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  Urticaria

The medical term for hives is urticaria which is a common form of allergic reaction. Generally, it is caused by direct contact of an allergenic substance but may also be due to stress, certain foods and medicines. The characteristic appearance of urticaria is raised reddish or pinkish skin welts which can be around 5 mm (0.2 inches) in diameter or more accompanied by severe itchiness. These hives often have a paler border that appears and disappears abruptly without any trace or scar. In some cases, the hives are associated with burning or stinging sensations. A more serious form of hives called angioedema can sometimes occur which involves swelling of the deeper tissues of the eyes, mouth, hands or genitals resulting to a more frightening appearance but it usually goes away in less than 24 hours. Angioedema is considered to be life threatening especially when there is swelling of the throat (pharynx) and voice box (larynx) causing blockage of the airways.

Urticaria Skin diseases
Urticaria


In majority of cases, a viral infection can cause a single attack of urticaria. However, some sufferers tend to get repeated attacks which occur as an allergic reaction to foods (e.g. nuts, chocolate, fish, tomatoes, eggs, fresh berries and milk) or due to insect stings. Upon exposure to the allergen, hives usually break out within a few hours and the patients figure the cause by themselves even without consulting a health care practitioner.

Another form of recurrent hives formation is the physical urticaria which develops in certain individuals once exposed from sunlight, cold, pressure, vibration or exercise. Dermatographism is the term used if the hives develop merely from scratching or firmly rubbing the skin which doesn’t always itch. Dermatographism is the most common of the physical urticarias affecting around 5% of the general population.

Cholinergic urticaria occurs in some people who develop tiny extremely itchy hives once they react to anything that make them hot or sweaty such as sunlight, exercise, hot baths, blushing or anger.

If the hives persists for longer than 6 weeks to several years, it is called chronic urticaria. In these cases, patients become so miserable and worried with this chronic problem aggravated by the fact that neither the patient nor the doctor can identify the cause of the hives. In around 95% of chronic hives cases, there is no identifiable cause also known as “idiopathic\". It is still quite worthwhile to consult a physician to determine if there is any possible underlying cause such as thyroid or liver problems, sinusitis and other skin diseases as well as an allergic cause (e.g. reaction to food, drug, insect bite, etc.) which comprises around 5% of chronic urticarias with an identifiable etiology. This can be determined by the dermatologist upon a good medical history and physical examination with additional information by performing evaluations such as blood and urine tests and sometimes a skin biopsy.

In about half of chronic idiopathic hives cases, the pathophysiology is explained by an overactivity of the body’s immune system. This mean that the body’s own macrophages are attacking the normal tissues of the body thus, causing hives. This disorder is also known as “autoimmune”. Some patients even have other associated underlying autoimmune diseases such as thyroid (Hashimoto’s disease) problem, vitiligo (patches of depigmented skin), swollen joints, or the presence of ANA (antinuclear antibody) as an abnormality in the blood.

Antihistamine is the mainstay of treatment for urticaria. Common reasons why there is lack of effectiveness among antihistamines are due to the following: the particular antihistamine used is not strong enough or not used in a dose high enough to relieve the symptoms and lastly, the antihistamines used are not continued for a long enough period.

Patients usually tolerated well as an initial treatment the newer class of non-sedating antihistamines such as loratadine (Claritin) and cetirizine (Zyrtec). If it fails in eliminating the hives, then the sedating-type of antihistamine such as hydroxyzine, cyproheptadine or doxepin is added to be given every night. If the above mentioned drugs still don’t work, short course steroids to eradicate the hives completely may be started. Prolonged intake of steroids is avoided due to its serious side effects such as Cushing syndrome, osteoporosis, diabetes mellitus etc.

For those with resistant, disabling severe cases of chronic hives, cyclosporine which is also a drug used for severe cases of psoriasis and kidney transplants is almost always effective in clearing the hives even at low doses. However, the same with steroids it should be given for a shorter course only due to its significant side effects if taken for a prolonged period of time.

Other non-standard treatments in addition to antihistamines if the hives are not resolving, are antacids such as cimetidine (Tagamet) and ranitidine (Zantac); dapsone and sulfasalazine (anti-inflammatory, antibiotics); nifedipine (antihypertensive agent); Accolate (anti-asthma), colchicine (anti-gout), and several others. These medicines though are not always as effective as compared to the standard therapies. A recently emerged drug known as Plaquenil is used for the treatment of autoimmune urticaria. This drug originally used for the tropical disease known as malaria.

The main goal of pharmacologic treatment is to suppress and prevent hives from breaking out which is achieved by giving enough medication to the patient. Some physicians even suggest that medications should be continued for long periods, even up to a month after the hives have disappeared. For proper management of urticaria, working and coordinating closely with your doctor is important.

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