I – Introduction:
A- Definition of urticaria:
Hives are a skin reaction that manifests as red, swollen patches, called papules, that can appear anywhere on the body. These plaques are often accompanied by itching, and can group together to form larger lesions. Hives are caused by the release of histamine and other chemicals in the blood, in response to an allergy, infection, stress, exposure to extreme temperatures or chemicals, or other factors . It can be acute, lasting less than six weeks, or chronic, with recurring episodes that can last for months or years. Hives can affect people of all ages, but are more common in women than in men. Although hives are not considered a serious condition, they can be very embarrassing for those who suffer from them, and can cause complications in severe cases. It is therefore important to recognize the symptoms and seek medical attention for proper treatment.
B- Prevalence and possible causes:
Hives are a common skin condition, affecting up to 20% of the population at some point in their lives. The causes of hives are diverse and can include allergies, infections, physical factors, medications, chemicals, insect bites, stress, or an autoimmune reaction. Food allergies, insect bites, medications, pollen, and animal hair are common causes of acute urticaria. Chronic hives, on the other hand, can be linked to autoimmune disorders, infections, tumors or thyroid disease. Emotional stress can also trigger or worsen chronic hives in some people. It is important to note that in some cases hives may not have an identifiable cause. Generally,
C- Importance of recognizing the symptoms:
It is important to recognize the symptoms of hives as they can be very bothersome for sufferers and can also cause complications in severe cases. The red, swollen patches can appear anywhere on the body and be accompanied by itching, burning, or pain. Symptoms can vary in intensity and duration, and may be more or less frequent depending on the individual. Recognizing the symptoms can help people with hives get proper diagnosis and treatment, which can reduce discomfort and the risk of complications. Symptoms can also be an indicator of triggers for hives, which can help prevent future episodes. Besides, It is important to recognize the symptoms of hives because they can be confused with other skin conditions, such as eczema, contact dermatitis or rosacea, and incorrect diagnosis can lead to inappropriate treatment. Ultimately, early recognition of hives symptoms can help patients effectively manage their condition and improve their quality of life.
II- Symptoms and diagnosis:
A- Description of the symptoms of urticaria:
Hives are characterized by the appearance of red, swollen patches on the skin, called papules, which can vary in size and shape. These plaques can be isolated or group together to form larger lesions, and can appear anywhere on the body. They are often accompanied by itching, burning or pain, which can cause great discomfort for those who suffer from them. Hives may also disappear and reappear within hours or days, and new episodes may occur without warning. Sometimes rashes associated with hives can also affect the lips, eyes, ears, and genitals. In severe cases, hives can also lead to symptoms such as facial swelling, lips or throat, difficulty breathing or low blood pressure, which may require emergency medical intervention. In general, early recognition and identification of hives symptoms are essential for effective diagnosis and treatment.
B- Differentiation with other skin conditions:
Hives can be easily confused with other skin conditions, especially when it presents in a mild or moderate form. Eczema, contact dermatitis, and rosacea are examples of skin conditions that can be confused with hives due to the presence of red patches on the skin. However, unlike hives, these conditions can be associated with dry, scaly skin, crusting, peeling, and more persistent lesions. Also, hives are often accompanied by itching and burning, which is less common in these other skin conditions. Other skin conditions such as chickenpox, herpes, measles, psoriasis and bullous pemphigoid can also cause rashes, but these conditions have different symptoms and causes than hives. If in doubt about the diagnosis, it is important to see a doctor for a full skin examination and tests to identify the underlying cause of the rash.
C- Diagnostic procedures:
The diagnosis of urticaria is mainly based on the clinical observation of red and swollen patches on the skin, associated with the symptoms reported by the patient. However, if the hives are chronic or the symptoms are severe, further testing may be needed to identify the underlying cause of the condition. Blood tests may be done to look for signs of inflammation or allergy, such as histamine or IgE antibody levels. Skin tests may also be done to identify potential allergens, such as insect bites or food allergens. In some cases, skin biopsies may be performed to examine skin tissue under a microscope and rule out other skin conditions such as contact dermatitis or lupus.
III- Types of urticaria:
A- Acute urticaria vs chronic urticaria:
Urticaria can be divided into two categories: acute urticaria and chronic urticaria. Acute urticaria is a temporary and often sudden form of hives that usually lasts less than six weeks. It can be caused by allergens such as food, insect bites, or medications, or be triggered by factors such as stress or exposure to extreme temperatures. Acute hives can cause great discomfort for sufferers, but it tends to go away on its own without treatment after a few hours or days.
