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Urticaria is a very common condition. One in four of us will experience it sooner or later. It’s just a kind of rash, but the itching that accompanies it can drive you crazy. Although there are many potential causes of urticaria, unfortunately in chronic forms it is possible to make an unambiguous diagnosis only in every fifth case. This usually minor ailment can be the first symptom of serious health problems.
Urticaria – what is it?
Urticaria is one of the most common skin diseases that poses a great diagnostic challenge for doctors of various specialties. Patients present themselves because of sudden skin changes resembling those after burns by nettle – hence the Polish name of the disease.
However, skin lesions in urticaria show great variability and dynamics. They may be limited to a few eruptions or cause generalized involvement of the skin of the entire body. The rash appears as tiny bubbles on a red surface. A very characteristic feature of lesions is their severe itching. They do not stay on the skin for a long time, appear quickly and quickly disappear, giving way to new changes. A relapse of acute urticaria usually lasts from a few hours to several days, and the forms that persist beyond 6 weeks are called chronic urticaria.
In approximately 50% of patients, urticaria is also accompanied by edema of the subcutaneous tissue (angioedema, Quincke’s edema), while in 40% of cases, urticaria is an independent symptom.
Urticaria – types of symptoms
It is not uncommon that the blisters that accompany hives may differ from person to person. In fact, even in the same person, the rash can change from day to day or with different episodes.
Although the blisters are raised, their surface is smooth (unlike dermatitis which tends to be rough). In some people, the blisters may be bright red, while in others they may be lighter and skin-colored. Some bubbles appear round with a pale center and a characteristic red rim.
Other symptoms may include a burning or stinging stinging and when pressed, the center of the red blister usually turns white – this is known as “paling”. The hives can move over the skin and it can take an hour on one part of the body to disappear and then return to another area.
Urticaria – the mechanism of its origin
The mechanism of the formation of this extremely characteristic disease is quite complex. Urticaria is essentially a vascular reaction. The appearance of the bubble is due to the ingress of plasma from the blood vessels into the skin. This is possible due to the increased permeability of blood vessels and their expansion. This vascular reaction is in turn driven by a variety of chemicals (including histamine) that are released from blood cells called mast cells.
Not all hives are allergic. There are many other triggers.
Some of the mechanisms leading to the activation of mast cells are allergic mechanisms, and then urticaria is simply a skin symptom of allergy to various substances. Such urticaria resulting from allergy is most often a reaction limited to the skin, but it also happens that it is the first symptom of a developing generalized allergic reaction, the so-called anaphylactic reaction.
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Allergic urticaria – risk factors
Hives are usually caused by an allergic reaction to a potential allergen. When an allergic reaction occurs, our body begins to release histamine into the bloodstream. Histamine is a chemical produced by the body to defend itself against infections and other pathogens.
Unfortunately, in some people, histamine can cause swelling, itching, and many of the symptoms found with hives. When it comes to allergens, hives can be caused by factors such as pollen, medications, food, animal hair, and insect bites.
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Acute and chronic urticaria
The classification of urticaria includes acute urticaria and chronic urticaria.
Acute hives – Also known as ‘common hives’, this category of hives usually resolves on its own within 6 to 8 weeks. The most common cause of wheal formation is an allergic reaction. Some forms of acute urticaria can also occur in the course of anaphylaxis (a severe, potentially life-threatening allergic reaction).
Chronic urticaria – Chronic hives usually last longer than 6 to 8 weeks and occur almost every day, with relapses lasting months to years. It is quite unusual to be able to pinpoint the exact cause of chronic urticaria (which is why the condition is referred to as idiopathic). Doctors may recommend laboratory or allergy tests when hives symptoms appear, but the results don’t always help pinpoint the underlying cause.
Accurate information about your medical history, oral consumption (food, medication, etc.), and personal habits may be helpful in determining potential causes. In some cases, a physician may determine an underlying medical condition, such as a thyroid disorder, type of cancer, celiac disease, rheumatoid arthritis, lupus, type 1 diabetes, or an infection that may be contributing to an exacerbation of urticaria.
