Hives (urticaria)

Description and Classification of the Disease

Urticaria – a sudden rash on the skin and mucous membranes with itchy blisters.

Urticaria is most commonly an allergic disease, with the main rash element being raised whitish blisters of 0.5-10 cm in diameter above reddened skin, of various shapes. Patients may also complain of poor condition, vomiting, fever up to 38-39 degrees, headache and/or dizziness, joint pain.

Classification of Urticaria by Course of the Disease:

acute,

chronic,

recurrent (constantly recurring, relapsing),

induced by physical factors.

Classification of Urticaria by Cause of the Disease:

of allergic origin,

of non-allergic origin,

hereditary.

Sometimes urticarial rashes are a symptom of other diseases, e.g., malignant tumors, rheumatism, porphyria, etc.

Causes and Risk Factors of the Disease

Food and medications usually cause acute (sometimes chronic) urticaria. The main causes of urticaria in children are nuts, eggs, beans, milk, fruits, and cereal products; while in adults, peanuts and seafood are important. Chronic urticaria causes can be food additives: preservatives, various dyes. Drug-induced urticaria is most commonly caused by penicillin (an antibiotic).

Infections. Urticaria can start in the initial phase of viral hepatitis B, as well as in patients with tonsillitis (angina), sinusitis, osteomyelitis, gallbladder, urinary tract infections, infectious mononucleosis, parasitic and fungal diseases, as well as in cases of dental pathology and presence of worms.

Physical factors. Urticaria can be triggered by cold, heat, sunlight. Solar urticaria manifests within minutes only in the exposed area. Systemic effects are also possible, e.g., wheezing. Skin lesions resolve within 4 hours.

Other diseases – systemic lupus erythematosus, Sjogren’s syndrome, malignant neoplastic diseases.

Symptoms

The main element of the rash in urticaria is a blister. Blisters appear quickly, sometimes within a few minutes. Their size ranges from a pinhead to the size of a palm. When several foci merge, large rashes resembling a map form. Sometimes general malaise symptoms occur – poor condition, vomiting, fever up to 38-39 degrees, headache and/or dizziness, joint pain.

Diagnosis

Urticaria is easily diagnosed from the patient’s collected data on how and when the rash appears, and the clinical picture, as well as minimal tests (blood, urine analysis, checking for worms).

Treatment

The first step is to identify and remove the allergen. For food allergens – strict diet avoiding allergens. It is important to eliminate existing infections in the body and treat concomitant diseases. Effective and antiallergic drugs, adrenaline are used to treat acute urticaria, but they do not help at all for chronic urticaria. In the case of chronic urticaria, it is necessary to identify factors promoting the disease (infection, helminthic diseases, stomach and intestinal diseases), and treat constipation.

External treatment is usually ineffective. Itching is relieved by a 1-2% menthol spirit solution, Excipial Pruri lotion.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology