for severe cases of urticaria.  It is a powerful histamine blocker and has rapid onset effects. The downside of it is that, it only lasts for a short amount of time within the body.  The commercial EpiPen which was created by Dey Pharmaceuticals in Napa Valley is a first-aid device that delivers a specific dose of 0.3 mg or 0.15mg of Epinephrine when required.  The auto injection system requires no preparation, and the self-administration technique is very simple. The person suffering from hives must be given the opportunity to demonstrate the correct technique for use. As far as the technique is concerned for children, their parents and/or guardians should be well-informed about correct technique, as well as understanding the proper strategies to avoid exposure of the child from threatening allergens.

Immunotherapy, also referred to as “vaccine therapy for allergies”, entails gradual administration in increasing doses of quantities of the relevant allergens to the patient, this continues until a dose is reached which then becomes effective for the patient in reducing the allergy, such that any natural exposure to the said allergen is no longer an issue.  Therapy of this nature is an additional option available to that of pharmacologic therapy.  It can certainly be used where the avoidance of allergens is not possible. Immunotherapy has been the most effective for allergies to ragweed pollen; however, treatment for grass, tree pollen, cat fur, and domestic dust mite allergies has also been extremely effective.

AntihistaminesProtecting any child from an urticarial attack will take vast amount of guided information and research during the treatment of the condition.  Given the fact the children are generally vulnerable with regard to their susceptibility to the disease, guidance, as well as careful monitoring is vital. Self-medication is not advisable because it may aggravate and/or worsen the condition. Therefore, it is always best to consult a pediatric physician about treatment and therapy your child.

Hives: Causes, Signs and Treatment

Hives or urticaria is a condition in which white elevated areas with painful itching appear on the surface of the skin.

Hives on BackThese eruptions can often follow after eating certain foods, or exposure to particular atmospheric conditions. Theoretically these or other physical influences can alter the chemistry of the skin so that the absorption of certain substances will produce the rash. Psychological factors may also be one of the causes of hives.

Hives often appear and disappear within the space of merely hours, but may persist for longer periods, become chronic, or recur persistently. More frequently than not, they will disappear after several days unless the person irritates or infects them – for example, by scratching.

Generally, the rash does not always appear in the same spot and in most cases, considered not to be a serious condition. However, it can be very irritating and annoying, and can eventually lead to a more serious complication.  In some cases, the hives can make breathing more difficult due to the constriction of the airways to the lungs. Hence, medical treatment should be given immediately.

So what do hives look like?

Hives on the throatWell they appear on the skin in either small or large amounts and clumped together and can quite literally spread all over the body. It is an eruption of puffy, pale red bumps or plaques (wheals). They can vary in size, from something as small as a pencil eraser to as large as a dinner plate, and may bond collectively forming a plaque (a localized abnormal patch on a body part or surface and most particularly on the skin).  Some forms of hives are characterized by a sever swelling on the outer rim of the eyes and/or lips, and in some cases it can also erupt on the hands, genitals and feet. Any hives of any sort can be life-threatening if constriction in breathing arises following the hives appearing.

The obvious first step in the treatment of this annoying malady is to locate the specific source.

Shellfish and NutsWoman scratching her armIf this can be done, and if the cause can be eliminated, control of the diseases should not be difficult. The person is advised to avoid chocolate, cocoa, nuts, peanuts, peanut butter, shellfish, some types of fish, herbs and spices.  Frequently a person may be desensitized, which basically means that an individual can be consistently given the trigger food or foods which set off this distressing ailment over a period of time.

For example, the extract of shellfish can be given in increasing quantities until the patient is able to eat this food with no ill effects. Antihistamines have also been used to control the susceptibility to hives. In acute urticaria, the condition can usually be promptly controlled by an injection of epinephrine hydrochloride. Severe cases also respond to treatment with cortisone, or metacorten.

For temporary relief of the itching which arises, certain antihistamines and hydrocortisone lotions or powders are available.

Physicians often prefer the powder form since it serves not only to relieve the itching but also to dry the affected area.  Anyone susceptible to changes in temperature should select their clothes careful and give thought to the climate they are in. Any garment which heats the skin or produces perspiration should be eliminated completely, since it will undoubtedly aggravate the infection and intensify the itching.

Persons who are noted to have allergic reactions and anaphylaxis should be strongly advised to wear medical identification to this effect.  An emergency first aid package containing epinephrine together with antihistamines is something that should be carried around as well as detailed instructions for emergency management during any attack that they may suffer.  They should be counseled to notify all health care workers as well as local paramedics about their allergy.  Warning stickers are available which can be attached to any car window enabling the police and paramedics to be aware of a driver or passenger’s allergies in the event of an automobile accident.

AllergiesPeople with any forms of allergy, especially those with the severe types should be provided with a list of alternative products and referred to local support groups; they are also advised to carry with them their own medical supplies, specifically individuals suffering from latex and rubber allergies.

People with type1 latex sensitivity may be unable to continue work if a latex-free work environment is not possible. This may occur with surgeons, dentists, operating room personnel, or intensive care nurses.

Normally, hives are easy to treat and the prognosis is good once the cause is determined at an early stage. However, some types of urticaria are quite difficult to treat since the underlying cause is not known, and can even last for many years without relief.  An example for this is Dermatographic urticaria. This type of skin disorder is seen in 4-5% of the population and is one of the most common types of hives. It is aggravated when the skin is scratched or rubbed excessively.

The skin becomes raised and inflamed forming wheals and plaques over a period of time.  It can be frequently confused with an allergic reaction to an object which causes the individual to scratch, when in actual fact, it is the scratching that causes the wheals to appear and eventually to spread.  Usually, the wheals will decrease without any treatment within about 15-30minutes, but in severe cases, it can last for hours and even a number of days (Jedele KB, Michels VV (1991)).

Hives on armIn general, hives can be managed purely by avoidance, pharmacologic interventions, and immunotherapy.

Alternative medicines such as the use of acupuncture and herbs are also being utilized to treat the condition. Although the effectiveness of these alternative medicines is not yet established, it is said to be a possible result of the placebo effect. Nonetheless, until now, this kind of treatment it still vague and modern science has yet to find the “wonder drug” in order to cure this type of urticaria. Nevertheless, it is safe to say that hives can be properly managed and cured.