Urticaria: Urticaria is characterized by wheals (hives) or angioedema (swellings, in 10%) or both (in 40%). There are many types of urticaria. The designation urticaria is derived from European stinging nettle ‘Urtica dioica’.A wheel is a superficial skin-colored or pale skin swelling, customarily circumvented by erythema (redness) that lasts anything from a few minutes to 24 hours. Customarily very itchy, it may have a burning sensation.
Angioedema is deeper swelling of the skin or mucous membranes and can be skin-colored or red. It resolves within 72 hours. It may be itchy or painful but is often asymptomatic.
Types & Symptoms of Urticaria(Hives)
Urticaria types according to its duration-
Acute urticaria (Less than 6 weeks, and often gone few hours to days)
Chronic urticaria (More than 6 weeks, with daily or episodic weals)
Chronic urticaria may spontaneous or inducible. Both types may co-exist.
Inducible or physical urticaria includes:
- Symptomatic dermographism
- Contact urticaria
- Delayed pressure urticaria
- Cold urticaria
- Cholinergic urticaria
- Vibratory urticaria
- Aquagenic urticaria
- Solar urticaria
- Heat urticaria
Urticarial wheels can be few millimeters or several centimeters in diameter, colored white or red, with or without a red flare. Each weal may last a few minutes or several hours and may change shape. Wells may round, or form rings, a map-like pattern or giant patches. Urticaria may affect any site of the body and inclines to be distributed widely.
Angioedema is more often localized. It commonly affects the face (ocular lids and perioral sites), hands, feet, and genitalia. It can involve tongue, uvula, soft palate, or larynx.
Serum sickness because of blood transfusion and serum sickness-like reactions due to some drugs cause acute urticaria leaving bruises, pyrexia, swollen lymph glands, joint pain, and swelling. In chronic inducible urticaria, wheels appear about 5 minutes after a stimulus and last a few minutes or up to one hour. Characteristically, weals are:
- Linear in symptomatic dermographism
- Confined to contact areas in contact urticaria
- Diminutive in cholinergic urticaria
Diffuse in cold urticaria—if sizably voluminous areas of skin are affected, they can lead to fainting (potentially perilous if swimming in cold dihydrogen monoxide)
The weals are more assiduous in chronic spontaneous urticaria, but each has gone or has altered in shape within 24 hours. They may occur at certain times of the day.
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What Causes Hives?
Acute urticaria induced by following factors but the cause is not always identified.
Acute bacterial infection— a dental abscess, sinusitis
Acute viral infection— upper respiratory infection, infectious mononucleosis, viral hepatitis, mycoplasma
Drug allergy (IgE mediated)— often an antibiotic
Drug pseudoallergy— opiates, aspirin, nonselective nonsteroidal anti-inflammatory drugs, radiocontrast media; these cause urticaria without immune activation
Food allergy (IgE mediated)— usually milk, egg, peanut
- Bee or wasp stings
Widespread reaction following localized contact urticaria—eg rubber latex
Astringent allergic urticaria may lead to anaphylactic shock (bronchospasm, collapse).
Immune complexes due to blood transfusion because of serum sickness and some drugs cause serum sickness-like reactions (urticaria leaving bruises, swollen lymph glands, pyrexia, joint pain, and swelling).
Chronic spontaneous urticaria is idiopathic (cause unknown), likely An autoimmune cause. About a moiety of investigated patients carries functional IgG autoantibodies to immunoglobulin IgE or high-affinity receptor FcεRIα.
Chronic spontaneous urticaria has additionally been associated with:
Chronic underlying infection, eg Helicobacter pylori, bowel parasites
Chronic autoimmune disease, eg systemic lupus erythematosus, celiac disease, thyroid disease, vitiligo, and others
Weals in chronic spontaneous urticaria may be aggravated by:
- Viral infection
- Tight attire
- Drug pseudoallergy— opiates, aspirin, nonsteroidal anti-inflammatory drugs
- Food pseudoallergy—salicylates, azo dye coloring agents such as tartrazine (102), benzoate preservatives (210-220) and other victuals (food) additives
Urticaria can conventionally be diagnosed by examining the distinctive red rash. If have chronic urticaria, a number of tests needed to identify the underlying cause.
Your physicians can customarily diagnose acute urticaria by examining the rash.
They’ll additionally ask you some questions to ascertain what triggered your symptoms, including:
- when and where the rash commenced
- what you eat just before it commenced and details of your conventional diet
- if you commenced taking any incipient medication just afore your symptoms commenced
- if you live or work in an environment where you come into contact with possible triggers – such as pets, chemicals or latex gloves
- if you were stung or bitten by an insect just afore your symptoms commenced
- your current state of health and if you’ve had any recent infections
- if you’ve recently traveled to a peregrine country and if so, where
- if there’s a history of urticaria in your family
- In around a moiety of all cases of acute urticaria, a cause can’t be identified.
- If physicians think symptoms are caused by an allergic reaction, you may have to peregrinate to an allergy clinic.
