What is acute and chronic urticaria and how is it treated?

Hives is a skin disorder that causes rashes. It is characterized by itching of varying severity, often severe.
The disease is associated with the release of biologically active (transmitting signals from cell to cell) substances by immune (mast) skin cells. Hives can be caused by an understandable and known cause (such as food, medicine, or insect bites), but often the cause is unknown.

Short information about urticaria

Forms and complications of urticaria

Urticaria is divided into acute and chronic.

Diagnosis of these forms is based only on the duration of continuous rashes. The border is 6 weeks of rashes.

Acute urticaria, as a rule, does not require any special examinations, with the exception of suspected allergies. In this case, allergy testing with a suspected allergen (e.g. food) may be required. Most often, acute urticaria is triggered by infections such as ARVI.

If the rash does not stop within 6 weeks, it can be assumed that chronic urticaria is developed.

Chronic urticaria, in turn, is divided into:

- Induced (factors - cold, sun, water or others);
- Idiopathic (neither the patient himself nor the doctor can determine the causes of the rash).

Hives or the so-called urticarial rash can also be a non-specific manifestation of some common diseases.

The doctor will help determine the form of the disease, prescribe the necessary examinations and treatment. According to international guidelines, numerous and detailed examinations of patients with urticaria are not performed. If urticaria is induced, the cause of the rash will be determined at the first appointment. In most cases, hives are idiopathic and are not caused by diet or lifestyle.

Hives can be one of the manifestations of severe allergic reactions.

In these cases, it occurs simultaneously with symptoms such as edema (angioedema), shortness of breath and difficulty breathing (bronchospasm), vomiting, diarrhea, decreased blood pressure, lethargy, weakness - up to loss of consciousness. In this situation, emergency medical care is required.

The causes of urticaria

Acute, new-onset urticaria or chronic induced urticaria can be a reaction to a viral infection, drugs, food, exercise, exposure to intense sunlight, contact with animals, cosmetics, chemicals (such as latex or nickel), or it can be caused by other causes.

Acute urticaria can be one of the manifestations of a parasitic infection. But since, according to the WHO, parasite infections are not widespread in developed countris, when deciding on the appointment of a survey, it is necessary to take into account risk factors and other manifestations of infection (visiting regions with a high risk of infection, eating raw fish or meat, the presence of complaints from the gastrointestinal -intestinal tract, blood eosinophilia and others).

Most cases of chronic urticaria have no external cause.

Under the influence of external factors or without external causes, histamine and other substances are released from mast cells, swelling and itching of the skin begins, and rashes appear. This can be caused by various types of immunological reactions. These can be allergic reactions, reactions caused by the influence of complement or immune complexes. Chronic urticaria is usually associated with autoimmune reactions, but there is no reliable test that can accurately determine this.

Urticaria symptoms

- Rash.
- Itching, which is important but sometimes not observed.

Urticaria treatment

The main group of drugs for the treatment of both acute and chronic urticaria are type I histamine receptor blockers (antihistamines, for instance Cyproheptadine). In accordance with the international GA2LEN recommendations, a combination of different drugs or an increase in the dose of an antihistamine is possible.

In severe exacerbations, short-term use of corticosteroid hormones is possible. Such treatment does not affect the prognosis of the course of the disease, but it can quickly reduce severe and pronounced symptoms.

With an insufficient effect of antihistamines (at the maximum dose) in the treatment of chronic urticaria, it is possible to prescribe antileukotriene drugs, histamine II type receptor blockers. And in case of its severe course - biological therapy with omalizumab or immunosuppressive therapy with cyclosporine can be used.

Features of urticaria treatment methods

Even with significant itching, a large area of rashes and a prolonged (sometimes many years) course, chronic urticaria does not lead to changes in the internal organs. In most cases, it stops gradually (sometimes over several years or even decades).

The main task of the doctor here is to help the patient achieve and maintain a comfortable quality of life, determine possible causes of the disease and observe the patient to identify other diseases with similar rashes.

Diagnosis of urticaria and treatment selection

In order to prescribe the necessary treatment, a dermatologist will examine your skin and ask questions about your condition.

It is important to tell your doctor what factors you feel are causing your condition to worsen; what treatment you received before, was it effective; which drugs worked best and which did not work.

The diagnosis of urticaria is established on the basis of a doctor's examination; there are no specific laboratory diagnostic tests.

Additional research may be required to clarify the form of the disease. If the doctor has doubts about the suitability of your condition for the diagnosis of urticaria, a diagnostic skin biopsy (taking a piece of skin) and histological examination (examination of the obtained material under a microscope) may be required.

It may take some time to find drugs to control the disease. First, small doses of drugs are prescribed, then they are gradually increased.

After achieving a stable improvement, treatment should be continued, in the future, the dose of prescribed drugs can be gradually reduced until complete cancellation.

Drugs for the treatment of severe urticaria

- Antihistamines such as Fexofenadine (180 mg), Cyproheptadine, and others.
- Omalizumab is an antibody to immunoglobulin E and is used for severe chronic idiopathic urticaria and bronchial asthma. Before prescribing the drug, the doctor will conduct an examination and make sure that the simpler methods of treatment have been ineffective. The drug is injected subcutaneously 1 time in 4 weeks. Treatment is carried out on an outpatient basis, but always under medical supervision. The drug is generally well tolerated, side effects are rare. The downside is the high cost of treatment.
- Cyclosporine is another drug used for severe chronic idiopathic urticaria. It belongs to a group of drugs that reduce the body's immunological reactions and, due to this, has an anti-inflammatory effect. In addition to the treatment of chronic urticaria, it is used in dermatology to treat severe forms of atopic dermatitis, psoriasis and some other diseases. Before starting treatment and during treatment, it is necessary to monitor the state of the body, the doctor will conduct an examination and make sure that simpler methods of treatment have been ineffective.

Recommendations of a dermatologist for patients with urticaria

- Seek medical attention immediately if you experience rapid or difficult breathing, nausea, vomiting, abdominal pain, or loss of consciousness;
- Exclude triggers (factors that cause aggravation) that you know with certainty, foods to which you have a proven allergy.

Dieting for chronic urticaria is controversial. A diet that eliminates pseudoallergens or foods containing histamine has not been shown to be beneficial in treating chronic urticaria. Compliance with these diets is difficult and is not supported by most current clinical guidelines.

Post by: Samuel Wrangler, M.D., Montgomery, Alabama