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Introduction to Urticaria
Urticaria, or hives, is a common problem seen in doctors’ offices. In some patients, in addition to hives, there may also be swelling of the lips or throat. This is called angioedema. The cause of the hives and angioedema is most likely degranulation of mast cells. Everyone has mast cells on the exposed parts of the body. Theses mast cells are loaded with histamine, leukotrienes, and several other chemicals. If these chemicals stay inside the mast cells, they do not cause any problems. Once they are released, the open up the blood vessels and create inflammation.
An inflammatory reaction in the outer layers of the skin is a hive. An inflammatory reaction in the deeper layers of the skin or in the GI Tract is angioedema. The question everybody asks is what makes these mast cells degranulate. The most common cause is an allergic reaction. However, these hives are acute and usually last no more than a few days. We can do skin testing and identify the allergen in these situations.
However, in chronic urticaria, infective agents like viral antigens may be the cause for the degranulation of the mast cells. These hives can last for weeks and sometimes for months.
Some physical factors like exposure to the cold and physical pressure can also degranulate mast cells. More common in this group is dermographism, but most of these hives have a “streaky” appearance.
Some medications such as morphine and codeine, and histamine-
In acute reactions, giving epinephrine, a short course of oral steroids, and antihistamines are indicated. In chronic hives, the usual treatment is a long-
In spite of these treatments, some patients have chronic hives for months or years. In these instances, we do blood work and a chest x-
What are the different types of urticaria?
They can be classified into two categories: Immunologic and Non-
How is urticaria treated?
Your allergist first will alleviate the discomfort with medications; for example, antihistamines. Severe attacks of urticaria can be temporarily relieved by injections of epinephrine; rarely in these cases corticosteroids may be prescribed for a short period. Other drugs may be required for specific types of urticaria.
Of course, if the cause can be identified, the best course of treatment is avoidance of the substance that triggers urticaria. If a problem with a specific food is strongly suspected, then is should be avoided. This may require a careful reading of packaged food labels and inquiry about ingredients in restaurant meals. Persons with Solar Urticaria should wear protective clothing and apply sunscreen lotions when outdoors. Loose-