urticaria: a nasty reaction; finger on the pulse

Health warning: avoid eating wild boar in Austria. Several years ago, my husband ate some while on holiday there and, within hours, he looked like an amorphous red blob. His body became covered in weals and intensely itchy blotches. As a young and enthusiastic medical student, I was thrilled that I could make the diagnosis of urticaria, but couldn't understand why he did not share my excitement.

One in five people will suffer from urticaria at some point in their lives and the majority won't identify the cause. Commonly known as nettle rash or hives, it usually affects the body. When it is concentrated on the lips, mouth or tongue, it is known as angioedema.

The hives tend to settle down in a few hours, but the itch continues. With the aid of antihistamines it should disappear in a few days. Unfortunately, for a few, it may go on for months, and they will need to remain on medication.

Most people want to go through an exhaustive list of everything they have consumed in the past six months to find the culprit - note the glazed look on your doctor's face. Usually, you won't find out the cause, but heat, cold, water or pressure can set it off. Going in a very cold sea caused one of my patients to come out in weals.

I'm often asked how it is possible to become allergic to something you had always been able to tolerate before. Well, it is. Every summer, I have gorged on strawberries. Until last year, when I came out in great lumps on my arms. This is called sensitisation, it's just that you may never have been near the offending trigger before. Everyone also wants to know how long it will last and will you get it again? It varies from person to person, and you may or may not get it back.

While the effects of my strawberry intolerance were short-lived, it did give me a sense of what it must be like to suffer from skin problems. The itch, the appearance, but most of all, just how miserable and self- conscious I felt.

The eczema or psoriasis sufferer is constantly aware of their skin. Forget to take your blood-pressure tablets for a day or two and you won't feel that much different, but neglect to plaster your skin with creams and oils and you will itch, scratch, become red and sore, and feel and look awful.

As a teenager, appearance is everything, but eczema or psoriasis sufferers can be made to feel like social lepers. The thought of going into a changing room and trying on clothes with a few of your mates, like so many teenagers love to do on a Saturday afternoon, is too awful.

For a parent of a child with eczema, the ultimate challenge has to be chasing a toddler around the bathroom with cream on your hands. When they are finally in bed, they warm up and scratch away. Long nights and tired days, due to interrupted sleep, makes everyone grumpy.

One in five of all GP referrals are to dermatologists. So, it is surprising that GPs often have little or no training in skin problems. We sometimes prescribe tiny tubes of cream, forgetting that the patient has to smear it all over their body, and become irrationally irate when they ask for more. Rationing is the name of the game in the health service, but when it comes to skin conditions, little and often should be our dictate.