Urticaria

urticaria

Urticaria , is commonly known as hives , is a kind of allergy of outer layer of skin dermis and epidermis presented in form of swollen, raised, reddish, itchy  bumps.
Hives may be associated with burning and stinging sensation.

Urticarial rash are sudden i.e. acute attack lasting for few hours in people who are allergic to some environment agents such as flowers, plants, chemicals, food products.

Such type of attack is known as acute urticaria and they are mainly the result of allergic trigger to immune system of body.

Sometimes the urticarial hives stays more than a week or more than six weeks then this type of urticaria is referred to as chronic urticaria and this type is rarely due any environmental allergen.

Chronic urticaria result due to autoimmune reaction of our body’s defense mechanism.

PATHOPHYSIOLOGY

patho

When an allergen enters the body the immune system of the body reacts by releasing the mast cells and basophils. These cells of the immune system release some chemical proteins such as histamine, bradykinin, leukotriene C4, prostaglandinD2, and other vasoactive substances in the dermis of the skin. These proteins cause release of fluid from vessels to accumulate in the nearby area of dermis causes swelling of the layer.

Urticaria occurs due to many other factors such as bacterial infection, viral infection, and reaction of the body to transfusion of blood, organs and also in cases of serum sickness.

Age / Sex groups affected by Urticaria

Urticaria can occur in any age group and sex. Chronic type of urticaria occurs especially in later age groups i.e. after the age of 45-50 years.
Individuals with low immunity and which are oversensitive to external environment are more prone to suffer from urticaria.
Both men and women are equally affected in case of urticaria.

Races affected by Urticaria

No particular race is more affected.

Causes of Urticaria

Urticaria includes wide range of causative factors

Urticaria due to exposure to cold
This type of urticaria occurs in individuals after the exposure to cold. This type of urticaria occurs when skin is exposed to extreme cold water or cold air. The immune response of the body lead to formation of urticaria rash on face hands and feet especially exposed parts of body to cold.

Severe reaction of the immune system is seen in cases where the patient is in direct contact with cold water as in cases of swimming in cold water. Due to direct contact there is excess amount of release of histamine which lead to which not even cause urticaria but also lead to sudden lowering of blood pressure, fainting of the patient, anaphylactic shock of severe condition even lead to death in some cases.

Urticaria on exposure to heat
This form of urticaria is very rare and if happen last for few hours one or two hours. Due to continuous exposure of skin to heat urticaria rash appear but as soon as heat is removed urticaria heal without any use of medication.

Urticaria due to sun heat (solar urticaria)
As the name represents this type of urticaria occur in those patients who are sensitive to sun exposure. As soon as the patient comes in contact with sun heat urticaria develop.

Urticaria induced by drugs
Some individuals show allergic reaction to some drugs such as aspirin, pencillin, sulfonamides, antidiabetic drugs. Urticaria induced by drugs not only causes the histamine to show hives on skin but also lead to failure of cardio respiratory system.

Urticaria due to some toxic plants or herbs or shrubs
Plants like poison ivy, poison oak, congress grass contain a particular type of reactive substance on their surface when individual’s skin come in contact the surface of plant that substance act as antigen and cause reaction on skin as the body release histamine against it.

Urticaria due to environmental agents
Dust, pollution, damp ceilings can be one of the cause for producing urticaria in some individuals who are hypersensitive.

Urticaria due to stress (cholinergic urticaria)
This type of urticaria occurs after acute stress, or due to prolong history of grief, strenuous exercise or sweating or activities leading to increase in temperature of body. The hives are present in localized areas and not big in size small red itching eruptions are present.

Urticaria occurring due to certain food products
There are two common food allergies present these days that is from shellfish, nuts and wheat allergy (gluten allergy). The common type of food allergies in adults are from shellfish and nuts. In case of children foods that cause allergies are peanuts, eggs, wheat, soy and nuts.

