1, allopathic treatment Allopathic treatment for urticaria is difficult, because the cause of urticaria is complex, often due to the combined effect of many factors. The more common causes are food and drug allergies, infections, a few physical factors such as heat and cold, mental factors (for adults, mental factors are common triggers), genetic factors, autoimmune or other diseases. For most acute urticaria with mild symptoms, attention to diet and oral anti-allergy medication can provide relief; for more severe urticaria that tends to recur, or chronic urticaria, it is necessary to try to find the cause. For example, some underlying infections, oral medications that promote the release of histamine, allergies to certain foods, and so on. If necessary, try an allergen test. Allergen testing is best done with blood, because the prick test itself is irritating to the skin and can easily cause false positives. 2, step treatment I often hear some urticaria patients in the clinic complain that they have gone to several hospitals but can not see, and lose confidence in doctors and treatment. In fact, for eczema, urticaria, a disease that is prone to recurrence, doctors often choose the drug with the lightest relative effect and the least side effects during the first treatment (generally the efficacy of the drug is proportional to the side effects), and if it does not improve, only then add a more potent drug. Just like going up the stairs, medication is also used in increasing steps (except for hives, in fact, many chronic diseases are treated according to the principle of stepwise treatment). Most patients change hospitals after one bad visit, not giving the doctor a chance to adjust the medication at all. The doctor’s workload is too heavy, and sometimes it is difficult to carefully instruct each patient, which indirectly leads to the “incurable” urticaria. The actual fact is that you will be able to find the right medication and then you will not be able to do everything. Many patients feel that they are well after the rash has subsided and stop taking the medication without permission, only to have another attack within a few days. This situation can be avoided completely. Acute urticaria (<6 weeks) should be maintained for a period of time after the rash has completely subsided (2-3 days in mild cases, 5-7 days in severe cases, and generally not less than a week for the entire course of treatment), and chronic urticaria (>6 weeks) should be reduced more slowly. For example, change one piece of loratadine per day to one piece every other day, every 2 days, every 3 days …… in decreasing order to maintain the cycle of 2-4 weeks, so that the chances of success in stopping the drug will increase. 4, control diet Acute urticaria in addition to fish and shrimp, seafood, beef and mutton, tropical fruits, spicy stimuli, wine and coffee strong tea need to avoid, but also should avoid eating pickled products and fermented foods. These foods, which are decomposed by bacteria and fungi, tend to produce salicylates and nitrites as well as alkaline peptides, which stimulate the release of substances that promote allergic reactions in the body. In addition, patients who are prone to hives are advised to control their diet and eat easily digestible foods when they have a cold or diarrhea. Otherwise, in a state of poor gastrointestinal function, it is difficult to completely break down the food you eat, which can easily lead to allergies after entering the bloodstream. The duration of diet control should be slightly longer than the duration of medication. Usually, the normal diet will be resumed after 1-2 weeks after stopping the medication. Note: For those with extremely chronic urticaria, it is important not to blindly control the diet, as this may lead to nutritional deficiencies. Much of the literature mentions that most of those stubborn chronic urticaria are autoimmune in nature and are not really related to food allergies. A more appropriate approach is to keep a food diary, i.e., record the types of food you eat every day, and if you find that your hives worsen when you eat a certain food, you can avoid it in the future. Even fresh seafood and beef and lamb can be eaten in small amounts if tried and not allergic (note that it is best to keep a tightly controlled diet during medication reduction to increase the success of the reduction). Foods that are not fresh should be firmly avoided. It should be mentioned here that chronic urticaria is a very complex condition, and even after carefully following doctor’s instructions, a small percentage of people do not heal as well as they would like. The first step is to find a medication that can completely control the symptoms, and the second step is to use various methods to reduce the dosage to achieve the purpose of stopping the medication; however, either step requires joint exploration and efforts of the doctor and the patient, and cannot be solved with just a few words or even one or two visits. I hope that all chronic urticaria patients can adjust their mindset to cooperate with their doctors as much as possible, so that we can work together to overcome the disease!