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

• Hives
• Nettle Rash
• Weals

What is Urticaria? (Definition/Background Information)

• Urticaria is a common inflammatory condition of skin that results in weals (red skin signs 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
  • Chronic Urticaria is a skin condition that usually lasts over 6 weeks. The signs and symptoms are observed for a long-term; daily or periodic occurrence of weals may be noted. It is reported that between 25-30% of the individuals with Acute Urticaria may develop Chronic Urticaria
• The condition may be triggered by factors that include common cold and flu (in many cases), bacterial infections, autoimmune disorders, certain medications, food allergies, and physical contact with certain substances. In many cases, no cause is established for 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 skin ulceration and scarring, which can cause emotional stress from cosmetic concerns
• Urticaria is treated symptomatically and by avoiding the known triggers. Although, Acute Urticaria may not need treatment and the condition may resolve on its own, in some individuals
• In individuals requiring treatment, the condition is treated using topical ointments and creams, antihistamines, and immunosuppressive medication, in case of severe signs and symptoms. The prognosis with adequate treatment is usually good
• 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, in a considerable number of individuals, Chronic Urticaria is a long-term duration skin condition that may recur for years. This can affect the quality of life resulting in severe emotional stress

Who gets Urticaria? (Age and Sex Distribution)

• Urticaria is a common skin condition that is observed in children and adults
• There is no gender, race, or ethnic preference observed

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

The risk factors for Urticaria may include:

• Infections caused by viruses that include infectious mononucleosis, respiratory infections affecting the upper respiratory tract (which is the most common cause), hepatitis
• Infections caused by bacteria that include Mycoplasma pneumoniae infection, Helicobacter pylori infection, sinusitis, and oral abscess
• Autoimmune disorders including systemic lupus erythematosus (SLE), vitiligo, rheumatoid arthritis (RA), Graves’ disease, etc.
• Roundworm infection affecting the gastrointestinal tract
• 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)
• In some individuals, the condition is known to run in the families
• Other precipitating factors include pregnancy, contact with a variety of chemicals, exposure to sun, cold, exercise, etc.

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 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. Thus, the triggers for Acute Urticaria may be known or unknown
• Chronic Urticaria may be caused by an underlying infection, through hypersensitivity on exposure to certain substances causing an allergic reaction, or due to body’s immune system attacking one’s own body

What are the Signs and Symptoms of Urticaria?

The signs and symptoms of Urticaria may vary from one individual to another and may be mild or severe. It may 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 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

The itching may be worsened by substance or factors such as viral infections, tight clothing, food and drug allergies, alcohol, stress, and exercises.

How is Urticaria Diagnosed?

A diagnosis of Urticaria may involve the following tests and examinations:

• 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
  • Serum level of complement
  • Serum C-reactive protein blood test
• Tests to rule-out other underlying conditions (infections, autoimmune disorders, etc.)
• 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

A differential diagnosis may be considered to eliminate certain skin conditions, prior to arriving at a definitive diagnosis. The following conditions may be considered:

• Chronic itching due to a variety of other causes
• Contact dermatitis
• Dermatitis herpetiformis
• Drug eruptions of skin
• Eczema
• Erythema multiforme
• Insect bites
• Pemphigoid
• Pityriasis rosea
• Polymorphous eruption of pregnancy
• Urticarial vasculitis

Note: Generally, no lab tests are needed and Acute Urticaria condition is diagnosed clinically.

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 Urticaria?

The following complications of Urticaria may be noted:

• Intense scratching may result in bruising and scarring
• Itching can lead to ulceration of skin, causing superimposed bacterial and fungal skin infections
• Sleep disruption
• Cosmetic concerns in some individuals leading to stress
• Recurrent condition: In about 25-30% of the individuals, the acute condition may become chronic
• Frequent episodes of Urticaria can affect the quality of life, which can result in severe stress. This severe stress can in-turn be a trigger for further worsening of the condition
• Involvement of the larynx due to angioedema, may be life-threatening and a medical emergency. If the larynx is involved, it can result in sudden breathing difficulties, due to laryngeal edema
• Severe Urticaria can result in anaphylactic shock, which is a potentially life-threatening medical condition

Generally, Acute Urticaria is a self-resolving skin condition and no major complications are noted.

How is Urticaria Treated?

The treatment depends upon the severity of the signs and symptoms and it includes the avoidance of triggers. The treatment may be specific to the particular trigger causing the symptoms. In severe cases, an allergy specialist may be consulted. The treatment measures for 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
• Systemic steroids
• Anti-histamine therapy
• In individuals with severe signs and symptoms, immunosuppressive medication may be administered
• Patient education in understanding the condition is beneficial
• Stress management for severe and chronic conditions

Note:

• In many individuals, Acute Urticaria resolves on its own and the symptoms get better within a few days to weeks
• In case of idiopathic Urticaria, there is no cure and only management of the symptoms, as they occur, are undertaken

How can Urticaria be Prevented?

Although 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:

• Appropriately treating Acute Urticaria
• Treating viral and bacterial infections early and appropriately
• Avoiding exposure to drugs that cause the condition
• Avoiding the use of materials that cause acute or chronic 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)

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

The prognosis of Urticaria depends on the type (whether acute or chronic) and triggering factors. It also depends upon the severity of the signs and symptoms.

• 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
• The prognosis of Chronic Urticaria is generally good with suitable treatment, although it is known to recur in some individuals
• Anaphylactic reaction/shock can be fatal without treatment

Additional and Relevant Useful Information for Urticaria:

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

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