Urticaria (Hives) - Everything You Need To Know

Video transcript :-
Urticaria, commonly known as hives, is a vascular reaction of the skin characterized by transient, pruritic wheals, which appear as raised, erythematous, edematous plaques on the skin.
It results from plasma leakage into the superficial dermis due to increased capillary permeability.
Urticaria can be acute or chronic.
In acute urticaria, the symptoms typically last less than 3 weeks.
It can be caused by various factors, including viral, bacterial, or parasitic infections.
Allergens, including various foods such as nuts and shellfish, drugs, especially non-steroidal anti-inflammatory drugs and antibiotics, insect stings, and contact allergens such as latex and various chemicals.
Other than those factors, cold, heat, and exercise can also induce urticaria.
Chronic urticaria typically lasts more than 6 weeks.
Most cases of chronic urticaria are idiopathic, meaning there is no identifiable cause.
Other cases are usually associated with an autoimmune condition such as thyroiditis, systemic lupus erythematosus, and vitiligo.
Additionally, personal or family history of allergies, asthma, or eczema, also known as atopy, and psychological stress may increase the risk of getting urticaria.
The central event in the pathogenesis of urticaria is degranulation of mast cells in the dermis.
This releases histamine, leukotrienes, prostaglandins, and other inflammatory mediators.
Histamine increases vascular permeability, causing edema, giving rise to wheels, and stimulating sensory nerves, and causing pruritus.
The condition is characterized by sudden onset of raised, erythematous, and pruritic wheals on the skin.
Lesions may vary in shape and size.
Individual wheels usually last less than 24 hours, but new ones can appear subsequently.
Swelling of the lips, eyelids, and mucosae, also known as angioedema, may accompany some cases.
The condition resolves completely without any residual skin changes.
In severe allergic reactions, patients may have systemic symptoms, including shortness of breath, low blood pressure, and signs of anaphylaxis.
The diagnosis of urticaria is clinical, based on the history and examination findings.
Laboratory tests are required for chronic urticaria.
These include complete blood count, ESR, ANA levels if an autoimmune pathology is suspected, and thyroid function tests.
Finally, the treatment for urticaria.
If an identifiable triggering factor is present, it should be eliminated first.
In addition, avoidance of these triggering factors will help prevent further attacks of urticaria.
Second-generation H1 antihistamines, including cetirizine, loratadine, and fexofenadine can be used as first-line therapy in urticaria.
An H2 blocker like ranitidine can be added if there is poor response.
For severe cases, adding a leukotriene receptor antagonist such as montelukast can be helpful.
For refractory acute episodes, a short course of prednisolone can be used.
Cyclosporine or other immunosuppressants may be used in refractory autoimmune urticaria.

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