Urticaria: treatment, symptoms and diagnosis

It’s good to be healthy, but unfortunately, we cannot always boast of an excellent state of mind and body. Everyone has heard about hives. This is a fairly common allergic disease that can occur at any age. Ruthless statistics say that 15-20% of the population of our planet have observed at least one case of urticaria throughout their lives.

Urticaria is a widespread disease that manifests itself in the form of characteristic rashes, similar to nettle burns, on the skin and mucous membranes and is very rarely accompanied by itching.

In childhood, each of us was inadvertently burned by nettles, so it is quite easy to remember the symptoms of this disease. Hippocrates was one of the first to talk about this seemingly simple disease: he drew an analogy between urticarial rashes in people suffering from urticaria and problems of the gastrointestinal tract.

Causes of urticaria

Very often, the cause of hives is an allergic reaction of the body to certain substances or allergens. There are different ways that allergens enter the body, depending on which urticaria occurs:

food (citrus fruits, seafood, pork, nuts, eggs, tomatoes, berries are the culprits),
insect (as a result of insect bites), including those resulting from infection with parasites (helminths, ticks),
medication (for penicillin, aspirin, codeine),
result of stress
toxic allergies (to dust, pollen),
as an individual reaction to cold, heat, prolonged ultraviolet irradiation.

In all of the above cases, you need to consult an allergist.

Forecast

Often, an episode of acute urticaria may be the only one in a patient's life. If the patient is less fortunate and the allergy becomes chronic, then spontaneous remission can be expected in 50% of cases.

Potentially life-threatening are laryngeal edema with urticaria and the acute form of the disease with anaphylactic reactions. For patients with cold urticaria, swimming in cold water can be fatal due to asphyxia or systemic reactions with a drop in blood pressure.

Classification of the disease

There are two forms of urticaria:

acute (duration is about 6 weeks),
chronic (over 6 weeks).

There are different types of immunological urticaria:
Allergic
Compliment addict.
Autoimmune.
Physical is divided into:
temperature: thermal or cold contact;
allergies that develop under the influence of other extraneous factors.
There are also the following forms of urticaria:
Aquagenic.
Adrenergic.
Idiopathic.
Urticaria caused by non-IgE-mediated mast cell degranulation.
Cholinergic.
Drug-induced urticaria with development mechanisms different from those previously described.

Traditional therapy

How to treat hives? The first step is to eliminate the causes and triggers of the disease if possible. Refusal of medications that provoke rashes, an attempt to avoid the influence of provoking physical factors, as well as adherence to a hypoallergenic diet can reduce the frequency of relapses of the disease, but all this has rather low effectiveness without drug therapy.

An important task is the rehabilitation of foci of chronic infection and correction of concomitant somatic pathology. Sometimes these measures are enough to prevent relapses.

The main drugs for urticaria, with which drug therapy begins, are, of course, H1-histamine receptor blockers. According to the recommendations of the World Allergy Organization, therapy should begin with second-generation antihistamines.

If symptoms persist for 2 weeks, then it is permissible to increase the dose to four times and continue taking it for up to 4 weeks. A sedating H1 blocker may be prescribed at night. If ineffective, it is recommended to change the drug or add antileukotriene drugs. During exacerbations, a short course of systemic glucocorticosteroids (3–7 days) is acceptable.

If manifestations of urticaria/angioedema persist, the issue of switching to 2nd line drugs must be resolved - glucocorticosteroids, immunosuppressants (cyclosporine), monoclonal antibody drugs (omalizumab). In the treatment of urticaria pigmentosa, as well as urticaria caused by physical factors, the stabilizer ketotifen is used mast cell membranes.

Angioedema (with the exception of hereditary forms associated with defects in the complement system or kinin system) is treated according to the same principles. In case of life-threatening conditions associated with the risk of asphyxia (swelling of the larynx, tongue), emergency treatment with the administration of adrenaline is required; emergency intubation or tracheostomy may also be necessary.

