HIVES: ITCH NOW OR NEVER

TA is a patient who first began experiencing wheals (pantal) during her high school years.

- GRACE CAROLE BELTRAN, MD

Raised, red welts on the skin - a common sign of hives.

(Dola AI)

She recalls these episodes as severe allergic reactions that caused extensive hives (pantal) across her face and body. The condition persisted for a while before eventually resolving during her college years.

In August 2025, TA noticed the return of symptoms — this time as small red spots on her right arm. Concerned, she consulted a medical professional and was diagnosed with dermatographism. She was advised to identify possible triggers, but despite her efforts, she did not experience any noticeable improvement or relief.

By mid-October, feeling discouraged by the lack of progress, TA sought my opinion. Upon hearing her story, I suspected a case of chronic spontaneous urticaria (CSU). My primary goal was to help her identify and eliminate potential allergens or triggers. I recommended a strict diet plan even if studies using diet restrictions have shown that foods are not relevant in CSU and diet restrictions are ineffective. Nevertheless, other studies with diet restrictions observed that 17 to 73 percent of patients with CSU achieve complete or significant remission of symptoms after a restriction diet. I also included some changes to her personal skincare routine, and some adjustments to her lifestyle.

While TA found these changes challenging at first — especially the dietary restrictions and adjustments to her skincare regimen — she showed remarkable dedication in following through. I encouraged her to remain observant and to record any patterns or potential triggers that might be linked to her flareups. Despite her consistent efforts, TA found the process of tracking triggers tiring and, at times, overwhelming. She mentioned that waking up on an empty stomach might make her symptoms worse, although she wasn’t certain. She even switched to a baby-safe laundry detergent, but her hives persisted.