urticaria

Urticaria (Hives) Description

Urticaria, also known as hives, is a skin condition characterized by the appearance of itchy red rashes or lumps called weals. These weals are typically well-circumscribed, erythematous, and pruritic (itchy), with smooth, slightly elevated papules or plaques.

Key Features:

• Itchy Red Rashes: Urticaria presents as an itchy red rash or lumps called weals.
• Migratory Weals: The weals can move around on the skin and may appear in different locations over time.
• Erythematous Plaques: The affected areas are typically erythematous (red) and pruritic (itchy).
• Smooth, Slightly Elevated Papules or Plaques: The weals are smooth and slightly elevated.

Causes:

Urticaria can be caused by a variety of factors, including:

• Allergic reactions to insect bites, food, or drugs
• Infections
• Autoimmune disorders
• Stress

Symptoms:

The symptoms of urticaria may include:

• Itching and redness of the skin
• Appearance of weals (hives) on the skin
• Swelling of the face, lips, tongue, or throat (in severe cases)
• Difficulty breathing (in severe cases)

References:

• [1] Urticaria consists of migratory, well-circumscribed, erythematous, pruritic plaques on the skin. Urticaria also may be accompanied by angioedema, ... (Source: Search Result 2)
• [3] Hives are raised or puffy areas of the skin that itch intensely (picture 1). Hives are a very common condition. (Source: Search Result 3)
• [5] Oct 1, 2024 — Hives — also called urticaria (ur-tih-KAR-e-uh) — is a skin reaction that causes itchy welts. Chronic hives are welts that last for more ... (Source: Search Result 5)
• [8] an itchy skin eruption characterized by weals with pale interiors and well-defined red margins; usually the result of an allergic response to insect bites or food or drugs (Source: Search Result 8)

Urticaria, also known as hives, is a skin condition characterized by the appearance of itchy, raised welts or bumps on the skin.

The main symptoms of urticaria include:

• Raised welts or bumps: These can appear anywhere on the body and can be red or skin-colored.
• Itching: This is usually the most bothersome symptom of hives, and it may be severe enough to interfere with work and sleep [1][2].
• Blanching: When pressed, the center of a red hive turns white [1].
• Swelling: Swelling can occur around the eyes, cheeks, or other areas of the body [5].

In some cases, urticaria can be accompanied by other symptoms such as:

• Dizziness
• Trouble breathing
• Swelling of the tongue, lips, mouth, or throat (in severe cases)
• Severe pain
• Blood blister-like spots

It's essential to seek medical attention if you experience any of these symptoms, especially if they are severe or accompanied by other concerning signs.

References:

[1] Hives Symptoms · Raised itchy bumps, either red or skin-colored · “Blanching” (when pressed, the center of a red hive turns white) ...

[2] Itching is usually the most bothersome symptom of hives, and it may be severe enough to interfere with work and sleep.

[3] Swelling can occur around the eyes, cheeks, or other areas of the body.

[5] Signs and symptoms include: Welts that form in minutes to hours; Swelling, especially around the eyes, cheeks ...

Note: The information provided is based on the search results within the context.

Diagnostic Tests for Urticaria

Urticaria, also known as hives, can be diagnosed through a combination of medical history, physical examination, and laboratory tests.

• Medical History: A thorough review of the patient's medical history is essential to understand the pattern and duration of symptoms. This includes asking about previous episodes of urticaria, allergies, and other health conditions.
• Physical Examination: A physical examination can help identify any current lesions or skin changes associated with urticaria. Dermatographism, a condition characterized by linear urticaria, may also be tested for.
  • Dermatographism should include identifying and characterizing any current lesions, testing for dermatographism (urticaria, often linear, ...) [8]
• Blood Tests: Blood tests can help determine the underlying cause of urticaria. These may include:
  • Complete blood count with differential
  • Erythrocyte sedimentation rate or C-reactive protein
  • Thyroid-stimulating hormone
  • Urinalysis
  • Liver function tests
• Skin Tests: Skin prick test results can help identify a food allergy as the cause of urticaria.
  • Prick or radioallergosorbent assay testing may be useful if contact urticaria is suggested. Skin prick test results may help identify a food ... [1]
• Autologous Serum Skin Test (ASST): This test has been reported to have 81% sensitivity and 78% specificity for investigating chronic urticaria.
  • At present, an autologous serum skin test (ASST) is the most useful test for investigating chronic urticaria and has a reported 81% sensitivity and 78% ... [3]

In some cases, no laboratory tests or allergy tests are needed for acute urticaria.

