Abstract
Urticaria or hives is a common condition. This article discusses in detail the common causes and management of urticaria.
Contents
Published on Aug 24, 2016 and last reviewed on Mar 05, 2022 - 4 min read
Abstract
Urticaria or hives is a common condition. This article discusses in detail the common causes and management of urticaria.
A skin disease made up of a wheal, and flare reaction is known as urticaria. An area of redness surrounds the localized wheal in urticaria, and it is typically itchy. In the case of hives, a local increase of the permeability of the capillaries and small venules results in transient, erythematous, or edematous swelling of the dermis or subcutaneous tissues. Cutaneous hives may last for 30 minutes to 24 hours. If the wheals or hives persist for more than 24 hours in an individual and have joint pain and bruising, then it should be considered urticarial vasculitis. Systemic symptoms like rhinitis, difficulty in breathing, the sensation of heaviness in the chest, wheezing, and abdominal pain may accompany the skin lesions and are indications for urgent treatment to avoid the complication of laryngeal edema. Potential mediators of urticaria include histamine, prostaglandin D2, platelet-activating factor, bradykinin, etc.
Urticaria can be broadly classified into acute and chronic.
1. Acute urticaria is usually IgE mediated. The duration is less than 6 weeks. It occurs due to various foods, drugs, and infections.
2. Chronic urticaria lesions continue to appear in an individual at least twice a week for more than 6 weeks due to inflamed blood vessels, physical and autoimmune causes, etc.
The provoking causes of urticaria are: Physical factors account for 20% of cases. They are stroking (dermographism), constant pressure like prolonged sitting on a chair or tight belt, vibration like kitchen grinder or blender, cholinergic like emotion, exercise, cold and aquagenic such as urticaria after swimming. Medications such as Aspirin, Penicillin, Codeine, Morphine, ACE inhibitors (Envas - Enalapril), and NSAIDs (nonsteroidal anti-inflammatory drugs) like Brufen (Ibuprofen), Combiflam (combination of Ibuprofen and Paracetamol) provokes urticaria. Foods and food additives can cause urticaria. For example, foods such as shellfish, eggs, nuts, strawberries, etc., and additives like tartrazine, azo dyes, hydroxyl benzoates, etc. Inhalants such as grass pollens, animal danders, tobacco smoke, and house dust. The contact urticaria syndrome is mainly due to latex, caterpillars, animals, and plants. Arthropod assaults like insect bites are the most important cause of papular urticaria. Infections of bacteria, viral, candidal, and protozoal can also be the cause. General medical disorders such as hypo or hyperthyroidism, lymphoma, polycythemia, lupus erythematosus, pruritic urticarial papules, and plaques of pregnancy. Psychogenic causes and genetic causes like hereditary angioedema.
The following are the clinical features of urticaria:
These lesions may also occur as:
Depending on the cause, the time taken by the lesions to appear might differ. In people with contact urticaria, the skin may react to latex or any other irritants. The skin starts to react within 10 to 60 minutes and may last up to a day. Urticaria occurs within an hour in people with food allergies, but reactions to additives and food colorings may appear after 12 to 24 hours. However, bodily reactions to a drug start to begin at once or later, even years after using the medication. In the case of chronic hives, the symptoms may persist for several days, months, or years.
Urticaria may develop on different parts of the body such as legs, arms, face, and trunk.
A detailed history gives a better yield regarding the cause than a battery of investigations in all patients. Provocative tests for physical urticarias like ice cube test for cold urticaria, exercise test for cholinergic urticaria, stroking for dermographism, etc., are definitive for diagnosis. In selected patients, the need will arise to check the following blood tests. Complete blood count. ESR (erythrocyte sedimentation rate). Urine analysis. Stool examination for ova and cyst. Blood chemistry profile. ANA (antinuclear antibody). Hepatitis B and C antigens and antibodies. Thyroid antibodies. Cryoglobulins. CH 50. Hereditary C1 esterase deficiency. Plasma and erythrocyte protoporphyrins (solar urticaria). Skin biopsy in urticarial vasculitis and IgE and IgE receptor antibody assay.
