Urticaria is an allergic disease that manifests itself by the formation of blisters on the surface of the skin and on the mucous membranes. Urticaria rash itches, rises above the surface of the skin, sometimes painful. The diagnosis is established on the basis of typical manifestations of the disease and anamnestic data, skin allergological tests. Treatment should include allergen elimination, taking antihistamines, enterosorbents, and in severe cases, corticosteroids.
ICD 10
L 50
General information
Urticaria (from Lat. “urtica” – nettle) is a dermatosis that occurs with the formation of blisters or angioedema. 25% of the population have experienced symptoms at least once in their lives, while the majority of them are women. The onset of morbidity occurs at the age of up to 40 years, 2-7% of patients are children. If contact with the allergen is permanent, then urticaria acquires a chronic course. In 40% of cases, disease is accompanied by Quincke’s edema.
Causes
Insect bites, transfusion of blood components, vaccination preparations, the use of any medicinal substances, as well as direct direct contact with an allergen or eating foods that can cause allergies can provoke disease. Urticaria rash can be a consequence of allergies to cold or high-temperature exposure, sunlight, vibration, mechanical friction. The direct causative factors may be infectious pathogens (bacteria, fungi, parasites). In about a third of patients, the causes of urticaria remain unknown.
Pathogenesis
The main mechanism for the formation of blisters on the skin is the release into the blood of a large amount of histamine, which is formed upon contact with an allergen. Depending on how quickly the sensitization of the body develops, disease can occur during initial contact or after repeated exposure to an allergen, and when the concentration of antibodies in the blood is high enough, symptoms of urticaria occur. The walls of the capillaries under the action of active substances increase their permeability, the fluid from the vessels sweats into the dermis and a blister appears, therefore disease is considered an allergic disease.
Urticaria symptoms
Acute and chronic urticaria
Numerous blisters of bright pink color suddenly appear on the skin and mucous membrane. With this disease, the main part of the rash appears within an hour, when the concentration of histamine in the blood is still high enough, but a little later some more blisters may appear, while the main part of skin diseases begins gradually with several elements. After a few hours, the blisters either disappear without a trace, or a second wave of urticaria occurs with the formation of new blisters. Chronic form lasts for months, and sometimes years.
Blisters are itchy and painful to touch, the skin around them is swollen and hyperemic. Depending on the size of the lesion, the general condition may not change, or there is a rise in temperature, malaise and headache.
Chronic forms are associated with auto-intoxication and occur in diseases of the digestive system, liver. Foci of chronic infection in the tonsils and gallbladder, caries and various worm infestations can also sensitize the body and cause chronic form. With relapses of urticaria in patients, headache, nervousness, nausea and vomiting, sleep disorders are possible, in some cases can be complicated by swelling of the membranes of the brain.
Children’s urticaria
Children’s urticaria, or strofulus, refers to allergic skin diseases that develop due to food sensitization against the background of exudative diathesis. In children who are on artificial feeding and in children whose diet does not correspond to age, a nodular-bubble rash occurs. Constant contact with allergens, insect bites and the presence of infectious diseases and parasites in the body contribute to the development of urticaria.
The resulting blisters quickly transform into pink-brown nodules up to 3mm in diameter with a small bubble on top. Since the blisters itch with urticaria, the affected skin is quickly macerated, combs, erosions and bloody crusts appear. Disease affects large folds of the body, the upper extremities sometimes elements spread throughout the body. In young children, especially under the age of three, dyspeptic disorders are observed: vomiting, diarrhea or vice versa constipation. If urticaria takes a chronic sluggish character, then children become sluggish, capricious, loss of appetite and sleep disorders are noted. Due to maceration, elements of urticaria are infected with pyococcal flora. Urticaria in children should be differentiated from scabies due to similar clinical manifestations. After seven years, almost all children have disease without a trace.
Giant form
Giant urticaria, or Quincke’s edema, is characterized by the sudden appearance of swelling of subcutaneous tissue, muscles and fascia, this form occurring in the larynx is especially dangerous, since patients die from asphyxia if untimely care is provided. Giant form is characterized by the presence of diffuse edema, which spreads along the muscles and fascia. Usually, the swelling lasts from several hours to several days and passes without a trace. With Quincke’s edema, patients are subject to emergency hospitalization for hyposensitization therapy.
Cold urticaria
Since disease can be provoked by various factors, cold urticaria is divided when blisters appear in people sensitive to cold, this is the so-called cold allergy. With hypersensitivity to ultraviolet light, solar urticaria appears, blisters appear in people with sensitive skin in the spring-summer period on open areas of the skin after solar irradiation. Solar urticaria mainly affects women with fair skin and fair hair. In elderly people, urticaria occurs with a sharp change in temperature and can manifest itself both immediately and within a few days after a change in temperature.
Other forms
In some women, the symptoms of urticaria appear immediately before menstruation, and in addition to external manifestations does not cause discomfort, sometimes there may be mild itching and slight swelling, most often this form of urticaria occurs with the formation of 10-15 elements in the chest and face. Toxic urticaria is associated with direct contact of some plants, insects, fish and animals with the skin. It can occur in contact with jellyfish, poisonous plants. The presence of cats in the house can be the cause of chronic sluggish urticaria.
Diagnostics
The diagnosis is made based on the clinical manifestations and the patient’s survey. There is almost always contact with an allergen, a deep examination reveals sensitization of the body, worm infestations, the presence of foci of chronic infection. To identify the exact type of allergen, allergological tests are carried out.
Urticaria treatment
The most effective way to treat is to identify and eliminate the allergen. But if there is no way to establish an allergen or urticaria is episodic, then local therapy and taking antihistamines help to quickly eliminate symptoms. It is important to follow a hypoallergenic diet during treatment, not to use perfumes and contact with aggressive substances, so as not to provoke a new attack of urticaria.
Disease is treated by a dermatologist and an allergist-immunologist. Locally prescribed gel-like preparations with antipruritic, cooling, decongestant and soothing effect. The drug dimethinden is effective in all forms of urticaria, its effect begins immediately after applying the drug to the skin.
Ingestion of antihistamines is indicated. Fexofenadine, loratadine do not cause side effects in the form of drowsiness and attention disorders, and therefore do not prevent patients from leading a normal lifestyle. Calcium glucanate and calcium chloride, like all calcium preparations, reduce the manifestations of allergies. But you need to be careful, since many patients with recurrent urticaria have hypersensitivity with intravenous administration of calcium chloride and sodium thiosulfate, although these drugs contribute to the elimination of allergens from the body. In the event that antihistamines are ineffective and in severe forms of urticaria, corticosteroid therapy is used. Locally, low-percentage hormone-containing ointments are also shown.
With food urticaria, it is necessary to take adsorbents, light laxatives and the use of a large amount of liquid for the forced removal of the allergen from the body. Since urticaria is more common in people with disorders of the autonomic nervous system (vegetative-vascular dystonia), taking sedatives in the form of courses can completely eliminate urticaria. Autolymphocytotherapy is the newest method in the treatment of urticaria, statistical data indicate the high effectiveness of the technique. Elements of the cellular immune system are isolated from the patients’ blood and injected subcutaneously after relieving a recurrence of urticaria.
Prevention
People prone to urticaria should refrain from contact with possible allergens. Patients who have an allergic predisposition and who have previously been diagnosed with urticaria, it is necessary to use antihistamines before local anesthesia procedures and before vaccination. It is necessary to conduct a complete allergological examination to identify the spectrum of allergens that can cause undesirable reactions.