What are the other Names for this Condition? (Also known as/Synonyms)

• Urticaria, Acute type

What is Acute Urticaria? (Definition/Background Information)

• Urticaria is a common inflammatory condition of skin that results in weals (red skin sign with itching) and/or angioedema (swelling due to fluid accumulation). It is seen in individuals of a wide age group and may be described as acute or chronic, based on the duration of the signs and symptoms
• Acute Urticaria is a common skin condition that usually lasts less than 6 weeks. The signs and symptoms are observed for a short-term; it often resolves between a few minutes to a few days
• The condition may be triggered by factors that include common cold and flu (in about 40% of the cases), certain medications, and rarely food and other allergies. In about half the cases, no cause is established for Acute Urticaria
• Any region of body skin may be affected, but usually the head and neck, chest and back, arms and legs are involved. Intense itching may lead to bruising, skin ulceration, and scarring, which can cause emotional stress from cosmetic concerns
• Acute Urticaria is treated symptomatically, when required. The treatment may involve the use of topical ointments and creams, antihistamines, and immunosuppressive medication, in case of severe signs and symptoms. The prognosis with adequate treatment is usually excellent
• In many individuals, Acute Urticaria is a short-term duration skin condition that is known to get better on its own without any treatment. However, it may recur in the presence of the triggers

Who gets Acute Urticaria? (Age and Sex Distribution)

• Acute Urticaria is common and 20% of the individuals may get the condition once in their lifetime. It is more often seen in children than adults
• There is no gender, race, or ethnic preference observed

What are the Risk Factors for Acute Urticaria? (Predisposing Factors)

The risk factors for Acute Urticaria include:

• Infections caused by viruses that include infectious mononucleosis, respiratory infections affecting the upper respiratory tract (the most common factor responsible for this type of urticaria), and hepatitis
• Infections caused by bacteria that include Mycoplasma pneumoniae infection, sinusitis, and oral abscess
• Insect bites and stings
• Food allergies including peanut allergy and shellfish allergy
• Blood transfusion causing serum sickness
• Intravenous contrast materials used during radiological studies
• Certain drug reactions, such as occurring from antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and painkillers (opiates)
• Contact with certain materials such as latex; this may result in widespread allergic skin reaction, even though the contact may be localized

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acute Urticaria? (Etiology)

Urticaria can be caused by a variety of factors. The condition develops due to the release of chemical substances, such as histamines, platelet activating factor, and cytokines (example bradykinin), from inflammatory cells called mast cells and basophils.

• In over 50% of the Acute Urticaria cases, the cause is identified. In case the cause is unknown, the condition is known as Acute Idiopathic Urticaria. The triggers for Acute Urticaria may be known or unknown
• Acute Spontaneous Urticaria: It is a form of spontaneous urticaria that develops as a single episode, usually lasting a few days to a few weeks. The triggers may be known, which is usually the case, or unknown

What are the Signs and Symptoms of Acute Urticaria?

The signs and symptoms of Acute Urticaria usually include:

• Initially, localized itching of skin may be observed; the skin may appear swollen
• Formation of skin rashes or weals (wheals) that are associated with redness (or pinkish discoloration) and intense itching
• The skin surrounding the affected area (weal) may be normal skin color or appear red (erythema)
• The weals may change in shape and size; weals may be spherical, arranged in a random form, or ring-like pattern
• In some individuals, there may be a burning sensation accompanying itching
• Individual weals may vary in size from a few mm to few cm; but, numerous weals covering a large area of the body skin are usually observed
• The weals may last for several minutes to up to a day; few cases are non-itchy
• Urticaria can occur in any part of the body and can be focal or extensive
• In some cases, it can lead to hyperpigmentation (increased skin pigmentation) or hypopigmentation (decreased skin pigmentation)
• When pressure is applied on the hives, it blanches (becomes pale or white in color)
• Scratching can result in worsening of the symptoms and lead to further skin complications such as ulceration and secondary infections
• Angioedema: It may or may not occur with Acute Urticaria
  • Angioedema is swelling due to fluid accumulation in the mucus membranes or deep within the skin. This lasts for up to 3 days, it can be also itchy
  • Angioedema usually occurs focally; most common sites are the head and neck region, hands, feet, and genitalia. In the head and neck region, it can involve the eyelids, lips, or oral cavity
• Pain, pain on touch
• In individuals with serum sickness, fever, fatigue, painful joints, body aches, and swollen lymph nodes may be noted, apart from hives (skin rashes)

The itching may be worsened by substance or factors such as alcohol, stress, and exercises.

How is Acute Urticaria Diagnosed?

Generally, no lab tests are needed and Acute Urticaria condition is diagnosed clinically. In some cases, lab tests are necessary and a diagnosis of the skin condition may involve:

• Physical examination of the skin and medical history evaluation
• Skin allergy test
• Blood test to detect various antibodies against allergens including:
  • Complete blood count (CBC)
  • Antinuclear antibody (ANA) test
  • Erythrocyte sedimentation rate (ESR) test
• Tests to rule-out other underlying conditions (if any necessary)
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A skin biopsy is usually unnecessary and is performed only in rare cases.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acute Urticaria?

Generally, Acute Urticaria is a self-resolving skin condition and no major complications are noted. however, in some cases, the following complications may be noted:

• Intense scratching may result in skin scarring
• Itching can lead to ulceration of skin, causing superimposed bacterial and fungal skin infections
• Cosmetic concerns in some individuals leading to stress
• Recurrent condition: In about 25-30% of the individuals, the acute condition may become chronic
• Severe Acute Urticaria can result in anaphylactic shock, which is a potentially life-threatening medical condition

How is Acute Urticaria Treated?

In many individuals, Acute Urticaria resolves on its own and the symptoms get better within a few days to weeks. If necessary treatment may be provided and this depends upon the severity of the signs and symptoms. Treatment management includes the avoidance of triggers.

The treatment measures for Acute Urticaria include:

• Individuals with mild symptoms can be treated using over-the-counter medications
• Cooling the skin using moist towels
• Topical steroid treatment that may include moisturizing creams to soothe the condition
• Anti-histamine therapy
• In individuals with severe signs and symptoms, immunosuppressive medication may be administered
• Patient education in understanding the condition is beneficial

How can Acute Urticaria be Prevented?

Although Acute Urticaria may not be prevented, further and future flare-ups may be avoided, if the triggers that cause the condition are known and recognized. In such cases, the following may be considered:

• Treating viral and bacterial infections early and appropriately
• Avoiding exposure to drugs that cause the condition
• Avoiding the use of materials that cause Acute Urticaria; informing the healthcare provider suitably of any food, drug, or contrast material allergies (if these are identified earlier)
• Ensuring adequate protection against insect bites and stings (such as bee and wasp stings)

However, in about 50% of the cases, no causative factors are identified and Acute Urticaria is not preventable.

What is the Prognosis of Acute Urticaria? (Outcomes/Resolutions)

• The prognosis of Acute Urticaria is excellent, since it is often a self-limiting condition. The condition is known to resolve in less than 6 weeks
• In many individuals, the skin condition gets better without any substantial treatment and gets back to normal state
• Anaphylactic reaction/shock can be fatal without treatment

Additional and Relevant Useful Information for Acute Urticaria:

Please visit our Skin Care Health Center for more physician-approved health information:

http://www.dovemed.com/healthy-living/skin-disorders/