Secondary Amenorrhea

What Is Chronic Urticaria?

[dropcap]U rticaria is an immune based skin disorder characterized by multiple eruptions of well-demarcated edematous, intensely pruritic (itchy) plaques that may be small or reach the diameter of many centimeters with surrounding erythema (redness) each lasting less than 24 hours.¹

Q: What is the immune reaction in hives?

A: Hives form when, in response to histamine, blood plasma leaks out of small blood vessels in the skin. Histamine is a chemical released from specialized cells along the skin’s blood vessels. Allergic reactions, chemicals in certain foods, insect stings, sunlight exposure, or medications can all cause histamine release.²

In many patients, in spite of extensive investigations, the cause remains elusive. The term idiopathic is often used to denote this category. Now it is known that autoimmunity is the cause of chronic urticaria in 50% of cases.

Treatment is generally started with nonsedating antihistamine in the daytime and sedating antihistamine in the night.³

What Is Chronic Urti caria In Celiac Disease and/or Gluten Sensitivity?

• Relationship between chronic urticaria and celiac disease. Chronic urticaria is an associated immune disorder in celiac disease.
• Relationship between chronic urticaria and diagnosis of celiac disease. Urticaria as a presenting manifestation may provide an early clue to diagnosis of celiac disease in patients with minor or absent gastrointestinal symptoms.⁴
• Relationship between chronic urticaria and inflammation. Inflammation in the gastrointestinal tract may have an important role in the development of chronic urticaria.⁵
• Relationship between chronic urticaria and cold. A poor course of cold urticaria in the absence of evidence of another underlying condition should lead to suspicion of celiac disease.⁶
• Relationship between chronic urticaria and gluten. The association between celiac disease and other immune disorders may be due to the sharing of a common genetic background, such as HLA antigens. However, in a very large study, involving 909 patients with celiac disease, Ventura and his associates found that the development of immune disorders in Celiac Disease was clearly related to the duration of exposure to gluten.⁷

How Prevalent Is Chronic Urticaria In Celiac Disease and/or Gluten Sensitivity?

Chronic urticaria has increased prevalence in patients with untreated celiac disease, occurring in 1.8% of patients.⁵

What Are The Symptoms Of Chronic Urticaria?

• Chronic urticaria is marked by itchy, raised wheals on skin and mucosa.

How Does Chronic Urticaria Develop In Celiac Disease and/or Gluten Sensitivity?

• Chronic urticaria results from immune mechanism, gastrointestinal inflammation in celiac disease, and increased intestinal permeability which facilitates the passage of antigens from the gut into the bloodstream.

Does Chronic Urticaria Respond To Gluten Free Diet?

Yes. Urticaria improved after one month and totally disappeared after 3 months gluten free diet.¹

6 Steps To Improve Chronic Urticaria In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1 Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both chronic urticaria and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁸
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2  Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁹
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁹
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁹.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁹
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁹
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁹[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3  Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4  Manage Your Medications Safely:

[box type=”shadow” ]

Certain medications may cause hives and some medications used to treat hives may deplete nutrients.  Ask your doctor or pharmacist about this possible adverse effect. Do not stop prescribed medications without supervision.

Medicines that may cause hives: 

• Aspirin is the commonest drug to aggravate urticaria. Aspirin and other NSAIDs can worsen chronic urticaria in 20-30% of patients during active phase but probably not in remission.¹⁰
• ACE inhibitors (Capoten®, Vasotec®, Monopril® and others) can cause hives.

Medicine for hives may deplete nutrients.

• Anti-histamines may deplete melatonin which is needed for sleep.

[/box]

• [dropcap]5 Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6 Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Chronic Urticaria In Celiac Disease and/or Gluten Sensitivity?

CASE REPORT SUMMARIES

“Urticaria and adult celiac disease.” This case report of patient with skin manifestation unresponsive to treatment with astemizole for one month describes hospitalization for worsening generalized urticaria. Patient tested positive for antibodies for celiac disease but not IgE to wheat. Celiac disease was confirmed by intestinal biopsy. The alcohol soluble prolamin fraction of gluten (gliadin in wheat, secalin in rye, avenin in oats, and hordein in barley) was identified as the offending substance. No significant difference in total serum IgE level measurement was observed during the course of the disease.

It is possible that immune-complex-dependent sequelae might cause urticarial lesions also when concomitant celiac disease occurs. Consequently, the restoration of mucosal integrity after a Gluten Free Diet may explain the improvement of urticaria.¹

“Cold urticaria and celiac disease.” This case report describes a new association with cold urticaria in a boy aged 3 years 8 months who presented local urticaria-angioedema when exposed to cold temperatures. An ice cube test was positive and iron deficiency anemia was demonstrated. He later developed legume intolerance, rhinoconjunctivitis related to pollen sensitization, and asthma. Due to persistence of cold urticaria symptoms and refractory anemia, a test for immunoglobulin A autoantibodies to tissue transglutaminase and an intestinal biopsy were performed. Results of both tests were compatible with celiac disease. A study of human leukocyte antigen indicated a high risk phenotype (HLA, DR6/DR7; DQA 0501, 0201; DQB 0301, 0201).

After 7 months of a gluten-free diet, the boy’s anemia resolved and he is free of symptoms when exposed to cold. This is a first description of the possibility of an association between celiac disease and cold urticaria. A poor course of cold urticaria in the absence of evidence of another underlying condition should lead to suspicion of celiac disease.¹¹

Sources:

1. Scala E, Giani M, Pirrotta L, Guerra EC, DePita O, Puddu P. Urticaria and adult celiac disease. Allergy. 1999;54:1008-9. [↩] [↩] [↩]
2. www.webmd.com [↩]
3. Godse KV. Chronic urticaria and treatment options. Indian J Dermatol. 2009 Oct-Dec; 54(4): 310–312. [↩]
4. Poon E, Nixon R. Cutaneous spectrum of coeliac disease. Australasian Journal of Dermatology. May 2001;42(2):136-8. [↩]
5. Liutu M, Kalimo K, Uksila J, Kalimo H. Etiologic aspect of chronic urticaria. International Journal of Dermatology. Jul 1998;37(7):515-9. [↩] [↩]
6. Pedrosa Delgado M1, Martín Muñoz F, Polanco Allué I, Martín Esteban M. Cold urticaria and celiac disease. J Investig Allergol Clin Immunol. 2008;18(2):123-5. [↩]
7. La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol. 2003;9(6):1377-1380. [↩]
8. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
9. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
10. Godse KV. Chronic urticaria and treatment options. Indian J Dermatol. 2009 Oct-Dec; 54(4): 310–312. [↩]
11. Pedrosa Delgado M1, Martín Muñoz F, Polanco Allué I, Martín Esteban M. Cold urticaria and celiac disease. J Investig Allergol Clin Immunol. 2008;18(2):123-5. [↩]