Ayurvedic Approach in the Management of Urticaria – A Case Study

Urticaria, commonly known as hives, is a frequent dermatological condition affecting approximately 15–25% of individuals at some point in their lives. It is marked by the sudden appearance of itchy, raised skin lesions known as wheals. These lesions are typically pink to red, often with a pale center, and can vary in size from a few millimeters to several centimeters. Characteristically transient, the wheals usually resolve within 48 hours without leaving any trace.¹ Urticaria is broadly classified into two categories: acute and chronic. Acute urticaria is defined by the presence of lesions lasting less than six weeks, while chronic urticaria is characterized by the recurrence of lesions for more than six weeks, typically appearing on most days of the week.² The pathogenesis of urticaria involves the activation of mast cells and the release of inflammatory mediators. In acute urticaria, an IgE-mediated hypersensitivity reaction leads to mast cell degranulation, primarily releasing histamine, which causes the characteristic transient erythema and edema. Mast cells require time to replenish their granules, explaining why lesions do not recur immediately in the same area. In contrast, chronic urticaria often involves antigens binding to high-affinity IgE receptors on mast cells and basophils, triggering repeated degranulation. Autoimmune mechanisms also play a significant role, with pre-existing IgE antibodies facilitating a more rapid allergic response upon subsequent antigen exposure.³The recurrent and unpredictable nature of urticaria can significantly impact quality of life, making an understanding of its presentation and management essential. In Ayurveda, Urticaria fits in to either of Sheetapitta, Udarda, Kota or Utkota based on the difference in lakshanas mentioned in classics.  In the present case study, the symptoms aligned with the diagnosis of Utkota, marked by circular, itchy, reddish, numerous, recurrent lesions and the condition was effectively managed through Shodhana followed by Shamana treatment.

CASE REPORT

Details of the case

A 57year old man, presented in the Outpatient department of Visha Chikitsa at Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Hassan in the month of July with complaints of recurrent, itchy, raised round reddish rashes over face, neck, bilateral arms and legs since last 3 months.

History of present illness:

Patient was apparently normal 3 months back. Later after being exposed to construction works at his home, he noticed development of raised round rashes over different parts of the body associated with itching, which subsided on its own. He ignored the condition for nearly one and half months. Later, the condition became severe and was found not subsiding itself. On consultation he was diagnosed with Urticaria by the physician and advised to take Bilastine. Symptoms were found to reappear on discontinuation of medicine. So, he approached our hospital for better management.

History of past illness:

No history of Diabetes, Hypertension or any other metabolic disorders.

Family history: Nothing significant

Personal history

Diet – Mixed

Appetite- Good

Bowel- Regular

Micturition- Regular

Sleep- Disturbed

General Examination

There was no evidence of pallor, edema, clubbing, cyanosis, icterus, or lymphadenopathy on general physical examination.

Vital Signs

Pulse: 74/min

Blood Pressure: 120/70mmHg

Respiratory Rate: 16/min

Temperature: 97 F

Weight: 84kg

Height: 174cm

Systemic examination

Central nervous system, cardiovascular system, respiratory system and gastrointestinal system examinations show no abnormality.

Integumentary system 

Distribution- Generalized  

Number of lesions – Multiple

Pattern – Discrete; later confluent

Areas involved – Trunk, limbs, face

Local examination (Representative lesion)

Site- Right Upper limb

Size- 3 × 2 cm

Shape- Oval

Surface- Smooth

Margins- Well defined

Color- Pink to red

Dermographism - Positive

Asta-Vidha Pareeksha:

Nadi: Vata pitta

Mala: Prakruta

Mutra: Prakruta

Jihwa: Alipta

Shabda: Spashta

Sparsha: Anushna-Sheeta

Drik: Prakruta

Akriti: Madhyama

Dashavidha pareeksha

Prakruti: Pitta Vata

Vikruti: Kapha Vata

Saara: Madhyama

Samhanana: Madhyama 

Pramana: Madhyama

Satva: Madhyama

Satmya: Madhura Katu

Aharashakti: Madhyama

Vyayama shakti: Madhyama

Vaya: Madhyama

Investigations

Allergic test suggested that he is allergic to ethylene anhydride, dust mite, house dust, chili, pepper, curd, yeast, lemon, pea, eggplant, peanut, lentil, grape and common reed. Lipid Profile - Triglycerides- 204.1mg/dl, VLDL cholesterol – 40.8 mg/dl. All other reports were within normal limit.

Therapeutic Intervention

Initially, proper Ama pachana and Agni deepana was done on OPD basis and on first two days of admission with Bilwadi Gutika and Gandaka rasayana. It was followed by Snehapana for 5 days with Panchatiktaka Guggulu Grita with a starting dose of 30 ml to 220 ml on the last day. Sarvanga Abhyanga with Marichadi taila followed by Bashpa sweda was done for one day during visrama kala and Vamana (emesis therapy) was conducted with Madanaphala pippali, Vacha, Yashtimadhu, Saindava, Pippali, Honey. Diet advised during the course of treatment was Mudga yusha, Kichdi, Ganji.

Discharge medicines

1. Bilwadi gutika 1-0-1 A/F
2. Guduchi capsule 2-0-0 B/F
3. Avipathikara churna 5gm at night B/F
4. Marichadi taila E/A

On Follow UP (After 15 days)

1. Bilwadi gutika 1-0-1 A/F
2. Guduchi capsule 2-0-0 B/F
3. Avipathikara churna 5gm at night B/F
4. Marichadi taila E/A

OBSERVATIONS AND RESULTS