The treatment options for urticaria are listed below.
Avoidance of precipitating or provoking causes is curative in the case of urticaria.
Conclusion:
Out of two types of urticaria, acute can be treated permanently with medications. However, in the case of chronic urticaria, the infection will relapse once every six days. So timely transport to the emergency department is needed when the patient suffers from the symptoms of chronic urticaria.
The following includes the list of the most common causes of an urticaria reaction:
- Foods.
- Medications.
- Infections
- Insect bites.
Internal disease.
The round rashes can last for a varied amount of time in different individuals. Usually, the eruptions that are formed last only for a few minutes. Rarely, it might extend to several hours or several weeks to months. But most commonly, individuals who are affected with hives have a rash, not more than 24 hours.
Several infections can cause urticaria are:
- Throat infections such as streptococcus infection.
- Stomach and genitourinary tract infections.
- Fungal infections.
- Infectious mononucleosis.
- Hepatitis.
When you are affected by an urticaria infection, you are supposed to avoid histamine-rich foods. It includes the following:
- Cheese.
- Yogurt and other old dairy products.
- Preserved meats and bacon.
- Fruits like strawberries and cherries.
- Spinach.
- Tomatoes.
- Eggplant.
- Alcoholic beverages.
- Fermented food products such as bread.
- Fast food.
No, urticaria is not a severe condition. It causes difficulties like severe itching on the initial stages but resolves in most patients with proper treatment. It commonly resolves within 24 hours from the time of onset.
Urticaria can be caused by various infections that affect the human body. It also includes fungal infections. The most common fungal infection that causes urticaria is trichophyton infection.
The urticaria rash is being termed as hives. It typically appears on the skin as reddish lesions. It might be very itchy. It can appear as elevated areas of skin with a blanched center. They can appear in different shapes and sizes, ranging from a few millimeters to several centimeters in diameter. These rashes can also occur in any region of the body.
The following are the methods that can aid in permanent cure of an urticaria reaction:
- Apply a cold compress several times a day. But avoid this method if cold triggers your hives.
- Use topical creams that you can buy in the medical shop without a prescription.
- If symptoms persist, consult a doctor.
Chronic cases of urticaria can also be caused as a result of an immune response. An immune response can be triggered by various factors such as heat, extreme physical activity, or alcohol usage. Stress can also be a potential cause of urticaria and can aggravate it.
The following are the antihistamine medicines that can be used for patients affected with an urticaria reaction:
- Loratadine.
- Fexofenadine.
- Cetirizine.
- Desloratadine.
The following are the list of physical factors that can aggravate an urticaria reaction
- Cold.
- Heat.
- Excessive sweating.
- Exercise.
- Pressure.
- Sunlight.
- Water.
- Vibration.
Even though hives are associated with several autoimmune conditions such as thyroid diseases and inflammatory bowel disease, treating the autoimmune condition cannot cure hives. However, in most affected people with chronic urticaria, the rashes will gradually disappear with time.
Urticaria can be prevented by following some simple lifestyle changes. The primary preventive measure is by avoiding triggers such as food and medicines. You should always ensure adequate personal hygiene. It can aid in preventing infections that can cause hives.
Along with our body's circadian rhythms, different health conditions can lead to itchy skin reactions. It is known to become worse at night. This occurs in skin diseases like eczema, psoriasis, and urticaria.
The following are everyday food items that can trigger urticaria. Avoiding those foods from the diet can prevent and cure urticaria:
- Tomatoes.
- Food additives such as vinegar.
- Food preservatives.
- Wine.
Cold urticaria is defined as a skin condition in response to cold that occurs within minutes after the event of cold exposure. The affected region of the skin develops reddish rashes. It is known as hives.
The following are the best treatment options to cure cholinergic urticaria:
- Antihistamines.
- Leukotriene inhibitors.
- Immunosuppressives.
However, cholinergic urticaria has a higher chance of recurrence.
There is no cure for cold urticaria. However, preventive methods can help avoid the condition. The primary preventative measure is avoiding cold exposure. These patients can also get some relief by using appropriate medication.
Last reviewed at:
05 Mar 2022 - 4 min read
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