What are the common types of skin allergies. How can you identify different skin allergy symptoms. What treatments are available for allergic skin reactions. How can you prevent skin allergy flare-ups. When should you see an allergist for a skin rash.

Understanding Different Types of Skin Allergies

Skin allergies can manifest in various forms, each with distinct characteristics and triggers. Recognizing these differences is crucial for proper diagnosis and treatment. Let’s explore the most common types of skin allergies:

Eczema (Atopic Dermatitis)

Eczema is a chronic condition characterized by dry, sensitive skin. Patients often experience red, itchy patches that can flare up periodically. During severe episodes, the affected areas may crack, ooze, and itch intensely. The severity of eczema can range from mild cases with just dry skin to more severe instances where the skin becomes red, scaly, thick, fissured, and oozing.

Hives (Urticaria)

Hives appear as raised, itchy bumps on the skin. These bumps typically have a reddish appearance and will “blanch” (turn white) in the center when pressed. Hives can occur suddenly and may be triggered by various factors, including allergies, stress, or certain medications.

Contact Dermatitis

Contact dermatitis occurs when the skin comes into direct contact with an allergen or irritant. This condition usually presents as red, itchy bumps at the site of contact. Common triggers include certain metals, cosmetics, plants, and chemicals.

Identifying Skin Allergy Symptoms

Recognizing the symptoms of skin allergies is the first step towards seeking appropriate treatment. Here are some key signs to watch for:

• Persistent itching
• Redness or inflammation
• Dry, flaky, or scaly skin
• Swelling or puffiness
• Blisters or bumps
• Skin that feels warm to the touch
• Oozing or crusting

Can skin allergy symptoms vary in severity? Indeed, the intensity of symptoms can range from mild discomfort to severe reactions that significantly impact quality of life. Some individuals may experience occasional flare-ups, while others might have chronic, persistent symptoms.

Common Triggers for Allergic Skin Reactions

Understanding what triggers your skin allergies is crucial for managing and preventing reactions. Some common triggers include:

1. Environmental allergens (pollen, dust mites, pet dander)
2. Certain foods (nuts, dairy, eggs, soy)
3. Metals (nickel, cobalt)
4. Fragrances and cosmetics
5. Latex
6. Harsh soaps and detergents
7. Certain fabrics
8. Extreme temperatures or humidity

Is it possible to develop new skin allergies later in life? Absolutely. While some people are born with a predisposition to certain allergies, others may develop them over time due to repeated exposure to allergens or changes in their immune system.

Diagnosing Skin Allergies: When to See an Allergist

If you suspect you have a skin allergy, consulting with an allergist can provide valuable insights and appropriate treatment options. Consider seeing an allergist if:

• Your symptoms persist or worsen despite over-the-counter treatments
• You experience frequent or severe flare-ups
• Your quality of life is significantly impacted
• You’re unsure of what’s triggering your reactions
• You develop new or unusual symptoms

How do allergists diagnose skin allergies? Allergists use a combination of methods, including:

1. Detailed medical history
2. Physical examination
3. Skin prick tests
4. Patch tests
5. Blood tests

These diagnostic tools help identify specific allergens and rule out other potential causes of your symptoms.

Effective Treatments for Allergic Skin Reactions

Once diagnosed, various treatment options are available to manage skin allergies and provide relief from symptoms. These may include:

Topical Treatments

• Corticosteroid creams or ointments
• Calcineurin inhibitors
• Moisturizers and emollients

Oral Medications

• Antihistamines
• Oral corticosteroids (for severe cases)

Biologics

For moderate to severe atopic dermatitis, biologics like dupilumab have shown promising results in managing symptoms.

Phototherapy

Controlled exposure to ultraviolet light can help reduce inflammation and itching in some cases.

How quickly do these treatments work? The effectiveness and speed of relief can vary depending on the individual and the specific treatment. Some topical treatments may provide immediate relief, while others, like biologics, may take several weeks to show significant improvement.

