Urticaria - Symptoms & Treatment

Urticaria is an itchy rash which causes areas of skin to become inflamed raised and red, and is more commonly known as 'hives' or 'nettle rash' (even though it's not caused by nettles). These welts can appear anywhere on the body including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to several days before fading. Angioedema is similar to urticaria, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands and feet. It generally lasts longer than urticaria, but the swelling usually goes away in less than 24 hours. Occasionally, severe, prolonged tissue swelling can be disfiguring. Rarely, angioedema of the throat, tongue or lungs can block the airways, causing difficulty breathing. Urticaria occurs following release of histamine, bradykinin, kallikrein, and other vasoactive substances from mast cells and basophils, resulting in intradermal edema from capillary and venous vasodilation and occasionally from leukocyte infiltration. Urticaria has four major mechanisms. Most commonly, it is a manifestation of acute immunoglobulin E (IgE) mediated hypersensitivity with histamine and other vasoactive peptides released from mast calls and basophils. Nonimmunologic urticaria occurs when an exogenous substance results in mast cell degranulation either by direct stimulation of the mast cell or by unknown mechanisms (reaction to intravenous contrast dye). Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) cause urticaria by a non mast cell mechanism, especially in asthmatics.

Urticaria also called nettle-rash or hives or wheals in a common language, simply means itching with rash and mainly effects the neck, arms, legs and trunk of the children. Urticaria is an allergic reaction pattern of the skin, characterized by eruption of wheals or hives, which are itchy, transient, reddish and edematous swelling of the skin and mucosal surfaces that spread by peripheral extension and assume bizzare patterns on the skin. Wheals are caused by release of histamine and other chemical mediators which are released by mast cells which accumulate in the dermis of the skin as a response to some immunological or non immunological allergic response in the body. Urticaria is an allergic skin disorder. Characteristically the skin eruptions are erythematous, raised above the skin level, with intense itching and usually worsened by itching & with slight local warmth. Urticaria is classified as either acute or chronic. Acute urticaria is defined as urticaria that has been present for less than 6 weeks. Chronic urticaria is defined as urticaria that has been continuously or intermittently present for at least 6 weeks. The 6-week period is a guide and not an absolute demarcation. Skin lesions and pruritus occur, caused by an allergic or nonallergic mechanism.

Causes of Urticaria

Find common causes and risk factors of Urticaria :

• Pregnancy.
• Allergens in food.
• Heat/cold pressure, exercise.
• Medicines-painkillers, antibiotics, antihypertensives, codeine.
• Urticaria and alcohol.
• Emotional factors( emotionalstresses).

Signs and Symptoms of Urticaria

Sign and symptoms may include the following :

• Itchiness.
• Rash.
• Stress.
• Swelling .

Treatment for Urticaria

Treatment may include :

• All these drugs cause varying degrees of drowsiness, hence driving, operating machines and other jobs which require mental alertness should be avoided while undergoing treatment.
• Urticaria, if not responsive to oral antihistamines, may have to be treated with injections of adrenaline or steroids especially for patients 'complaining of a choking sensation in the throat which occurs due to swelling in the respiratory passage.
• Suppressive treatment of urticaria is carried out by administering antihistaminic drugs like Chloropheneramine (Avil) triprolidine hydrochloride, Actidil and Cyproheptadine hydrochloride (Periactin). The dose and the frequency should be adjusted to give adequate coverage for 24 hours.
• Cool the affected area with a fan or an ice pack.
• Patients with urticaria pigmentosa should avoid aspirin, codeine, opiates, procaine, alcohol. polymyxin B, hot baths, and vigorous rubbing after bathing and showering. These can release histamine which can cause itching, flushing and hives.