• There is no need for routine laboratory tests and allergy tests in acute urticaria. [7]

Treatment Options for Urticaria

Urticaria, also known as hives, can be treated with various medications to alleviate symptoms and reduce the frequency of episodes.

• Antihistamines: These are the primary agents used to treat urticaria. Second-generation H1 antagonists such as loratadine (Claritin) and cetirizine (Zyrtec) are effective in reducing itching, redness, and swelling [4][5].
• First-generation antihistamines: Older H1 blockers like diphenhydramine (Benadryl) can be used for short-term relief but may cause drowsiness [4].
• Glucocorticoids: Prednisolone in the dose of 20-30 mg for three days is effective to control severe attacks of urticaria and angioedema [3]. Low dosage alternate day dosing may also be used.
• Biologics: XOLAIR, a biologic treatment, is approved for chronic spontaneous urticaria (CSU) with no known cause [2].
• Other medications: Doxepin, nifedipine, leukotriene-inhibitors, sulfasalazine, and other miscellaneous anxiolytics, sedatives, and hypnotics may be used as second-line treatments or for specific cases [8].

Important Considerations

It's essential to consult a healthcare provider before starting any medication regimen. They will help determine the best course of treatment based on individual circumstances.

References:

[1] P SCHAEFER · 2017 - Second-generation H1 antihistamines are first-line medication for the treatment of acute urticaria. [2] XOLAIR is the first FDA-approved biologic treatment for chronic hives with no known cause. [3] Prednisolone in the dose of 20-30 mg for three days is effective to control severe attacks of urticaria and angioedema. [4] Antihistamines are the primary agents used to treat urticaria. [5] Nonetheless, histamine H1 blockers are first-line therapy for acute urticaria. [6] Cetirizine and fexofenadine are approved by the US Food and Drug Administration (FDA) for chronic urticaria in children aged 6 months and older. [7] First line drug therapy comprises non-sedative and sedative antihistamines, second line doxepin, nifedipine, leukotriene-inhibitors, sulfasalazine, etc. [8] Anti-itch drugs. The standard treatment for hives and angioedema is antihistamines that don't make you drowsy.

Differential Diagnosis of Urticaria

Urticaria, also known as hives, can be a complex condition to diagnose, and it requires a thorough evaluation to determine the underlying cause. Here are some possible differential diagnoses for urticaria:

• Allergic Contact Dermatitis: This is an allergic reaction that occurs when the skin comes into contact with an allergen, such as latex or certain metals [5].
• Atopic Dermatitis: Also known as eczema, this is a chronic condition characterized by dry, itchy skin and can be associated with urticaria [5].
• Urticarial Vasculitis: This is a rare condition that involves inflammation of the blood vessels and can cause persistent hives or wheals [6].
• Drug Eruptions: Certain medications can trigger an allergic reaction, leading to urticaria [5].
• Erythema Multiforme: This is a skin condition characterized by target-shaped lesions and can be associated with urticaria [5].
• IgA Nephropathy: This is a kidney disease that can cause urticaria as part of its presentation [8].

Common Causes of Urticaria

In addition to the above differential diagnoses, there are several common causes of urticaria, including:

• Acute Urticaria: This is a self-limiting condition that often occurs in response to an infection or food/drink [3].
• Chronic Urticaria: This is a persistent condition that can be caused by various factors, such as autoimmune disorders or physical stimuli [3].

Physical Triggers

Some people may experience urticaria in response to physical triggers, including:

• Delayed Pressure Urticaria: This occurs when pressure is applied to the skin for an extended period [7].
• Heat Urticaria: This occurs when the body temperature rises suddenly [7].
• Solar Urticaria: This occurs when exposure to sunlight triggers urticaria [7].

References

[1] AL Matos (2022) - Differential Diagnosis in Acute Urticaria [2] N Schettini (2023) - Clinically, it is characterized by the presence of smooth, erythematous or blanching, itchy swelling, called wheals or hives, which greatly vary ... [3] Ordinary urticaria ; Acute urticaria is self-limiting and often related to infection, and less often due to food or is drug-induced. ; Chronic urticaria has no ... [4] P SCHAEFER (2011) - Urticaria Etiologies Based on Patient History and Physical Examination [5] Sep 16, 2020 - Differential Diagnoses [6] by AL Matos (2022) - Differential Diagnosis in Chronic Urticaria [7] Feb 16, 2024 - Inducible urticaria, for example delayed pressure urticaria, heat urticaria, solar urticaria, symptomatic dermatographism, vibratory angioedema, ... [8] by LA Brodell (2008) - Results: Besides acute, chronic, and physical urticarias, there are 2 categories of diseases that have urticarial lesions.