Chronic hives need to be monitored and treated by a doctor as symptoms can also affect internal organs (such as the digestive tract, lungs, and body muscles), and also lead to the development of other problems such as shortness of breath, muscle aches, diarrhea, or vomiting. Chronic causes can also be linked to immune system reactions or abnormalities.
Urticaria – types
Various types of physical stimuli can trigger hives. Examples are:
Dermografism: hives or raised areas of skin appear where the skin has been stroked, scratched or rubbed, or comes into contact with tight clothing,
Cold hives: hives appear on skin that has been exposed to cold air or cold water, or after contact with a block of ice or after cryotherapy,
Cholinergic urticaria: hives develop in response to sweat from exercise, emotional stress, or after a hot shower.
Contact urticaria: Urticaria occurs on contact with an allergen, pseudoallergen or irritant. Examples include cosmetics, latex, meat, medicines, saliva, nettle, textiles or white flour.
Pressure hives: hives appear (often with a delay of several hours) when pressure is applied to a specific area of the skin, such as through a purse, seat belt, or riding a horse.
Solar urticaria: it typically involves hives that appear in areas of the body that are not usually exposed to the sun, such as the abdomen and upper thighs, saving the face, neck and hands. Long wavelength UV light or visible light may be involved.
Thermal urticaria: hives develop on areas of the skin that have been in contact with the hot water bottle or develop on the body after consuming a hot drink.
Vibratory urticaria: hives appear spontaneously after exposure to vibrations,
Aquagenic urticaria: hives develop under the influence of fresh, chlorinated or salty hot or cold water.
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- Recurrent hand allergy – is it atopic dermatitis?
Urticaria accompanying other diseases
Another group of hives are skin lesions that appear as a coexisting symptom of other diseases. This is where the long list of – sometimes very dangerous – conditions comes in. Hence, at the onset of urticaria, and especially in situations where the skin lesions recur and are resistant to treatment, it should be very carefully checked for symptoms that may suggest a coexistence of another disease.
It is known that urticaria can accompany various types of infectious diseases: parasitic infections, viral infections (hepatitis A, B and C, HIV) or streptococcal infections. It is also often associated with autoimmune diseases (so-called autoimmune diseases), such as thyroid disease, visceral lupus or vasculitis. It also happens that it is a symptom of malignant neoplasms, most often lymphomas.
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Urticaria – diagnosis
The diagnosis is made on the basis of the very typical appearance of skin lesions. Sometimes the trigger for change is easy to identify and avoiding it is the best treatment and prevention of urticaria.
However, sometimes – and this is the case most often in the case of chronic urticaria – it is impossible to determine the culprit despite extensive diagnostics. Then it is important to exclude other potentially very dangerous comorbidities. Treatment, on the other hand, is about removing symptoms.
Urticaria – angioedema
Angioedema, sometimes referred to as “great hives”, causes swelling of the deeper layers of the skin, mainly in the face, hands, feet and sometimes also the genitals. Deep swelling around the eyes (lids) and mouth can be dangerous and if it affects the tongue and throat it can also affect breathing, blocking the airways. If this happens, angioedema can be life-threatening.
Symptoms of angioedema include:
- large blisters appearing on the surface of the skin (mainly in the eyes, lips, cheeks, throat, hands or feet)
- redness (inflammation) and swelling of the affected areas (like discolored patches and a rash)
- sensations of heat, itching, or pain in the affected areas.
Swelling, although severe, may be short-lived and resolve within 24 hours. A genetic link has been noted whereby the condition can be passed on from parent to child (genetic transmission). This is called ‘hereditary angioedema’.
Urticaria – treatment
Various types of antihistamines are used, often in doses much higher than the standard recommended ones. Hence, treatment of urticaria should always be under medical supervision. In the event of treatment failure, you can also use steroids, but due to their numerous side effects, they should not be used chronically. In treatment-resistant cases, cyclosporine is also used.
You can also try herbal preparations in the form of infusions or teas for allergic changes on the skin. Try the Tea recommended for allergies, which contains firefly, hugs, thistles, nettle and blackberry leaves, rose and raspberries, burdock root, dandelion, angelica, cinquefoil rhizome and marigold petals.
If you have problem skin, try Exema hemp soothing cream with a low pH of 4,7 which soothes itching and burning and reduces redness.