Preventing Skin Allergy Flare-Ups

While it’s not always possible to prevent skin allergies entirely, there are steps you can take to minimize flare-ups and manage your condition:

1. Identify and avoid triggers
2. Maintain a consistent skincare routine
3. Use gentle, fragrance-free products
4. Keep skin moisturized
5. Manage stress levels
6. Wear protective clothing when necessary
7. Use a humidifier in dry environments
8. Follow your allergist’s treatment plan

Are there any natural remedies that can help with skin allergies? While scientific evidence is limited, some people find relief with natural remedies such as:

• Colloidal oatmeal baths
• Aloe vera gel
• Coconut oil
• Chamomile tea compresses

It’s important to consult with your allergist before trying any natural remedies, as some may interact with medications or cause further irritation.

The Impact of Sun Exposure on Skin Allergies

Sun exposure can have varying effects on skin allergies, depending on the specific condition and individual sensitivity. For some, UV rays may exacerbate symptoms, while others might find temporary relief. Here’s what you need to know:

Photoallergic Contact Dermatitis

This condition occurs when the skin reacts to an irritant or allergen after sun exposure. Common triggers include:

• Cosmetics
• Sunscreens
• Shaving lotions
• Perfumes

If you’re prone to this type of reaction, it’s crucial to identify the specific products causing the issue and avoid them, especially before sun exposure.

Sun Protection for Sensitive Skin

For those with existing skin allergies or sensitivities, protecting your skin from the sun is essential. Consider these tips:

1. Use broad-spectrum, hypoallergenic sunscreens
2. Wear protective clothing, including wide-brimmed hats and long sleeves
3. Seek shade during peak sun hours (typically 10 am to 4 pm)
4. Gradually increase sun exposure to build tolerance

Can sun exposure ever be beneficial for skin allergies? In some cases, controlled UV exposure through phototherapy can help manage certain skin conditions like eczema. However, this should only be done under the guidance of a healthcare professional.

The Connection Between Food Allergies and Skin Reactions

Food allergies can indeed manifest as skin reactions, with hives being a common symptom. Understanding this connection is crucial for proper diagnosis and management of allergies.

Common Food Allergens

While any food can potentially cause an allergic reaction, some are more common triggers:

• Peanuts and tree nuts
• Milk and dairy products
• Eggs
• Soy
• Wheat
• Fish and shellfish

Identifying Food-Related Skin Reactions

Symptoms of food-related skin allergies may include:

1. Hives or welts
2. Itching
3. Eczema flare-ups
4. Swelling, especially of the lips, face, or tongue

How quickly do food-related skin reactions occur? Symptoms can appear within minutes of consuming the allergen or may take several hours to develop. In some cases, reactions may be delayed by up to 24-48 hours, making it challenging to identify the trigger.

Diagnosis and Management

If you suspect a food allergy is causing your skin reactions, consider these steps:

1. Keep a food diary to track potential triggers
2. Consult with an allergist for proper testing
3. Consider an elimination diet under medical supervision
4. Learn to read food labels carefully
5. Carry emergency medication if prescribed (e.g., epinephrine auto-injector)

Can food allergies develop later in life? Yes, while many food allergies start in childhood, it’s possible to develop them at any age. Adult-onset food allergies are becoming increasingly recognized and can cause significant lifestyle changes.

Special Considerations: Latex Allergies and Skin Reactions

Latex allergies represent a unique category of skin allergies that can have serious implications, especially in healthcare settings. Understanding latex allergies is crucial for those affected and for healthcare providers.

Symptoms of Latex Allergy

Latex allergy symptoms can range from mild to severe and may include:

• Hives or itching at the point of contact
• Stuffy or runny nose
• Wheezing or difficulty breathing
• Chest tightness
• In severe cases, anaphylaxis

Common Sources of Latex Exposure

Latex can be found in various products, including:

1. Medical gloves
2. Balloons
3. Rubber bands
4. Condoms and diaphragms
5. Some adhesives

How does latex allergy develop? Latex allergy typically develops after repeated exposure to latex products. Healthcare workers, individuals with spina bifida, and those who have undergone multiple surgeries are at higher risk of developing this allergy.

Managing Latex Allergies

If you have a latex allergy, consider these management strategies:

• Inform healthcare providers about your allergy
• Wear a medical alert bracelet
• Use latex-free alternatives when available
• Be aware of potential cross-reactive foods (e.g., bananas, avocados, kiwis)
• Carry emergency medication if prescribed

Are there different types of latex reactions? Yes, there are three main types of latex reactions:

1. IgE-mediated allergic reactions (true latex allergy)
2. Cell-mediated contact dermatitis
3. Irritant contact dermatitis

Each type may require different management approaches, highlighting the importance of proper diagnosis by an allergist.