In contrast, chronic urticaria is a more persistent form of hives that usually lasts longer than six weeks. It can be caused by factors such as infections, autoimmune diseases, thyroid or liver problems, or be triggered by emotional or environmental factors. Chronic urticaria can cause considerable physical and emotional discomfort, and can also affect the patient’s quality of life. Treatment for chronic urticaria can be more complex than that for acute urticaria and may require long-term medication or lifestyle changes. In sum, the distinction between acute and chronic urticaria is important because it can affect treatment choices and the management of the condition.
B- Physical urticaria:
Physical urticaria is a particular form of urticaria in which the skin reacts abnormally to physical stimuli such as heat, cold, pressure, sunlight or water. Symptoms of physical urticaria may appear quickly after exposure to the stimulus and disappear after a short time. The severity of symptoms can vary greatly from person to person, ranging from mild red patches and itching to more severe symptoms such as swelling, joint pain and difficulty breathing.
The exact mechanisms of physical urticaria are not well understood, but it is thought to be due to an abnormal immune system response to certain physical stimuli. Some forms of physical urticaria are also associated with autoimmune diseases such as systemic lupus erythematosus. Treatment for physical urticaria depends on the severity of the symptoms and the underlying triggers. Antihistamine medications may help relieve symptoms, while lifestyle changes such as avoiding triggering stimuli may also be recommended. In more severe cases, immunosuppressive drugs may be needed to reduce immune system activity and relieve symptoms.
C- Idiopathic urticaria:
Idiopathic urticaria, also known as spontaneous urticaria, is a form of hives in which the underlying cause of the symptoms is not known. This form of hives can be acute or chronic and symptoms can last from weeks to years. Red patches and itching are the most common symptoms, but idiopathic hives can also be accompanied by swelling, pain and fever.
Although the causes of idiopathic urticaria are not known, it is believed to be due to an abnormal reaction of the immune system to certain triggers. Common triggers include stress, foods, medications, infections, and environmental allergens. People with idiopathic urticaria are often asked to keep a food diary and monitor their surroundings to identify potential triggers.
Treatment for idiopathic urticaria depends on the severity of symptoms and the duration of episodes. Antihistamines are usually prescribed to relieve symptoms, while corticosteroids may be prescribed for more severe cases. Lifestyle changes, such as avoiding known triggers, may also be recommended to help prevent symptoms. Overall, the management of idiopathic urticaria is often a long-term process, requiring close collaboration between patient and doctor to identify triggers and find an effective treatment.
IV- Treatment:
A- Self-care measures:
Although hives can be a frustrating and sometimes painful condition, there are self-care measures that can help relieve symptoms and prevent future episodes. First, it’s important to stay hydrated by drinking plenty of water and healthy fluids. Avoiding known triggers, such as certain foods, stress, and chemicals, can also help reduce symptoms.
Applying cold compresses to affected areas of skin can also help relieve itching and discomfort. Moisturizing lotions and creams can also help soothe dry, irritated skin. Loose, breathable clothing can also be helpful to avoid chafing the skin and causing rashes.
It is important to note that these self-care measures are not a substitute for professional medical treatment. If symptoms persist or worsen, it is important to see a healthcare professional for proper diagnosis and treatment. This is especially true for people with chronic hives, who may require long-term treatment to manage their symptoms.
B- Antihistamine drugs:
Antihistamine drugs are often used to treat hives because they block the effect of histamine, a substance released by the body in response to an allergic reaction. Antihistamines help relieve hives symptoms such as itching, redness, and swelling. Antihistamines are available over the counter or by prescription, depending on their strength and dosage.
First-generation antihistamines, such as diphenhydramine, can cause side effects such as drowsiness, dry mouth, and constipation. Second-generation antihistamines, such as loratadine and cetirizine, are often preferred because they have fewer side effects and are more effective over the long term. In cases of chronic urticaria, long-term treatment with antihistamines may be necessary.
It is important to note that although antihistamines can help relieve the symptoms of hives, they do not treat the underlying cause of the allergic reaction. If symptoms persist or worsen, it is important to see a healthcare professional for proper diagnosis and treatment.
C- Treatment of serious cases:
In severe cases of hives, more intensive treatments may be needed to relieve symptoms and prevent complications. Corticosteroids, such as prednisone, are sometimes used to reduce inflammation and relieve symptoms of severe acute hives. However, corticosteroids are not recommended for long-term use due to their potential side effects, such as weight gain, insomnia, and increased risk of infections.
In cases of severe chronic urticaria, other treatments may be used, such as omalizumab injections or other biologic drugs. These treatments target the cells and molecules involved in the allergic reaction, thereby reducing inflammation and symptoms. Other potential treatments include plasmapheresis, a procedure that filters blood plasma to remove hives-triggering substances, and allergen immunotherapy, a procedure that gradually exposes the patient to increasing doses of the allergen to reduce their reactivity. .