- Allergy testing may be needed to ascertain if you’re allergic to suspected triggers for urticaria.
If urticaria lasts for more than six weeks, it’s very unlikely to be caused by an allergy, so allergy tests aren’t customarily recommended.
However, your physicians should ask about anything that makes your urticaria worse, such as:
any medicines you’re taking
- your alcohol and caffeine consumption
- your stress levels
You may additionally be referred to a number of tests to ascertain if there’s an underlying cause of your chronic urticaria. These tests may include:
- A total blood count test (CBC) – tests to determine the calibers of antibodies in your blood
- A stool sample – identify intestinal parasites
- An erythrocyte sedimentation rate (ESR) test – which can avail to identify quandaries (problem) with your immune system
- Thyroid function tests – check for an underactive thyroid gland (hypothyroidism) or overactive thyroid gland (hyperthyroidism)
- Liver function tests – check if you have any quandaries(problem) with your liver.
Treatments and drugs
Your physicians will likely recommend treating your symptoms with home remedies, such as over-the-counter antihistamines.
Treat underlying factors causing symptoms. If physicians can determine that hives are caused by another condition, he or she will first endeavor to treat that. For example, in the case of chronic hives and inflamed thyroid (thyroiditis) may best be availed by treating the thyroid quandary (problem).
Take non-drowsy forms of antihistamine pills. Taking antihistamines pills daily avails block the symptom-engendering relinquishment of histamine. The more incipient(new) forms of the drugs (second-generation antihistamines) have fewer side effects, such as drowsiness than older antihistamines:
- Cetirizine (Zyrtec)
- Levocetirizine (Xyzal)
- Loratadine (Claritin, Alavert)
- Fexofenadine (Allegra)
- Desloratadine (Clarinex)
Take older forms of antihistamine pills. If new antihistamines don’t avail you, your physicians may recommend you take an older form of the drug, but only before bedtime, as it can make you lethargic. Examples include:
- Chlorpheniramine (Chlor-Trimeton)
- Hydroxyzine (Vistaril)
- Diphenhydramine (Benadryl)
Check with your physicians before taking any medications if you are pregnant or breastfeeding, chronic medical condition, or taking other medications.
If this drugs, not relieve your symptoms try other medications. This may include:
Histamine (H-2) blockers- known as H-2 receptor antagonists, may be injected or taken orally. Side effects range from digestive quandaries to a headache.
Anti-inflammation medications- Oral corticosteroids, such as prednisone, can avail abate swelling, redness, and itching. These customarily are utilized only for a short time to control rigorous hives or angioedema because they can cause earnest side effects.
Corticosteroids creams- applied to the skin customarily aren’t efficacious for chronic hives. Corticosteroids can emasculate(weaken) your immune system.
Antidepressants- The tricyclic antidepressant doxepin, used in the cream form, can help relieve itching. This may cause dizziness and drowsiness.
Other options. Several medications may help whose chronic hives resist treatment:
An injectable drug. Several studies show the drug omalizumab (Xolair) is more effective against a type of difficult-to-treat chronic hives. Asthma drugs with antihistamines. Medications that interfere with the action of leukotriene modifiers may help when used with antihistamines. Examples are montelukast and zafirlukast. Side effects include behavior and mood changes.
Cyclosporine- Cyclosporine affects the immune system and provides relief from chronic hives. Possible side effects range from a headache and nausea to increased risk of infection and reduced kidney function.
Tacrolimus- Similar cyclosporine, this drug reduces the immune system response that causes hives. And it may cause a range of side effects, from minor to serious.
Mycophenolate- This is an immune-suppressing drug also improves hives signs and symptoms. But for pregnant women, it increases the risk of miscarriage and birth defects.
Antidepressants- The tricyclic antidepressant doxepin, utilized in cream form, can avail assuage itching. This may cause dizziness and drowsiness.
Several medications may avail people whose chronic hives resist treatment:
An injectable drug- Several studies show the drug omalizumab (Xolair) is very efficacious against a type of arduous-to-treat chronic hives.
Asthma drugs with antihistamines. Medications that interfere with the action of leukotriene modifiers may be subsidiary when utilized with antihistamines. Examples are montelukast and zafirlukast. Side effects include behavior and mood changes.
Cyclosporine- Cyclosporine affects the immune system and provides palliation from chronic hives. Possible side effects range from a headache and nausea to an incremented risk of infection and reduced kidney function.
Tacrolimus- Kindred to cyclosporine, this drug reduces the immune system replication that causes hives. And it, additionally, cause a range of side effects, from minor to serious.
Mycophenolate- This immune-suppressing drug improves hives signs and symptoms. But for pregnant women, it increments the jeopardy of miscarriage and birth defects.
Who Gets Urticaria?
One in five children or adults has an episode of acute urticaria during their lifetime. It is more prevalent in atopic. It affects all races and both sexes.
Chronic spontaneous urticaria affects 0.5–2% of the population; in some cases, two-thirds are women. Inducible urticaria is more prevalent. There are genetic and autoimmune sodalities.