Emerging Treatments and Research in Skin Allergies

The field of allergy treatment is constantly evolving, with new therapies and approaches being developed to provide better relief for those suffering from skin allergies. Let’s explore some of the latest advancements and ongoing research:

Biologics for Atopic Dermatitis

Biologic medications, which target specific components of the immune system, have shown promising results in treating moderate to severe atopic dermatitis. These include:

• Dupilumab
• Tralokinumab
• Lebrikizumab

How do biologics differ from traditional treatments? Biologics work by targeting specific pathways in the immune system that contribute to inflammation, potentially offering more targeted relief with fewer side effects compared to broad-spectrum immunosuppressants.

Microbiome-based Therapies

Research into the skin microbiome is opening new avenues for treatment. Approaches being explored include:

1. Probiotic skincare products
2. Microbiome transplantation
3. Tailored antimicrobial treatments

Gene Therapy

Scientists are investigating gene therapy as a potential long-term solution for genetic skin conditions. This could involve:

• Correcting faulty genes responsible for skin barrier dysfunction
• Modifying immune responses at a genetic level

Personalized Medicine

Advances in genetic testing and biomarker identification are paving the way for more personalized treatment approaches. This could allow for:

1. More accurate prediction of treatment responses
2. Tailored treatment plans based on individual genetic profiles
3. Early intervention strategies for those at high risk

What role does artificial intelligence play in skin allergy research? AI is increasingly being used to analyze large datasets, identify patterns in disease progression, and even assist in diagnosing skin conditions through image recognition technology.

Novel Drug Delivery Systems

Researchers are exploring innovative ways to deliver medications more effectively, including:

• Nanoparticle-based treatments
• Transdermal patches with enhanced absorption
• Time-release formulations for prolonged effect

These advancements in skin allergy research offer hope for more effective, targeted treatments in the future. As always, it’s important to consult with your allergist to stay informed about the latest treatment options that may be suitable for your specific condition.

Skin Allergies | Causes, Symptoms & Treatment

What does a skin allergy look like?

There are several different types of skin allergy reactions that allergists treat.

Eczema (also commonly called  atopic dermatitis) typically results in dry, sensitive skin. You may experience red itchy patches. Eczema can come and go over time, and flare-ups may crack, ooze, and itch severely. It is very itchy and can vary in severity from mild (just dry skin ) to severe (red, scaly, thick, fissured and oozing skin)

Hives (also known as urticaria) are raised itchy bumps. Typically hives appear reddish, and will “blanch” (or turn white) in the center when pressed.

Contact dermatitis is typically caused by exposure to an allergen or irritant. If you have red itchy bumps on your skin, especially at the site of contact with some potential irritant or allergen, you may be experiencing contact dermatitis.

If you suspect you have any of these conditions, your allergist can conduct an examination and do testing to help determine the cause of your skin reaction and can recommend treatment to help relieve your symptoms.

How can I relieve the itching from my skin rash?

Avoid scratching! Scratching your rash or hives can create more irritation and can lead to infection. Frequent baths followed immediately with adequate moisturization may help ease your discomfort.

Allergists are specially trained to help treat your condition. Your allergist may prescribe a cream or oral medication to help alleviate your discomfort. Antihistamines and moisturizing ointments can also help ease irritation and dryness. Recently, new medications have been approved, including an ointment for mild to moderate atopic dermatitis and a biologic for moderate to severe atopic dermatitis. You can discuss these options with your allergist.

I haven’t changed anything about my usual routine – what could be causing my skin rash or hives?

There are many possible causes for your skin rash. Some types of rashes are caused by allergies, others may be caused by infections, skin conditions such as eczema or rosacea, or even just dry or damaged skin. Your allergist can help diagnose the cause of your symptoms and prescribe treatment to help you take control and find relief.

Should I stay out of the sun until my rash or hives are gone?

If your skin is already irritated or sensitive, exposure to UV rays and possible sunburn could cause you more discomfort. Take control of your condition by covering up and minimizing your time in direct sunlight.

In addition, some types of skin rash can be caused by the sun. Photoallergic contact dermatitis occurs when your skin has a reaction to an irritant or allergen after exposure to the sun. Cosmetics, sunscreen, shaving lotion, and perfume can trigger this kind of reaction.

