Causes and triggers
Shingles causes:
Shingles is caused by reactivation of varicella zoster virus. After an episode of chickenpox, the virus remains dormant in your nervous system. Years later, it can reactivate when your immune system weakens. Shingles is most commonly affected to adults.
Following are the possible triggering factors for shingles :
- Cancer or ongoing chemotherapy or radiotherapy
- Immunosuppressive medications (steroids)
- Concurrent illnesses
- Stress
- Immunosuppressive state
Hives causes:
Hives result from an immune response to a particular precipitating factor. Exposure to a foreign substance activates white blood cells, which release chemicals that cause hives.
History of previous hives is an important factor.
Precipitating factors:
- Recent illness
- Medication use
- IV radiocontrast media
- Travel
- Foods
- New perfumes, hair dyes, detergents, lotions, creams, or clothes
- Exposure to new pets (dander), dust, mold, chemicals, or plants
- Pregnancy (usually occurs in last trimester and typically resolves spontaneously soon after delivery)
- Contact with nickel, rubber, latex, industrial chemicals, and nail polish
- Sun or cold exposure
- Exercise
- Alcohol ingestion
Diagnosis
A doctor can diagnose these conditions by taking your medical history and performing a physical examination, which helps differentiate between them. Additional tests like blood tests may required in specific situations like in immunocompromised patients to confirm the diagnosis.
For hives, allergy skin tests and IgE antibody quantification may be used.
For Shingles fluid inside blisters can be also used to make a diagnosis.
What are the treatment options available for shingles and hives ?
Shingles
An episode of shingles is generally self-limited and resolves without intervention. But there are some specific situations where you may need medications to cure the disease condition.
- Severe symptoms
- A weak immune system
- A rash involving other than your torso
- A rash co-associated with a bacterial infection
Antiviral medications (e.g., acyclovir, valacyclovir) can be given orally. In severe cases it can be given intravenously as well. Antiviral therapy can reduce the duration of new blister formation, speed up scabbing, and alleviate acute discomfort.
Pain management strategies are :
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Opioids (tramadol)
Lotions like calamine and wet dressing with Burrow solution are also considered as conservative therapy.
Need of medications will be decided by your clinician.
Hives
The primary treatment for hives is avoiding further exposure to known triggers.
Other treatment options are
- Antihistamines (fexofenadine, loratadine, desloratadine, cetirizine, and levocetirizine) – 1st line therapy
- Steroids
- Methanol creams
Anaphylaxis is a severe allergic reaction which involve multiple systems in your body. It is a medical emergency that needs immediate hospital admission.
Symptoms of Anaphylaxis include :
- Swelling of your throat, tongue, or mouth
- Fast breathing or difficulty in breathing or wheezing
- Throat tightness
- Grey or bluish colour lips, tongue, or palms
- Swallowing difficulty
Adrenaline or epinephrine is the treatment of choice for anaphylaxis. Epinephrine should be administered intramuscularly.
Prevention
Prevention is better than cure. Following are the preventive strategies for both shingles and hives.
Shingles
Live attenuated varicella vaccine has led to a remarkable reduction in the incidence of chickenpox. Vaccine should be considered in older patients because shingles is more common and is associated with complications. With the age ,there is a decline in the function of immune system. So older population is at risk of getting shingles.
Available Vaccine is
- Shingrix for adults – two doses are recommended for adults over age of 50 and those are with a weakened immune system.
The Centres for Disease Control and Prevention (CDC) recommends administration of varicella-zoster immune globulin which boost your immunity to prevent occurrence of illness following exposure to chickenpox or shingles if you have a weak immunity.
Hives
You should avoid any medication, food, or other allergen that has precipitated hives or other serious allergic reaction previously.
For solar urticaria as a protective measure sunscreen can be used.
