Ms. Minh initially developed a few small, raised patches that quickly spread, causing her skin to swell, itch severely, and lead to insomnia. She was diagnosed with chronic urticaria and treated with antihistamines. However, her symptoms showed little improvement and rapidly recurred, causing her significant stress and fatigue. She then underwent more specialized treatment with immunomodulators and immunosuppressants for her severe condition. Despite adhering to the regimen and attending regular follow-ups, her symptoms remained persistent and not fully controlled.

At Tam Anh General Hospital Ho Chi Minh City, Doctor Nguyen Phuc Tan, from the Clinical Immunology department, diagnosed Ms. Minh with refractory urticaria. While most individuals with common chronic urticaria can manage symptoms with antihistamines and lifestyle adjustments, Ms. Minh's condition advanced to a point where even escalated treatment with immunosuppressants yielded no response. This indicated a deeper, more challenging-to-control immune disorder.

Ms. Minh's body covered in hives when exposed to wind. *Photo: Tam Anh General Hospital*

At this stage, inflammatory reactions no longer followed typical mechanisms. Her immune system was overactivated and out of control, causing her skin to react strongly even without obvious allergens. "This is why Ms. Minh's skin became overly sensitive to all surrounding stimuli," Doctor Tan stated, adding that wind, temperature changes, friction from clothing, leaning against a chair, or even a light touch could trigger severe hives.

The doctor thoroughly evaluated the disease progression, previous treatment regimens, and the patient's response to develop a personalized treatment plan. This plan was tailored to Ms. Minh's immune status and her underlying conditions, such as diabetes, dyslipidemia, and hypertension. Consequently, flare-ups were better controlled. After one week, the severe itching and body-wide swelling significantly decreased. The treatment regimen continues to be adjusted to maintain efficacy and ensure long-term safety.

Doctor Tan checks Ms. Minh's skin condition after treatment. *Photo: Tam Anh General Hospital*

Urticaria can affect individuals of all ages. However, among middle-aged and elderly groups, the condition is often diagnosed late because symptoms are atypical, easily mistaken for age-related itching or common allergies. According to Doctor Tan, urticaria in older adults is more challenging to treat than in younger individuals due to co-existing health conditions and the increased risk of drug interactions and slower responses to medication. Self-treating, confusing it with common allergies, or arbitrarily discontinuing medication can worsen the disease and make it difficult to control.

Doctor Tan recommends that individuals experiencing prolonged itching, excessive skin reactions to common stimuli, frequent recurrences, and a lack of response to treatment should visit a hospital with a Clinical Immunology department for an accurate diagnosis.

Minh Huong

*Character's name has been changed