Chronic Urticaria

URTICARIA.

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Acute Urticaria is often caused by an allergy and can last between several hours and six weeks; chronic urticaria persists beyond six weeks. Most hives go away within days to a few weeks. Occasional unlucky individuals will have itches and swellings that come and go over many years. Urticaria is classified as either acute or chronic. Acute urticaria is defined as urticaria that has been present for less than 6 weeks.

Chronic urticaria is defined as urticaria that has been continuously or intermittently present for at least 6 weeks. The 6-week period is a guide and not an absolute demarcation.Skin lesions and pruritus occur, caused by an allergic or nonallergic mechanism.

Urticaria occurs following release of histamine, bradykinin, kallikrein, and other vasoactive substances from mast cells and basophils, resulting in intradermal edema from capillary and venous vasodilation and occasionally from leukocyte infiltration. Urticaria has four major mechanisms. Most commonly, it is a manifestation of acute immunoglobulin E (IgE)–mediated hypersensitivity with histamine and other vasoactive peptides released from mast calls and basophils. Nonimmunologic urticaria occurs when an exogenous substance results in mast cell degranulation either by direct stimulation of the mast cell or by unknown mechanisms (reaction to intravenous contrast dye). Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) cause urticaria by a non–mast cell mechanism, especially in asthmatics.

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Causes of Urticaria

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1.Allergens.

2.Environmental factors.

3.Drugs.(Penicillin).

4.Urticaria and alcohol.

5.Emotional factors( emotionalstresses).

Symptoms of Urticaria

1.Rash

2.Itchiness

3.Stress.

4.Swelling

Treatment of Urticaria

Oral antihistamines control wealing and itching for the majority of patients with urticaria. Avoid aspirin and codeine. It is usually safe to take paracetamol and the newer Cox-II inhibitor anti-inflammatories and avoid alcohol. Non-sedating antihistamines (loratidine, fexofenadine, terfenadine, cetirazine, and astemizole) are less likely to cause drowsiness than the less expensive conventional antihistamines. They may be unsuitable in pregnancy. Terfenadine and astemizole may increase the risk of abnormal heart rhythms. They should be avoided if you have heart disease or you are also taking erythromycin, ketoconazole and some other medications. Fexofenadine, loratidine, desloratidine and cetirazine are safe. Oral steroids (prednisone) are useful for severe acute urticaria but unsuitable long term because of serious adverse effects. Antifungal agents, used to clear an assumed underlying infection.

Urticaria Treatment

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Antihistamine tablets may help to reduce the itching and subdue the rash. There are many different types of these and some of the longer-established ones can cause drowsiness. Although this side effect may be troublesome by day it also aids sleep when irritation keeps the patient awake.

A short course of oral corticosteroids may be needed in more severe cases particularly those which do not respond to antihistamines although these must be used with caution due to the significant side effects of long term use.

Antihistamines are useful also in chronic urticaria although they need to be given for prolonged periods while the rash persists. Oral corticosteroids may also be needed but more recently anti-immune therapy is becoming available.

Often no treatment is necessary as the rash commonly goes within 24-48 hours.
A cool bath or shower may ease the itch.

Antihistamine tablets can ease symptoms. Antihistamines block the action of histamine which is involved in causing urticaria. You can get antihistamines on prescription. You can also buy them from pharmacies. There are several brands. The pharmacist will advise.

A short course of steroid tablets is sometimes prescribed in severe cases to help reduce swelling in the skin.

If you have a severe episode of urticaria then you may be referred to specialist (immunologist or dermatologist). In particular, if angiooedema or anaphylaxis occured at the same time. This is to confirm the diagnosis, and where possible, to identify a cause. For example, if a nut allergy is suspected to have caused a severe episode then this can confirmed by tests. You may then be given advice on how to avoid the cause, and on what to do if it should occur again.

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