URTICARIA
Urticaria
otherwise called as ‘hives’ is a frustrating problem for the patient as it
can be caused by anything under the sun including the sun.
It is seen as red itchy blotches on the skin disappearing in 6 – 24
hours only to appear elsewhere. If
it is less than 2 months then it is called acute urticaria whereas more than 2
months is referred to as chronic urticaria.
Swelling of the eyelids, lips, limbs may occur, the angiedema component,
uncommonly breathing problems, fainting may occur and must be considered and
treated as an emergency. There are
many varieties of urticaria. Many
factors that increase the severity of urticaria have been proposed.
These include food – eggs, fish, strawberries, tomato. Drugs
–aspirin, salicylates and the ever present stress.
The main types of urticaria are classified under the cause
1.
Cold urticaria – Intense exposure
to cold causes red blotches mainly on the exposed areas, precipitated by a blast
of cold air ,as the patient steps outside.
The important point here is that patients with this condition should not
eat cold food stuffs like ice-cream, chilled drinks as it may block the airways
due to swelling. Swimming in cold
lakes also could pose a danger.
- Pressure
urticaria – Constant pressure can result in wheals at the
site of pressure. It may be
seen in the buttocks, soles and on the back pocket due to pressure by a
large wallet.
- Solar
urticaria – The wheals occur as a result of sun exposure
usually fairly immediately after being in the sun.
Some patients may have a medical condition called porphyria
underlying this type of urticaria.
- Cholinergic
urticaria – This rash caused by sweating results in a distinct
red rash consisting of hives that are 2-5 mm in diameter. It occurs after exercise even though sweating due to
stress can provoke a attack.
Dermographism
If you get hives and long red marks after rubbing your skin with a towel
you could have dermographism. A
simple test would be rub a blunt end of the pen firmly across the skin.
A few minutes later a red mark appears in line with the linear pattern.
Hereditary Angiedema
This runs in families and results in large swelling of limbs, eyelids,
lips known as angiedema. Internally
there could be pain in the abdomen, with nausea, vomiting.
It is caused by a deficiency of C1 inhibitor esterase deficiency and the
level of C1 inhibitor esterase can be checked in the blood to exclude this
condition.
Contact Urticaria
If this red hives occur around the mouth or hands, food and food
additives, drugs, saliva from pets, and plants
are possible causes.
Helpful hints
Make a diary of what you are doing, eating every day for one month.
Also note the time of wheal formation in your body.
At the end of the month correlate your diary and see whatever you can
find any factor that makes it worse.
Do not forget to add any over the counter medications as it may also
aggravate urticaria.
What happens to the urticaria patient
If it is acute generally the problem settles within a week.
Otherwise it may recur if the allergen or factor is reintroduced.
In chronic urticaria the problem is more difficult.
Some patients may have wheals that last for years.
In acute urticaria no investigation is usually needed.
In chronic urticaria a full blood count, biochemical profile, chest X ray
and urinary analysis is helpful. A
dermatologist may undertake more tests depending on the detailed history and
findings he undertakes.
Treatment
Obviously
any factors that worsen the rash have to be avoided.
If you find any particular food aggravates the rash, stop eating it.
Antihistamines that block H1 receptors in the skin are the treatment of
choice.
Sometimes H2 receptors blocking drugs used to treat ulcers may also be
prescribed by your doctor.
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