Symptoms of urticaria

Blisters can appear as pinpoint or large-focal, sometimes they merge with each other.
A blister, the primary element in the manifestation of a skin rash, is a local swelling of the papillary dermis, which occurs as a result of accelerated blood flow, vasodilation, and increased vascular permeability.
Blisters may also appear as cavityless exudative ephemeral elements. Dense, swollen, bright pink in color, they can rise above the skin level and have different shapes (large scalloped, rounded, etc.), different sizes (diameter - from 0.5 to 10-15 cm) and often a pale area in the center. Blisters may disappear without a trace (even after a few minutes).
Sometimes there may be a burning sensation or a blister may be accompanied by unpleasant itching of the skin.
Inflammation can occur anywhere. But most of all skin rashes appear in places where skin and clothing come into close contact: under straps, belts, and suspenders.
The duration of the visual presence of the rash can range from several minutes to a day.
In half of the patients, urticaria is accompanied by angioedema (Quincke's edema).

If swelling and rash have spread to the surface of the mucous membranes of the gastrointestinal tract, nausea and vomiting have appeared, this indicates a possible threat to human life and requires immediate intervention by a specialist.

Very often, urticaria is not treated and the disease is not given due importance. However, it is important to know that hives can be a signal of the appearance of diseases of the internal organs or some other serious infection in the body.

Do not forget about the predisposition to urticaria. This will be indicated by increased sensitivity of the skin and white stripes that remain after light scratching (white dermographism). If hidden infections are detected in time, the immune system will be able to function normally. It is important to assess the condition of the internal organs, being aware that if their functioning is disrupted, skin diseases may occur.

For what indications is specialist consultation necessary?

Consultation with an allergist is necessary in case of exacerbation of chronic recurrent urticaria, as well as in intermittent acute form of the disease. The causes of diseases associated with urticaria can be determined by an allergist. It is also necessary to consult a dermatologist, rheumatologist, parasitologist, endocrinologist and, possibly, an oncologist.

Brief description of some clinical forms of urticaria

Allergic urticaria

Most often acute or episodic
The most common allergens are food, medications, insect poison, latex
Patients also have other manifestations of allergy pathology, allergic heredity
Positive results of allergological examination
Elimination measures are effective

Autoimmune urticaria

Current type of chronic idiopathic urticaria
Frequent presence of autoimmune thyroiditis and thyroid diseases in the family
Severe general symptoms (weakness, malaise, gastrointestinal dysfunction)
Presence of histamine-releasing anti-Fcε-RI antibodies and anti-IgE antibodies
Positive test with autoserum

Cold urticaria

It can be acquired (idiopathic and arising against the background of an underlying disease, for example, viral hepatitis, lymphoproliferative disease, etc.) and congenital.
The appearance of itching, burning, hyperemia, urticarial rash, angioedema in areas of the skin exposed to low temperatures
Symptoms persist for 20-30 minutes and disappear without a trace after the patient warms up
exposed

Delayed pressure urticaria

Characterized by the appearance of swelling and blisters in pressure areas 4-6 hours after exposure.
Characterized by resistance to treatment

Heat urticaria

Occurs from exposure to heat.
Hereditary local thermal urticaria has been described, characterized by a delayed (4-6 hours) appearance of elements after local thermal exposure.
May be accompanied by systemic circulatory disorders and convulsions

Solar urticaria

Occurs under the influence of ultraviolet radiation
Blisters appear on exposed areas of the body after exposure to the sun; there may be fixed light urticaria
The disease can be primary (idiopathic photic urticaria) and
Secondary light urticaria may be associated with the action of drugs (tetracyclines, sulfonamides, quinolones) or associated with an underlying disease (SLE, thyroiditis, gastrointestinal dysfunction).