It is important to note that these more intensive treatments are usually only needed in the most severe cases and are not recommended for long-term use. If you have hives and your symptoms persist or worsen, it is important to see a healthcare professional for proper diagnosis and treatment.
D- Crisis prevention:
Preventing hives attacks can be a challenge, as it can be difficult to pinpoint the exact cause of hives in many cases. However, there are several preventative measures people with hives can take to minimize the risk of attacks. First, it’s important to avoid known triggers, such as food allergens, medications, or chemicals. People who have identified a specific trigger should avoid exposure to it as much as possible. Additionally, people with hives can try to adopt a healthy lifestyle by eating a balanced diet, exercising regularly, managing stress, and avoiding temperature extremes.
Finally, to help prevent attacks of hives, it may be helpful to see an allergist or dermatologist for a thorough evaluation of the condition and for specific recommendations for prevention. By following these preventive measures, people with hives can reduce their risk of attacks and improve their quality of life.
V- Urticaria in children and pregnant women:
A- Urticaria in children: differences and similarities with adults:
Hives are a skin condition that can affect children as well as adults. Symptoms in children are similar to those in adults, including red patches and itching, but there may be differences in the presentation of hives in children. Children are more likely to have lesions on the arms, legs, face and neck. They may also have symptoms such as fever, joint pain, and wheezing, in addition to itching and redness.
It is important to note that the underlying causes of hives in children may differ from those in adults. Children are more likely to develop hives due to a viral infection, such as an upper respiratory infection or an ear infection. They can also develop contact urticaria due to exposure to irritants, such as chemicals or perfumes.
Treatment for hives in children is similar to that for adults and often consists of antihistamines. However, doses may vary depending on the age and weight of the child. Additionally, parents should be aware of the need to identify and avoid potential triggers for hives in their child, such as foods, medications, and irritants. If in doubt, it is recommended to consult a doctor to establish an appropriate treatment plan for hives in children.
B- Risks and precautions for pregnant women:
Pregnant women with hives may be concerned about the potential risks to their baby. Although hives in themselves are not a dangerous condition, the itching and redness can be very uncomfortable for pregnant women and disrupt their sleep. Antihistamine medications are often used to relieve hives symptoms, but their use in pregnant women may pose risks to the fetus.
First-generation antihistamines, such as diphenhydramine, are generally considered safe in pregnancy, while second-generation antihistamines, such as loratadine, desloratadine, and fexofenadine, are considered relatively safe but should be prescribed with caution . In contrast, third-generation antihistamines, such as levocetirizine and bilastine, have limited safety data in pregnant women.
In general, it is recommended that pregnant women with hives work closely with their doctor to find the safest and most effective treatment options. It’s also important to avoid known triggers of hives, such as foods, medications, and irritants, and to maintain good skin hygiene to reduce the risk of complications.
VI- Conclusion:
A- Importance of consulting a doctor in case of symptoms of hives:
It is important to see a doctor if you experience symptoms of hives, as this condition can be a sign of a serious allergic reaction or an underlying disease. Although hives are often mild, sometimes they can be a symptom of a more serious health condition, such as an autoimmune disease or cancer. Also, the symptoms of hives can be similar to those of other dermatological conditions, which makes diagnosis difficult without the help of a medical professional.
A doctor can perform a physical exam, take a medical history, and run tests to determine the underlying cause of the hives. Depending on the cause, he may recommend treatment, which may include antihistamines, corticosteroids, or immunosuppressive drugs.
Additionally, people with chronic hives may benefit from seeing an allergist or dermatologist, who can help determine the triggers of hives and provide advice on ways to avoid them. By working closely with a healthcare professional, people with hives can reduce the impact of this condition on their quality of life and prevent long-term complications.
B- Reminder of the main points to remember about hives:
In summary, urticaria is a dermatological condition characterized by red, itchy rashes. It can be acute or chronic and have multiple causes, such as allergic reactions, infections, medications or underlying diseases. Symptoms of hives can be similar to those of other dermatological conditions, making diagnosis difficult without the help of a medical professional. Self-care measures, such as using cold compresses or avoiding known triggers, can help relieve mild symptoms. Antihistamines are commonly used to treat hives symptoms, while severe cases may require corticosteroids or immunosuppressive drugs. Pregnant women should be especially careful, as some drugs can be harmful to the fetus. Finally, it is important to consult a medical professional if you have symptoms of hives in order to obtain an accurate diagnosis and appropriate treatment to avoid long-term complications.