Dermographic urticaria

linear urticaria
This type of urticaria develops on rubbing something on skin like scratching the skin due to itching on skin. When the patients keep on scratching on skin the area where fingers or nails are used for rubbing show inflammation, redness and swelling in the linear lines on where the fingers are rubbed.
There is presence of linear hives in this type of urticaria.

Other factors leading to formation of urtica hives
• Pollen grains.
• Insect bites especially honey bee.
• Danger of animals like cats dogs.
• Parasitic infestations.
• Auto immune diseases present this symptom of hives very common.
• Associated with some illnesses such as leukemia, lupus erythematous.
• Occur in pregnancy especially last trimester.

Urticaria Signs and Symptoms

• Redness at the area of allergic reaction.
• Swelling of the area in different forms sometimes the area is circumscribed, and large swollen eruptions on skin covering large area with clear defined edges (called wheals).
•  Itching of the affected area.
• The raised hives are different areas of skin sometimes joining and form one single large area of hive.
• Swelling of lips in cases of urticaria due to food allergy.
• Patient goes in shock in severe cases of attack of urticarial reaction.
• Weakness in patient who suffers from repeated attacks of urticarial reactions.

Investigations of Urticaria

Diagnosis of the type of urticaria is depending on the type of reaction seen on the skin by doctor.
Cause behind the formation of eruptions will help to justify the type of urticaria the patient is suffering from.
Allergic test are done for food products such as nuts, shellfish, wheat etc.
Blood test
ESR
Platelet count
White blood cells
Basophils
Eosinophills
Neutrophills
Lymphocytes

Prognosis of Urticaria

Prognosis is good if the cause is easily removable.
In severe cases sudden shock leads to death of the patient when severity of attack is on very high scale or level.
In cases where urticaria is due to auto immune disease then treatment is difficult.

Differential diagnosis of Urticaria

• Eruptions due to drugs.
• Scabies.
• Pityriasis rosea.
• Purpura due to anaphylactic reaction (henoch-schonlein purpura).
• Allergic dermatitis or contact dermatitis.
• Atopic dermatitis.
• Mastocytosis.
• Erythema multiforme.

Complications of Urticaria

• Anaphylactic shock is major complication can lead to death also.
• Excessive swelling of the internal throat can lead to blockage of the airways and respiration ceases. Lead to sudden death.

Treatment of Urticaria

Avoiding the cause responsible for formation of urticaria helps a lot to treat the disease.
Citrizine tablet help to curb the allergic reaction.
Antihistamine is used to stop the allergic reaction.
In emergency cases where occur respiratory choking and shock condition management of shock is the most important test

Homeopathic treatment for Urticaria

Apis mellifica
• Sudden puffing up of whole body.
• Also well indicated medicine for erysipelas.
• Burning pain with carbuncles.
• Well indicated medicine for after bites of bees in which there is soreness and sensitivity along with.

Antimonium crudum
• Pustular eruptions with itching and burning, worse at night.
• Patient is sensitive to cold bathing.
• Eczema comes along with gastric troubles.
• Scabs on eruptions are thick, hard and honey colored.
• Also indicated in cases of gangrene which id dry.
• Urticaria, measles like rash.

Natrum muriaticum
• Skin is oily and greasy especially on hairy parts.
• There is itching and burning along with urticaria.

Urtica urens

• Very well indicated medicine for urticaria having violent itching, burning heat with formication.

• Symptoms occur after suppression of nettle rash.
• Nettle rash alternates with rheumatism.
• There is itching and stinging in scrotum.
• Urticaria   nodosa.

Diet / management for Urticaria

• Avoiding dietary allergens
• Avoiding natural salicylates ( present in fruits , beer and wine)
• Drinking Green tea
• Avoiding stress , as stress can make urticaria worse
• Aloe vera is also effective
• Vitamin C, Vitamin E and Zinc are also effective for treating urticaria
• Avoiding heat
• Grapefruit seeds are also healers for urticaria

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