Dermographic urticaria

The appearance of blisters due to mechanical irritation of the skin
Itching precedes the appearance of rashes
The phenomenon of dermographism is reproduced by intense line irritation of the skin with a blunt object (spatula)

Vibration urticaria/angioedema

There are hereditary (autosmal dominant type) and acquired forms
Characterized by the appearance of a rash and swelling in areas exposed to vibration
Rash and swelling appear 4-6 hours after exposure to vibration and persist for up to 24 hours.
The disease is caused by nonspecific degranulation of mast cells

Aquagenic urticaria

The rash occurs only after contact with water of any temperature
A rash with severe itching occurs immediately after contact with water
Characterized by the appearance of small blisters surrounded by erythematous spots

Cholinergic urticaria

Characterized by the appearance of pale pink blisters with a diameter of 1-5 mm, often surrounded by erythema, the rash is generalized
Provocative factors include exercise, stress, sweating, and hot showers.
May be accompanied by systemic manifestations (hot flashes, weakness, rapid heartbeat, headache, abdominal pain, shortness of breath
Can be reproduced by subcutaneous administration of acetylcholine

Adrenergic urticaria

Rarely seen
Characterized by the appearance of small papules with a white halo
Triggered by stress
Can be reproduced by intradermal injection of epinephrine

Anaphylaxis/urticaria caused by physical exertion

Characterized by the appearance of skin itching, rashes, angioedema during or immediately after physical activity
May be accompanied by systemic manifestations, including bronchospasm, laryngeal edema, vascular collapse
A provoking factor may be the consumption of certain foods (alcohol, apples, shrimp, tomatoes, nuts, celery) before physical activity.

Epidemiology

Data on the prevalence of chronic spontaneous urticaria vary somewhat. The lifetime risk of developing an episode of urticaria in the average population is thought to be between 20 and 25%. At the same time, searching for a potential allergen that caused the development of urticaria is a difficult task, despite significant advances in the development of modern laboratory diagnostics. Thus, in 20% of cases, the development of acute urticaria is associated with exposure to potential exogenous allergens, such as food or drugs. In 30% of cases, urticaria is caused by infectious agents, especially respiratory tract infections. However, the causes of the remaining 50% of urticaria cases remain unclear [5].

On average, chronic urticaria is reported in approximately 1% of individuals in the population [6]. Moreover, women get sick almost 2 times more often than men, and the onset of the disease most often occurs in the 3rd–5th decades of life [6]. Among the main risk factors for the development of chronic urticaria are obesity, anxiety, dissociative and somatoform disorders, and malignant neoplasms [7].

Additional research:

skin test when using autologous serum;
rheumatological tests;
nasal swab for the presence of eosinophils;
TSH, T3, T4, antibodies to thyroid peroxidase and thyroglobulin;
culture of throat flora, throat culture for sensitivity to antibiotics and bacteriophages;
stool analysis for sensitivity to bacteriophages and dysbacteriosis;
antibodies to helminths, as well as roundworms and lamblia;
coprogram;
HBsAg, AT to hepatitis C, RW, AT to HIV;
ultrasound examination of the thyroid gland;
Ultrasound of the abdominal cavity;
consultation with a gastroenterologist to identify H. pylori, endoscopy, consultation with a neurologist, ENT specialist (VSD);
ECG;
if urticarial vasculitis is suspected, a dermatovenerologist performs a skin biopsy.

Recommended drugs that are used to treat urticaria

Antihistamines. The Gorbakov Clinic uses new drugs that do not have side effects.
Leukotriene receptor antagonists.
Histamine H2 receptor blockers.
Immunosuppressants.
Glucocorticoids.
Slow calcium channel blockers.
Androgens.
Combination drugs that include M-anticholinergic drugs.
Antidepressants.
Medicines that are used in rheumatology.
Plasmapheresis.
Intravenous immunoglobulins.

Specialists at the Gorbakov Clinic individually determine the patient’s treatment tactics in each individual case. A systematic approach to treatment will help the patient get rid of the problem for a long time or forever.

Features of the treatment of urticaria at the Gorbakov Clinic:

Individual patient training at the immuno-school and asthma school.
Treatment begins on the first day of treatment.
A comprehensive examination is carried out on the day of treatment.
Return to normal life.
Rapid relief of a serious condition occurs within 1-3 days.

