Urticaria And Angioedema

Description
Other Name of Utricaria is Hives. It is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). It is generally classified as acute, chronic or physical. Second-generation, non-sedating H1-receptor antihistamines represent the mainstay of therapy for both acute and chronic urticaria. Angioedema can occur in the absence of urticaria, with angiotensin-converting enzyme (ACE) inhibitor-induced angioedema and idiopathic angioedema being the more common causes. Rarer causes are hereditary angioedema (HAE) or acquired angioedema (AAE). Although the angioedema associated with these disorders is often self-limited, laryngeal involvement can lead to fatal asphyxiation in some cases. The management of HAE and AAE involves both prophylactic strategies to prevent attacks of angioedema (i.e., trigger avoidance, attenuated androgens, tranexamic acid, and plasma-derived C1 inhibitor replacement therapy) as well as pharmacological interventions for the treatment of acute attacks (i.e., C1 inhibitor replacement therapy, ecallantide and icatibant). In this article, the authors review the causes, diagnosis and management of urticaria (with or without angioedema) as well as the work-up and management of isolated angioedema, which vary considerably from that of angioedema that occurs in the presence of urticaria.

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It is characterized by recurrent, pruritic (itchy), pink-to-red edematous (swollen) lesions that often have pale centers (wheals). The lesions can range in size from a few millimeters to several centimeters in diameter, and are often transient, lasting for less than 48 hours. Approximately 40% of patients with urticaria also experience angioedema (swelling that occurs beneath the skin)

Clasifications:

Chronic urticaria:

Chronic urticaria is more common in adults, and affects women more frequently than men. In general, chronic urticaria is classified as either chronic autoimmune urticaria or chronic idiopathic urticaria.

Patients with chronic idiopathic urticaria do not have evidence of autoimmunity. In this form of urticaria, there appears to be persistent activation of mast cells, but the mechanism of mast cell triggering is unknown. Although rare, chronic urticaria may also be a manifestation of a systemic illness.

Acute urticaria:

The most common causes of acute urticaria (with or without angioedema) are medications, foods, viral infections, parasitic infections, insect venom, and contact allergens, particularly latex hypersensitivity. Medications known to commonly cause urticaria ± angioedema include antibiotics (particularly penicillins, and sulfonamides), non-steroidal anti-inflammatory drugs (NSAID), acetylsalicylic acid (ASA), opiates and narcotics. The predominant foods that cause urticaria are milk, eggs, peanuts, tree nuts, fish, and shellfish. In approximately 50% of patients with acute urticaria, the cause is unknown (idiopathic urticaria)

Physical urticaria:
Physical urticaria is triggered by a physical stimulus. The most common physical urticaria is dermatographism (also known a “skin writing”), in which lesions are created or “written” on the skin by stroking or scratching the skin.

Symptoms:
Urticaria:

The welts associated with Urticaria can be:

* Red or flesh-colored
* Intensely itchy
* Roughly oval or shaped like a worm
* Less than one inch to several inches across

Most hives go away within 24 hours. Chronic hives can last for months or years.
Angioedema

Angioedema is a reaction similar to hives that affects deeper layers of your skin. It most commonly appears around your eyes, cheeks or lips. Angioedema and hives can occur separately or at the same time.

Signs and symptoms of angioedema include:

* Large, thick, firm welts
* Swelling and redness
* Pain or warmth in the affected areas

Causes:

Urticaria and angioedema can be caused by:

* Foods. Many foods can trigger reactions in people with sensitivities. Shellfish, fish, peanuts, tree nuts, eggs and milk are frequent offenders.

* Medications. Almost any medication may cause hives or angioedema. Common culprits include penicillin, aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve) and blood pressure medications.

* Common allergens. Other substances that can cause hives and angioedema include pollen, animal dander, latex and insect stings.

* Environmental factors. Examples include heat, cold, sunlight, water, pressure on the skin, emotional stress and exercise.

* Underlying medical conditions. Hives and angioedema also occasionally occur in response to blood transfusions, immune system disorders such as lupus, some types of cancer such as lymphoma, certain thyroid conditions, and infections with bacteria or viruses such as hepatitis, HIV, cytomegalovirus, and Epstein-Barr virus.

* Genetics. Hereditary angioedema is a rare inherited (genetic) form of the condition. It’s related to low levels or abnormal functioning of certain blood proteins that play a role in regulating how your immune system functions.

Risk factors:

Urticaria and angioedema are common. One may be at increased risk of hives and angioedema if he or she:

*Has had urticaria or angioedema before
*Has had other allergic reactions
*Has a disorder associated with hives and angioedema, such as lupus, lymphoma or thyroid disease
*Has a family history of hives, angioedema or hereditary angioedema

Complications:

Severe angioedema can be life-threatening if swelling causes your throat or tongue to block your airway.
Prevention

To lower your likelihood of experiencing hives or angioedema, take the following precautions:

Avoid known triggers. These can include foods, medications and situations, such as temperature extremes that have triggered hives or angioedema in the past.
Keep a diary. If you suspect food is causing the problem but aren’t sure which food is the trigger, keep a food and symptom diary.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.britishskinfoundation.org.uk/URTICARIAANDANGIOEDEMA.aspx
https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-7-S1-S9
https://www.mayoclinic.org/diseases-conditions/hives-and-angioedema/symptoms-causes/syc-20354908

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