HomeAnswersDermatologyhivesIs urticaria seen in few COVID patients?

I have chronic hives since last year, which is not relieved with medicines. What can be the cause?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Chithranjali Ravichandran

Published At April 10, 2021
Reviewed AtAugust 31, 2023

Patient's Query

Hi doctor,

I have chronic hives since last year. I have been taking Bilaxten 20 mg tablets since then, an almost daily tablet. Nowadays, it is once in two days or when hives appear. Even after one year, no relief. I am worried about what is the root cause. I consulted a dermatologist and did a blood test (result attached). Doctor said there is nothing to worry about, to continue managing with antihistamine, but still, the reason is unknown. Sometimes observed that some red patches appear on the skin, and it goes off. Sometimes itching develops, and then hives appear, and after sometimes, it goes off on taking an antihistamine, at least for one day, no hives. Another observation (may or may not be related to these hives): Had some dark brown patches (photo attached) on legs (only legs). Initially thought it was due to leg shaving (used to shave the legs using razor), and later, when applied some ayurvedic oil, it became very visible and rough texture. As per the dermatologist, that is eczema and applied ointment. Now it is reduced, and still the marks exist. No itching or pain, or discomfort. Weight, appetite, etc., are normal and no change. Also have a hormone imbalance and taking medicine. Have Vitamin D deficiency - Vitamin D total immunoassay- 9.5 ng/mL. I would like to know the root cause of these chronic hives. Is it due to any other health issue? Taking antihistamine for a prolonged period- any side effects? Any permanent cure?

Hello,

Welcome to icliniq.com.

I understand your concern. It is chronic urticaria, as you already know. Now urticaria can be of two types (besides acute and chronic). Chronic spontaneous urticaria: This is the commonest and seen in more than 70 % of patients of duration more than six weeks. It simply means that there are no triggering factors, and weals appear spontaneously. Chronic inducible urticaria: It has triggers like weals happen after heat, sun, cold, drugs, pressure, dental infections, acid reflux disease, etc. Do you have and inducible factors or triggers? Do you have any swelling of the eye or lips (Angioedema)? Any history of asthma or allergic rhinitis or recurrent sneezing or similar complaints in the family? Any history of recurrent fever, joint pain with these weals? Leg lesions looked like eczema only, and eczema and urticaria can be seen together frequently, as is dry skin, rhinitis, thyroid problems, asthma, etc. If you have symptoms like joint pain, fever, or any triggering factors, then further investigations are required, else it is chronic spontaneous urticaria, as is the case in most patients. When it comes to the treatment, antihistamines are the drugs of choice. And if you have no hives with a single dose of antihistamines, that means it is well in control. Another thing to remember is to take it daily and without a gap to ensure early control and complete recovery according to the guidelines for urticaria treatment. Safety data are available in clinical studies for antihistamines and can be used for years, so no long-term harm as such. No cause in most of the patients in most of the cases. If you have any triggering factors, as asked above, do let me know in the free follow-up. I recommend taking a second-generation antihistamine with Montelukast once daily without gap, like the Allegra-M tablet. In more than 50% of patients, urticaria subsides within one to two years. Please answer the questions related to history and triggering factors and feel free to ask anything in the follow-up. Take care.

Patient's Query

Hi doctor,

Thank you very much, doctor, for your quick reply. The answer to all the below questions are "No." Do you have and inducible factors or triggers? No, there is no known triggering factor. It comes very regularly. If I stop taking an antihistamine, it comes. Do you have any swelling of the eyes or lips (Angioedema)? No Any history of asthma or allergic rhinitis or recurrent sneezing, or similar complaints in the family? No Any history of recurrent fever, joint pain with these weals? No. I had taken antihistamine daily one tablet without a gap for more than six months, but no change or relief. The day I stop, the hives appear. I am now taking one tablet on alternate days. Can it be due to some viral infection? I heard that some COVID patients experience long-term urticaria after recovering from it.

Hi,

Welcome back to icliniq.com.

Thanks for answering the queries. Yes, urticaria has been seen in few COVID patients, and yes, viral infections or any kind of infection for that matter can trigger urticaria, but they improve in few weeks, do not usually last for months. As your urticaria is controlled, but you require continuous therapy, I think adding Montelukast will help. Take Levocetirizine or Fexofenadine with Montelukast (Teczine-M or Allegra-M). Take continuously for six weeks, then stop and see if any recurrence is there. If not, fine, but if recurrence is there, then restart, and continue for six more weeks. The fewer the interruptions in between, more the better. The thing is if it is controlled with antihistamines, and there are no triggering factors, the only thing recommended is to take it regularly only. Other drugs are tried only if an increasing dose of antihistamines or combination with Montelukast are not even able to control the weals. Right now, just add Montelukast and continue treatment. Eventually, it subsides. The important and positive thing is that you are responding to antihistamines. There are few who do not. Take care, and hopefully, you get cured soon.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Dilip Kumar Meena
Dr. Dilip Kumar Meena

Dermatology

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