Urticaria is an extremely common allergic disease, affecting one in five people worldwide. Most often, people do not attach importance to the symptoms and rarely consult a doctor if they notice characteristic rashes. However, urticaria is often a signal of the presence of serious diseases in the body. Contact a specialist at the first symptoms of allergic urticaria and undergo the recommended comprehensive examination.

It’s good to be healthy, but unfortunately, we can’t always boast of an excellent state of mind and body. Everyone has heard about hives. This is a fairly common allergic disease that can be acquired at any age. Ruthless statistics say that 15-20% of the population of our planet have observed at least one case of urticaria throughout their lives.

Urticaria is a widespread disease that manifests itself in the form of characteristic rashes, similar to nettle burns, on the skin and mucous membranes. Rarely accompanied by itching.

In childhood, each of us was inadvertently burned by nettles, so it is quite easy to imagine the symptoms of this disease. Hippocrates was one of the first to talk about this seemingly simple disease. He drew an analogy between urticarial rashes in people suffering from hives and problems of the gastrointestinal tract.

Causes of urticaria

Very often, the cause of hives is an allergic reaction of the body to certain substances (allergens). There are different ways that allergens enter the body, depending on which urticaria occurs:

food (citrus fruits, seafood, pork, nuts, eggs, tomatoes, berries or other products are the culprits);
insect (as a result of insect bites), including those resulting from infection with parasites (helminths, ticks);
medication (for penicillin, aspirin, codeine and other drugs);
result of stress;
toxic allergy;
as an individual reaction to cold, heat, prolonged ultraviolet irradiation.

In all of the above cases, you need to consult an allergist.

Classification of the disease

There are two forms of urticaria:

acute (duration is about 6 weeks);
chronic (over 6 weeks).

There are different types of immunological urticaria:

urticarial vasculitis;
allergic;
compliment dependent;
autoimmune.

Physical urticaria is divided into:

mechanical urticaria:
vibration;
dermographic;
temperature urticaria:
thermal;
cold contact;
allergies that develop under the influence of other extraneous factors.

There are also such forms of the disease:

contact;
aquagenic;
adrenergic;
urticaria, which is caused by non-IgE-mediated degranulation of mast cells;
cholinergic;
drug-induced urticaria with development mechanisms different from those previously described;
idiopathic (if the cause of urticaria is not established);

Symptoms of urticaria

A blister is the primary element in the manifestation of a skin rash. It is a local swelling of the papillary dermis, which occurs due to accelerated blood flow, vasodilation and increased vascular permeability.

Blisters can be either pinpoint or large-focal, sometimes they merge with each other.

Blisters may also appear as cavityless exudative ephemeral elements. Dense, swollen, bright pink in color, they can rise above the skin level and have different shapes (large scalloped, rounded, etc.), different sizes (diameter - from 0.5 to 10-15 cm) and often a pale area in the center. Blisters may disappear without a trace (even after a few minutes).

There may be a burning sensation or an unpleasant itching sensation.

The duration of the visual presence of the rash can range from several minutes to a day.

In half of the patients, urticaria is accompanied by angioedema (Quincke's edema).

Very often, urticaria is not treated and the disease is not given due importance. However, it is important to know that hives can be a signal of an infection in the body.

Brief description of some clinical forms of urticaria

Allergic urticaria:

often occurs acutely or episodically;
the most common allergens are food, medications, insect poison, latex;
Patients also have other manifestations of allergopathology, the so-called allergic heredity;
the results of the allergy examination are positive;
Elimination measures are effective.

Autoimmune urticaria:

characterized by a course of chronic idiopathic urticaria;
frequent presence of autoimmune thyroiditis and thyroid disease in the family;
severe general symptoms (weakness, malaise, gastrointestinal dysfunction);
the presence of histamine-releasing anti-Fcε-RI antibodies and anti-IgE antibodies;
the autoserum test is positive.

