Urticaria is a skin disorder characterized by raised, red, and itchy wheals. It can be acute or chronic and is often caused by reactions to foods, medications, chemicals, insect bites, infections, physical stimulants, or chronic inflammatory diseases. Diagnosis is based on history and physical exam, and treatment involves identifying the cause and managing symptoms with antihistamines, H2 antagonists, tricyclic antidepressants, leukotriene receptor antagonists, or glucocorticoids.
Urticaria, also known as urticaria, is a skin disorder characterized by wheals, which are raised skin lesions with well-defined edges of redness and swelling, often associated with itching. This condition can be acute or chronic, with the former lasting up to 6 weeks and the latter persisting for more than 6 weeks. Acute urticaria develops and disappears within hours of exposure to the triggering agents, and episodes often persist for days. Most often it is due to a reaction to foods, medications, chemicals, insect bites, infections, physical stimulants, or chronic inflammatory diseases.
Hives result from histamine release from mast cell granules, which may be immune-mediated or non-immune-mediated. An immune-mediated release of histamine is most often due to an immunoglobulin E (IgE)-mediated response against a foreign substance perceived by the body to be harmful. A non-immune-mediated release of histamine is due to chemicals that can directly induce mast cell degranulation. Urticaria most often affects individuals between the ages of 20 and 40, although individuals of all ages can be affected.
In children, allergic reaction to food is a major consideration in acute urticaria. The most common known foods that can cause an allergic reaction are peanuts, eggs, and seafood such as fish and shellfish. The drugs that usually cause acute urticaria are penicillin, aspirin, sulfa drugs, nonsteroidal anti-inflammatory drugs, opioids, angiotensin converting enzyme (ACE) inhibitors, polymyxin B, and diuretics. Ammonium persulfate, found in hair chemicals, latex, and intravenous radioactive contrast media, is an example of a chemical that can cause acute hives.
Viral infections are the most common infection that can cause acute hives. Examples are hepatitis B and C infections. Physical stimulants that can cause acute hives include cold, sunlight, pressure, water, and vibration. Examples of chronic inflammatory diseases that can cause acute urticaria are systemic lupus erythematosus and rheumatoid arthritis.
The diagnosis is usually established by a complete history and physical exam. Imaging studies and skin biopsy are done only if the history indicates. Management of the disease consists of identifying its etiology and, if possible, controlling its severity, relieving pruritus and discomfort, and educating the patient. Prevention of future episodes of acute urticaria can be accomplished by patient education and avoidance of the identified etiology. Relief of itching and discomfort may be achieved through the use of first- or second-generation antihistamines with or without histamine 2 (H2) antagonists, tricyclic depressants, leukotriene receptor antagonists, or glucocorticoids.
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