Journal of Traditional Medicine & Clinical Naturopathy
Open Access

The spontaneous recurrent episodes of wheals (hives), angioedema, or both that occur at least twice a week and last for six weeks or more without a specific known trigger are referred to as chronic spontaneous urticaria (CSU) [1-3]. Chronic urticaria's exact incidence and prevalence are unknown, but it affects at least 1% to 3% of the population, with females more frequently affected than males. Quality of life (QoL) is negatively impacted by attacks' unpredictability and severity, poor sleep quality due to itchiness, and fatigue. CSU is currently treated first-line with H1-antihistamines of the second generation, which do not cause sedation. Steroids, AST (autologous serum therapy), and cutting-edge biologics like Omalizumab are used in non-responding cases.

OMA is a humanized, recombinant monoclonal antibody against human immunoglobulin E (IgE) that is used to treat urticaria in patients who do not respond adequately to standard treatment. The Urticaria Activity Score (UAS 7) is an easy-to-use, well-known tool that can assist patients in quantifying urticaria and daily itching. CSU can be so bothersome and crippling that it affects one's subjective well-being and daily life. Therefore, the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), a disease-specific scale for measuring quality of life, is used to evaluate the impact of CSU.

The spectrum of Sheetapitta-Udarda-Kotha that is outlined in classic Ayurvedic texts can be used as a comparison for the symptomatology and causative factors of CSU [4]. It is a spectrum that encompasses all three of the doshas involved in the pathogenesis, with Pitta dominating, Vayu (the combination of two bodily humours), Rasadhathu and Rakthadhathu (two affected body tissues) serving as the primary Dushyas, and Vayu dominating. Sheethapitta, an allergic condition similar to urticaria, is dominated by Vata, whereas Udarda is dominated by Kapha. Asatmya Ahara, also known as unwholesome food, Virudhahara, or incompatible food, and Dushivisha, which is a type of internal toxin, are all common etiological factors for these diseases, and they can be linked to a variety of allergic conditions [5- 7]. In Ayurveda, this condition is mostly treated as an outpatient with oral medications. In cases where those medications don't work, the condition is treated as an inpatient with appropriate Panchakarma (five biopurification procedures) based on the severity, chronicity, patient strength, and basic constitution, among other factors. Panchakarma therapy improves the quality of life associated with chronic diseases like skin diseases while also reducing treatment time, drug use, and costs.

The examination revealed that the patient's blood pressure was 100/70 mmHg. On April 3, 2019, Hematological tests showed that hemoglobin (Hb) was 15.1%, neutrophils were 62%, and lymphocytes were 26%; 12% eosinophils; Count of platelets: 1.84 lakh/mm3. On October 10, 2018, total Ig E testing was performed, and the results showed an IgE level of 1293.3 iUA/L. The liver, kidney, and blood lipid levels were all within normal ranges. For the week preceding admission, the CU-Q2oL score was 103 and the UAS 7 score was 42.

The patient was asked to use a validated weekly UAS7 and CUQ2OL to monitor hives and itching for a week at the first visit. Given that the patient's condition was chronic and non-responsive to conventional treatment strategies and oral Ayurvedic medications, the primary focus was to detoxify and rejuvenate the body for disease cure and prevention of autoimmune responses, auto-allergy, and mast cell activation. The scores were 42 and 103, respectively, suggesting that the patient had severe disease activity and poor quality of life. Oral medication was administered during the first visit, resulting in a slight improvement in the symptoms and QoL. Due to the predominant symptoms of itchiness and rashes, the patient was admitted to the hospital for the administration of Vamana, also known as therapeutic emesis. Deepana-Pachana, or therapeutic enhancement of digestive capacity, was performed for two days with Vaiswanara Choorna, a powder formulation for improving digestive power, as a preparatory step for Vamana. After two days, the patient reported feeling light in the body, having a good appetite, and having enough energy. After that, Mahathikthaka Ghrtha—a medicated ghee preparation used in the management of skin diseases-and Snehapana—therapeutic administration of unctuous formulations like ghee and oil—were used until the signs of oleation were observed. The presence of gheestuck bowels, soft, oily skin, an aversion to ghee, nausea, and fatigue were all indications of oleation. The complaints began to decrease on the fifth day of Snehapana and disappeared completely after Vamana. The hives and itching completely subsided, and the patient was given a prescription for medication and told to keep an eye on them every day for a week.

In the treatment of chronic skin conditions, Ayurveda recommended numerous purifying treatments. After 28 days, the patient returned to the OPD for treatment and reported recurrent symptoms that could be managed with prescribed medications. He was admitted back to the hospital for Sadyovirechana for one day before being released with oral medications. He was instructed to report hives and itching at 15 days' follow-up and to monitor them daily for one week using the UAS 7 score. Included are the OPD and IPD interventions.

Discussion

A deep-seated pathology was assumed to be associated with the disease due to its slow progression and inability to respond to conventional treatments like antihistamine therapy, oral Ayurvedic medications, and AST and OMA. After Snehapana (oral administration of an oleaginous preparation) with Mahathikthaka Ghrtha, in-patient Panchakarma treatment-Vamana-was administered in light of the persistent and severe symptoms of the disease. Mahathikthaka Ghrtha was chosen because it is indicated in Kusta, a group of skin diseases that are especially associated with Pitta predominance. Vamana was performed to eliminate the accumulated toxins that are kapha predominant. Seethapitta suggests that haridra khanda be used to prevent recurrence. The involvement of rakta was inferred from the patient's allergic skin lesions, which included reddish discoloration and itchiness. Rakta involvement and reddish discoloration are treated with Manjistadi kwatha [8-10]. By temperance of fixings it is a Thikthakashaya (unpleasant and astringent taste) dominating detailing that further forestalls Kapha dosha disturbance. Because it contains Katuki (Picrorhiza kurrooa Royle), which aids in maintaining mild laxation during treatment, Arogyavardhini Vati, which is recommended for the treatment of skin diseases, was given in conjunction with it. The involvement of rakta was inferred from the patient's allergic skin lesions, which included reddish discoloration and itchiness. Rakta involvement and reddish discoloration are treated with Manjistadi kwatha. By temperance of fixings it is a Thiktha-kashaya (unpleasant and astringent taste) dominating detailing that further forestalls Kapha dosha disturbance. Because it contains Katuki (Picrorhiza kurrooa Royle), which aids in maintaining mild laxation throughout the treatment, Arogyavardhini Vati, which is recommended for the treatment of skin diseases, was administered alongside it.

Conclusion

Oral medication and panchakarma treatments are safe and effective for managing CSU that does not respond to standard treatments like OMA injections. It can also keep chronic diseases like CSU from happening again. For validation, additional studies in a variety of settings with a larger sample size are recommended.

Conflict of Interest

The authors declared that there is no conflict of intrest

Acknowledgment

None

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