Case Study of Ayurvedic Management of Acute Urticaria

Patient details

• Age / sex: 33 years, male
• Date of first consultation: 22 October 2025
• Main complaint: Raised welts all over the body with severe itching (acute onset)
• Relevant past history: Not available / not significant in records provided
• Allergies/medications: Not recorded prior to presentation

Clinical findings on presentation (22.10.2025)

• Widespread urticarial wheals (evanescent erythematous raised lesions) with severe pruritus
• No evidence of angioedema of lips, tongue, uvula or respiratory compromise in records provided
• No fever, no systemic symptoms recorded

Investigations (baseline)

• Total IgE: 319.30 IU/mL (elevated)
• Total bilirubin: 0.72 mg/dL
• Direct bilirubin: 0.30 mg/dL
• Indirect bilirubin: 0.40 mg/dL
• SGOT (AST): 27.5 U/L
• SGPT (ALT): 54.3 U/L (mildly above typical adult reference)

Working diagnosis

• Western correlation: Acute urticaria (hives) with probable atopic/allergic tendency (supported by elevated total IgE).
• Ayurvedic correlation: Sheetapitta/Vicharchika spectrum — a Pitta‑Kapha involvement with derangement of Rasa and Rakta leading to cutaneous manifestations (urticaria/”visphota”/kandu). Treatment focused on pacifying Pitta and Kapha, restoring Agni, blood purification (rakta‑śodhana) and mild Virechana (purgation) where indicated.

Therapeutic plan ( instituted 22.10.2025 )

The following formulations were prescribed (as recorded by the treating physician):

1. Vasaguluchyadi kashaya (ks) — classical/compound kashaya chosen for liver support, blood purification and Pitta‑Kapha balancing. (Form: kashaya)
2. Panchatiktakam kashaya (ks) — five bitter herbs decoction used for skin diseases and blood purification.
3. Kaishora Guggulu — classical guggulu formulation used widely in Kushta (skin diseases) and inflammatory dermatoses.
4. Apfil tablet (Apex) — proprietary tablet recorded in notes (documented as part of the prescribed regimen).
5. Haridra Khandam — turmeric‑based classical/khandam preparation used for allergic skin conditions and pruritus.
6. Avipathi Churnam — advised for purgation (Virechana) for 15 days as a short course to remove aggravated Pitta and aid systemic detoxification.

In addition to medicines, the patient was counseled about a Pitta‑pacifying, non‑allergenic, plain and easily digestible diet and avoidance of known triggers (spicy food, alcohol, seafood, extremes of temperature, tough physical exertion). The patient was also advised to return for repeat blood tests after 15 days.

Course and outcome

• Over the course of treatment the patient reported progressive reduction in itching and near complete disappearance of welts. No further acute episodes were recorded.

Repeat investigations (13.11.2025):

• Total IgE: 225 IU/mL (decline from 319.30 IU/mL)
• Total bilirubin: 0.66 mg/dL
• Direct bilirubin: 0.32 mg/dL
• Indirect bilirubin: 0.34 mg/dL
• SGOT (AST): 25.5 U/L
• SGPT (ALT): 37.6 U/L (reduced toward normal range)

Clinical correlation: Symptomatic resolution accompanied by objective improvement in IgE and normalization/reduction of liver enzymes.

Management after review (13.11.2025):

• Dose of prescribed medicines reduced (step‑down maintenance as per clinical judgment)
• Diet to be continued strictly for one month
• Advisement for review after one month

Discussion — Ayurvedic and modern interpretation

Pathophysiology (Ayurvedic view). Urticaria‑like presentations are classically discussed under Sheetapitta, Visphota and Kushta categories where Pitta and Kapha doshas vitiate Rasa and Rakta leading to pruritus, wheals and burning sensations. The chosen medicines (tikta‑kashayas, Kaishora Guggulu, Haridra) aim at pacifying Pitta, expelling morbid Kapha, purifying the rasa and rakta, and restoring Agni. Classical texts and modern Ayurvedic case reports document the use of Panchatikta and Kaishora type regimens for allergic and chronic urticarial conditions.

Rationale for selected formulations (brief):

• Panchatiktakam kashaya: employed for its bitter cleansing (tikta) action and raktashodhana properties — commonly used in kushthas/skin disorders.
• Vasaguluchyadi kashaya: used here as a hepatoprotective and rakta‑shodhaka (blood‑cleansing) decoction supporting liver function and metabolism during systemic cleansing.
• Kaishora Guggulu: classical anti‑kushtha preparation indicated in several skin conditions and for its anti‑inflammatory/blood purifying profile.
• Haridra Khandam: turmeric‑based formulation used for its anti‑inflammatory, anti‑allergic and skin‑calming properties.
• Avipathi Churna: administered as a short Virechana (purgation) course to expel aggravated Pitta and help systemic detoxification, a commonly used classical measure in pitta‑dominant conditions.

(These choices reflect classical therapeutic principles: pacify Pitta, remove morbid Kapha, restore digestive fire, and purify rasa/rakta.)

Objective biochemical response. The patient’s total IgE decreased from 319.3 to 225 IU/mL over ~3 weeks; in parallel SGPT fell from 54.3 to 37.6 U/L. Clinically the pruritus and wheals resolved. While a fall in total IgE can be concordant with reduced systemic allergic activity, total IgE is not a precise marker of disease activity for every patient and may vary with time and testing methods; clinical correlation remains the mainstay.

Safety and monitoring. Baseline mild SGPT elevation was noted prior to treatment and surveillance was appropriately performed; SGPT normalized on follow‑up. Herbal and Ayurvedic formulations can be hepatoprotective but can also—rarely—be associated with liver enzyme elevations. Regular monitoring of liver function tests (LFTs) during treatment, awareness of new symptoms (jaundice, anorexia, severe abdominal pain), and judicious use of high‑quality, authenticated formulations remain essential for patient safety.

Learning points

1. An integrated Ayurvedic regimen combining decoctions (kashayams), classical formulations (Kaishora Guggulu, Haridra Khandam), and a short course of purgation (Avipathi Churna) can be associated with clinical resolution in acute urticaria in selected patients.
2. Baseline and interval laboratory monitoring (IgE, LFTs) provides helpful objective data; laboratory trends should be interpreted in clinical context.
3. Mild transaminase elevations require vigilance but can normalize with appropriate selection of formulations and monitoring; herb‑induced liver injury is uncommon but recognized and must be guarded against by choosing quality products and by monitoring.
4. Diet, trigger avoidance and patient education are essential pillars of long‑term relapse prevention.

Follow‑up plan (as advised)

• Continue reduced/maintenance dose of medicines as prescribed by the treating physician
• Maintain Pitta‑pacifying diet and lifestyle for 1 month
• Return for review and repeat LFT / IgE after one month, or earlier if symptoms recur

Conclusion

This case documents an episode of acute urticaria in a young adult male managed with an Ayurvedic therapeutic protocol emphasizing systemic cleansing, Pitta‑pacification and skin‑calming measures. Clinical remission was achieved within three weeks, accompanied by a reduction in total IgE and normalization of SGPT. The case highlights the value of objective monitoring and continued vigilance for hepatic safety while using herbal regimens.