Urticaria: Causes, Classification and its Complications.

 Urticaria: Causes, Classification and its Complications.

Hives on back



Urticaria is also known as Hives.It is a skin rash. The rash is usually red in color, raised abovev the surface of skin, edematous wheals in shape and intense itching. They last for few hours.
Urticaria are mostly due to allergic reaction, may be due to particular food, drug etc.
The lesions which are large, having mild itching, and diffuse swelling on the lips, tongue, eyelids, hands and genitals or other body parts are known as angiodema.
Wheals shaped Hives on Abdomen




edema on foot due to urticaria


Aetiopathology-

Urticaria occurs due to release of mediators causing increased capillary permeability and accumulation of fluid in surroundings tissues. In most of the cases Histamine is released from the mast cells but release of kinins (cytokines) and serotonin from cells in the skin may also be the cause. Most urticaria have immunological and allergic base. But some may be due to physical agents like heat, sweat, cold, pressure, exposure to sun, water etc.

Causes may be summarized as:-

  1. As a result of allergic reaction with food, food additives, drugs, inhalants, insects bite, contactants.
  2. Following infections and infestations like viral hepatitis, mononucleosis, HIV etc.
  3. Physical factors like heat, cold, pressure, water, sweating.
  4. Psychological stress
  5. Autoimmune reaction 

Clinical features:-

  • Eruption of itchy wheals pink or red rose in colors.
  • Bushing or stinging sensation
  • Angioedema (deeper and more diffused swelling)
  • Mild to moderate fever in some case.

Some systemic features associated with Urticaria

  1. Fever 
  2. Headache
  3. Dizziness
  4. Feeling of a lump in the throat 
  5. Hoarseness
  6. Wheezing
  7. Shortness of breath
  8. Nausea
  9. Vomiting
  10. Abdominal pain 
  11. Diarrhea
  12. Arthalgia

Classification

It may be Acute and Chronic
Hives lasting for less than six weeks as termed as Acute and that occurring daily or almost daily for at least 12 weeks is called as Chronic
Urticaria can also be classified as immunologic or non-immunologic. Immunologic urticaria is caused by type I or anaphylactic hypersensitivity reaction mediated by antigen induced IgE.

Investigations:

  • CBC (Complete blood count)
  • ESR
  • Total Eosinophill count
  • Patch Test
  • Shoot Test
  • Raised IgE
  • C-reactive protein

Complications of Acute Urticaria-

  1. Anaphylactic Shock- Pallor, sweating, hypotension, collapse preceded, by headache, bronchospasm, nausea, vomiting.
  2. Angioedema
  3. Obstruction of the upper airway.

 


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