Hives ( Urticaria and angioedema ) : 5 things to know
- It is a disease that disappears in 98% of cases.
- While it persists, it produces a very bothersome itch and redness.
- Without being a serious disease, it does significantly decrease the quality of life of the patient.
- There are multiple causes and it is almost never due to food.
- Correct treatment requires specialized care.
1. What is Urticaria and angioedema?
The goal of this article is to explain acute and chronic urticarias in a simple and understandable way. In future articles we will describe each of the possible causes one by one in a simple and brief way.
Urticaria is a disease characterized by hives and redness of the skin that is associated with itching and where the lesions typically disappear or change location within 24 hours. These lesions are typically circular, being able to adopt another shape generally due to the accumulation of such circles, and they turn white with pressure. These injuries also do not leave permanent lesions on the skin.
In those patients where the disease develops in the mucosa instead of in the skin, a swelling occurs which is called angioedema. Urticaria and angioedema are part of the same disease and therefore often occur at the same time.
Although it is a disease that only rarely can cause the death of the patient, these cases being practically limited to severe reactions to drugs, food and insects, as well as patients with angioedema in the respiratory tract, it is nevertheless a disease that greatly alters the quality of life of the patient since they have constant itching or itching that does not allow them to have a normal life both in their work, leisure, study or any activity of daily life. It is the task of the allergist to ensure that the patient has an absolutely normal life.
If you are reading this article you may be aware of how unbearable this disease is, both for the patient and for the doctor, because it is rarely solved from the first visit. An example that identifies such a doctor-patient union is the poetry of the Spanish doctor Ignacio Dávila (will require online translation).
2. How Urticaria works?
Urticaria is produced by the activation of cells that are found in our skin and are called mast cells, these cells being the ones that in turn release a protein called histamine.
Histamine activates receptors for itching, pruritus or itching, causes the vessels to become larger and dilated, thus creating an accumulation of blood (hence the red color of the skin in the lesions) and, since these blood vessels have Small holes, when dilated, will leak fluids without red cells that will cause swelling or hives in the pale-colored skin.
It is important to note that not all patients will produce the same amount of histamine and therefore antihistamine treatment does not have to be the same for each patient. The activation that these mast cells will in turn cause the call of another type of cells to the inflamed skin area, a fact that occurs in other allergic diseases, although it is called the accumulation of cells in the skin will give less problems to the patient than the same call which occurs for example the nose during allergic rhinitis.
3. What are the types of Urticaria?
It is very important for the allergist to know if the urticaria has more or less than 6 weeks of duration, because based on this we will call it acute or chronic urticaria. The differences between the two are explained below:
Chronic Urticaria: Lasting more than 6 weeks.
Chronic urticaria, unlike acute, is not produced by an identifiable stimulus, although there are circumstances that can reactivate it, in many cases confusing the patient what they believe is the cause of the disease.
It is important to know that this disease disappears spontaneously in 65% of cases at 3 years and in 85% at 5 years, with approximately 2% of cases in which this disease lasts for more than 10 years. The allergist can tell you an estimate of how many years the hives may persist, and the patient must understand that this calculation is not accurate.
At present, we have more and more scientific evidence that chronic urticaria seems to be produced by an autoimmune mechanism, or in other words, that our own defense system attacks cells of our body by mistake.
An example of this association is that this disease is closely related to autoimmune thyroid disease where our own body attacks our thyroid gland producing hypothyroidism and urticaria.
In patients with chronic urticaria, the allergist must perform at least one blood test on the patient, since chronic urticaria can be related to other diseases that can be more serious than the urticaria itself.
The allergist has to rule out the presence of such diseases in the patient in a reasonable way. This analysis will depend on the characteristics of each patient but can generally be performed in any laboratory since it does not require great complexity.
Acute Urticaria: Lasting less than 6 weeks.
It tends to occur as a rapid consequence (less than 2 hours) of some type of stimulus.
Stimuli that can cause acute urticaria include viral infections, allergic reactions to antibiotics and other medicines, insect bites, physical stimuli such as cold, pressure, or the sun, and a wide range of other substances that can cause acute urticaria.
It is the task of the allergist to carry out a correct clinical history to the patient (a correct interview) asking him about all those stimuli that can produce acute urticarias. In my personal experience, patients tend to misinterpret such stimuli, opening a large number of them who believe that their symptoms are produced by food when it is not the culprit of their illness.
4. How to treat Urticaria?
The first thing to remember is that this disease is usually exasperating for the patient, who usually suffers in excess of the wait necessary for the allergist to be able to adjust the treatment until a normal life is achieved for the patient without itching. This is usually accomplished in one, two, or three reviews.
In the vast majority of cases we can control it with different doses and combinations of antihistamines, being in a minority of cases those that we must require the use of modern drugs called monoclonal antibodies in which Dr. Tito Rodriguez Bouza has published experience.
5. Why to ask an online consultation?
Online consultation by videoconference is especially useful in the case of urticaria. This is because there is great availability to quickly contact your allergist and therefore be able to make the two or three changes in the medication that are usually required to control the patient.
In a traditional practice this can be delayed for weeks or months, unnecessarily prolonging the suffering and itching of the patient. On the other hand, since tests other than analytical tests are generally not required, the diagnosis can be made in a simple way since the doctor can request an analysis to be carried out by the patient’s convenience laboratory.
Also given the suffering of the patient, it is advisable to find a true specialist in the field to reduce the time of suffering. The only limitation would be for those few patients in whom the disease cannot be controlled between two or three check-ups and it is necessary to administer treatments that can only be given in the hospital, although even in these cases given that the patient will have been able to pass both or three revisions in a quick way, the time of suffering of the patient is also reduced.