Actualities of urticaria treatment
Urticaria, most commonly known as rash, often scares both the patient and the doctor. Usually, possible causes of urticaria are attributed to allergies, and it is forgotten that other factors can also cause urticaria, and sometimes it can just resemble rashes caused by other diseases. We talk about the most important forms of urticaria that can be identified and distinguished by collecting anamnesis, its symptoms, and treatment principles with the dermatologist Jurijus Šablė from Vilnius district central polyclinic.
How often do patients with urticaria come to your daily outpatient practice?
Of all the patients coming to me for consultation, about 20% suffer from urticaria, of which about 70% are women. Most of these patients are young or middle-aged, up to 40 years old.
What are the causes of urticaria? Have you noticed what most often causes urticaria in your patients?
Urticaria can be caused by many factors and reasons, such as various allergens - drugs, food, inhalants, contactants. Urticaria can also be caused by various physical factors. According to the causes, urticaria is classified as: idiopathic (when the cause is unclear), caused by physical factors: dermographic, pressure, vibratory; cold, heat, cholinergic; solar; adrenergic; physical exertion; aquagenic. Urticaria can be acute or chronic. Acute urticaria is characterized by symptoms (skin rashes, etc.) lasting less than 6 weeks. In usual cases, symptoms subside in less than 24 hours. Chronic urticaria is considered if rashes appear regularly (usually daily) and last for at least 6 weeks. The duration of a single episode of rash is from 4 to 36 hours. Chronic urticaria is often secondary, occurring due to another, underlying, disease, such as systemic, autoimmune pathologies, malignant tumors, etc.
What do patients with urticaria most commonly complain about? How can a doctor recognize this disease?
The most characteristic sign of urticaria is skin rashes with red or pink itchy edematous wheals, with a pale or whitish center. The size of the rash elements varies from a few millimeters to several centimeters. Rashes can merge, forming plaques. Urticarial rashes can appear in various parts of the body: on the skin - in the hairy part of the head (scalp), on the palms, soles, etc. Urticarial rashes are very itchy, itching is most intense in the evenings and at night. Sometimes patients describe the sensation as stinging or burning. The itching caused by urticaria is better relieved by rubbing rather than scratching, so patients with urticaria practically do not have excoriations, abrasions on the skin: redness of the skin caused by rubbing is visible.
From what diseases should urticaria be differentiated? Is the differential diagnosis difficult in outpatient, family doctor practice?
Urticaria should first be differentiated from infectious diseases, poisoning, contact dermatitis. Usually, this is not difficult after evaluating the anamnesis and symptoms specific to the disease, their course.
How is urticaria treated?
Urticaria is treated comprehensively: with non-drug measures (avoidance of factors causing the disease) and pharmacotherapy. Patients should know that certain factors worsen the course of urticaria: overheating, stress, alcohol. Sometimes, in cases of very intense itching, locally acting anti-itch medications are prescribed: 1-2% aqueous menthol cream, calamine lotion, or similar. Histamine H1 receptor blockers are the most important drugs in treating symptoms related to urticaria. Short courses of systemic glucocorticoids may be recommended for patients with severe urticaria, when rapid and complete symptom control is needed. Glucocorticoids are recommended only when treatment with maximum doses of H1 antihistamines is ineffective. H1 receptor blockers are the main treatment for urticaria, effective for the majority of patients with this condition. From a pathophysiological point of view, antihistamines are inverse H1 receptor blockers. New, second-generation H1 antihistamines also have anti-inflammatory effects. Clinical trials have shown that antihistamines effectively treat skin lesions caused by urticaria and relieve itching, but urticaria symptoms completely disappear in about 40% of patients. In recent years, new, highly effective and safer H1 receptor blockers have appeared on the market, one of which is bilastine. It is one of the newest H1 antihistamines, almost without sedative effects. Clinical studies have shown that bilastine effectively treats allergic rhinoconjunctivitis (seasonal and perennial) and urticaria, with the frequency of adverse effects not differing from patients treated with a placebo. Bilastine is particularly selective for peripheral H1 receptors, making it well tolerated. When taken orally, the drug is rapidly absorbed from the gastrointestinal tract. Bilastine is not metabolized by CYP450 enzymes, so the likelihood of interactions with other drugs is minimal. Not only the usual therapeutic dose (20 mg/day), but also higher doses of bilastine do not cause sedation or other signs of central nervous system depression, nor do they enhance the depressive effect of alcohol on the central nervous system. The drug does not cause cardiodepressive reactions or arrhythmias, so it can be prescribed to patients with concomitant heart and vascular diseases. In my experience, patients taking bilastine did not feel any side effects, were productive, and the treatment improved their quality of life.
Interview with Dr. J. Kastys