Cold urticaria:

can be acquired or arising against the background of an underlying disease (for example, viral hepatitis, lymphoproliferative disease and others) and congenital;
the appearance of itching, burning, hyperemia, urticarial rash, angioedema in areas of the skin exposed to low temperatures;
symptoms persist for 20-30 minutes and disappear without a trace after the patient warms up.

Delayed pressure urticaria:

characterized by the appearance of swelling and blisters in pressure areas 4-6 hours after exposure; Inflammation can occur anywhere. But most often, skin rashes appear in places where skin and clothing come into close contact: under straps, belts, and suspenders.
characterized by resistance to treatment.

Heat urticaria:

occurs from exposure to heat;
hereditary local thermal urticaria has been described, characterized by a delayed (4-6 hours) appearance of elements after local thermal exposure;
may be accompanied by systemic circulatory disorders and convulsive syndrome.

Solar urticaria:

occurs under the influence of ultraviolet radiation;
blisters appear on exposed areas of the body after exposure to the sun, there may be fixed light urticaria;
the disease can be primary (idiopathic light urticaria) and secondary;
secondary light urticaria can be associated with the action of drugs (tetracyclines, sulfonamides, quinolones) or with an underlying disease (systemic lupus erythematosus, thyroiditis, gastrointestinal dysfunction).

Dermographic urticaria:

the appearance of blisters due to mechanical irritation of the skin;
itching precedes the appearance of rashes;
the phenomenon of dermographism is reproduced by intense line irritation of the skin with a blunt object (spatula).

Vibration urticaria/angioedema:

there are hereditary (autosomal dominant type) and acquired forms;
characterized by the appearance of a rash and swelling in areas exposed to vibration;
rash and swelling appear 4-6 hours after exposure to vibration and persist for up to 24 hours;
the disease is caused by nonspecific degranulation of mast cells.

Aquagenic urticaria:

the rash occurs only after contact with water of any temperature;
the rash appears instantly;
presents as small blisters surrounded by erythematous spots.

Cholinergic urticaria:

occurs more often in young people;
characterized by the appearance of pale pink blisters with a diameter of 1-5 mm, often surrounded by erythema;
the rashes are generalized;
provocative factors are physical exercise, stress, sweating, hot shower;
may be accompanied by systemic manifestations (hot flashes, weakness, rapid heartbeat, headache, abdominal pain, shortness of breath);
can be reproduced by subcutaneous administration of acetylcholine.

Adrenergic urticaria:

rare;
characterized by the appearance of small papules with a white halo;
triggered by stress;
can be reproduced by intradermal injection of adrenaline.

Polina Vasilyeva

dermatologist

There are several important prevention rules to prevent the recurrence of urticaria. These include eliminating or limiting hives triggers and seeing a doctor (pediatrician or allergist) to identify the allergen to limit your exposure to it as much as possible. A patient prone to anaphylactic reactions is also recommended to wear a bracelet or note with information about the allergens that cause them.

There are situations, and they are not isolated, when it is not possible to understand what irritant caused the symptoms of urticaria. This happens especially often if the parents did not consult a doctor in time, thinking that the annoying rash would go away on its own, but this did not happen.

If the irritant is unknown, the child is prescribed treatment in the form of a hypoallergenic diet. All foods containing histamine liberators should be excluded from his diet. The list of risks includes:

Bright red and orange fruits: orange, pineapple, tomato, strawberry, etc.
Chocolate, coffee, cocoa.
Legumes, including soy products.
Wheat and other grains containing gluten.
Fermented cheeses and blue cheeses.
Marinated, salted, fermented foods.
Fish and seafood.
Ham and smoked meats.
Nuts, seeds.
Spices, herbs and spicy vegetables such as radishes, horseradish, etc.
Eggs.
Honey.
Spinach.
Food additives - dyes, preservatives, flavors.

The diet is prescribed for a while until the symptoms disappear. After this, you can begin to return foods to your baby’s diet one at a time, monitoring the body’s reaction.

If within 1–2 months the diet does not bring results, it is necessary to move on to drug treatment. It is prescribed by the doctor who is observing the child.