Consult with your allergist to determine the cause of your skin reaction and the best course of treatment.

Could my skin reaction be caused by a food allergy?

Yes! A reaction to a food allergen can cause you to have a skin reaction like hives.

There are many possible causes for hives and rashes, so consult with your allergist to determine the cause of your symptoms and the best course of treatment.

Latex Allergy | Causes, Symptoms & Treatment

Triggers and Symptoms

What triggers the allergic reaction to latex?

When people with latex allergy come into direct contact with latex, an allergic reaction may follow. Common examples include:

• A medical or dental procedure conducted by health care workers wearing natural rubber latex gloves
• Blowing up a rubber balloon

What are latex allergy symptoms?

In most cases, latex allergy develops after many previous exposures to latex. Latex allergy symptoms may include hives, itching, stuffy or runny nose. It can cause asthma symptoms of wheezing, chest tightness and difficulty breathing. Symptoms begin within minutes after exposure to latex containing products. The most severe latex allergy can result in anaphylaxis, a serious allergic reaction involving severe breathing difficulty and/or fall in blood pressure (shock).

Allergic skin problems can occur following direct contact with allergic latex proteins in latex glove products. Symptoms may include immediate itching, redness and swelling of skin that touched the item containing latex. These and other latex allergic reactions are less common now. Many hospitals or doctors’ offices have switched to non-latex gloves or low protein latex gloves.

A second type of skin allergy called “allergic contact dermatitis” may be caused by chemicals used to manufacture rubber gloves. This dermatitis is recognized by the eczema and blisters on the back of the hands. It resembles a poison ivy rash, and begins 1 to 3 days after wearing rubber gloves.

Direct physical contact with latex products is not needed to trigger an allergic reaction. Anaphylaxis and severe asthmatic reactions have been caused by inhaling latex proteins in the air resulting from the powder in the latex glove.

What foods are potential problems for people with latex allergy?

If you have latex allergy you also can have food allergies. The foods most likely to cause this problem include: apple, avocado, banana, carrot, celery, chestnut, kiwi, melons, papaya, raw potato and tomato.

Management and Treatment

How is latex allergy diagnosed?

Latex allergy is diagnosed by an allergy blood test.

How is latex allergy treated?

The best treatment for latex allergy is avoidance. If you have severe latex allergy reaction you should:

• Wear medical alert identification
• Carry an Epinephrine has been produced synthetically as a drug since 1900. It remains the drug of choice for treatment of anaphylaxis."}" data-sheets-userformat="{"2":8963,"3":{"1":0},"4":[null,2,16777215],"11":4,"12":0,"16":10}">Epinephrine is a naturally occurring hormone, also called adrenaline. It is one of two chemicals (the other is norepinephrine) released by the adrenal gland. Epinephrine increases the speed and force of heart beats and thereby the work that can be done by the heart. It dilates the airways to improve breathing and narrows blood vessels in the skin and intestine so that an increased flow of blood reaches the muscles and allows them to cope with the demands of exercise. Epinephrine has been produced synthetically as a drug since 1900. It remains the drug of choice for treatment of anaphylaxis.</span>” rel=”tooltip”>epinephrine (adrenaline) auto-injector for emergency treatment

Health care workers with a history of latex sensitivity who must wear gloves should stop wearing latex gloves. Their co-workers should also not use latex gloves, but rather switch to synthetic gloves.

Patients with latex allergy are at risk of asthma on exposure to latex-containing aerosols. They should try to avoid areas where powdered latex gloves or other latex products are used.

How can latex allergy be prevented?

If you have latex allergy you should avoid direct contact with all products and devices that contain latex. Also avoid food that causes an allergic reaction. Latex allergy problems during dental, medical or surgical procedures can be prevented by warning health care providers about latex allergy before any test or treatment. Latex allergic people can receive medical or dental care in a latex-safe area. Hospitals and clinics that use only low protein latex gloves and non-latex gloves have experienced dramatic declines in new cases of latex allergy.

Allergists can provide latex-allergic people with information and assistance to help them avoid products which may contain latex. The American Latex Allergy Association also has additional information.

With the right treatment plan, you’ll understand how to manage your allergies, so you can be in control.

Allergy ointment. How to eliminate an allergic rash – an article on the site Aptechestvo, Nizhny Novgorod

An inadequate reaction of the body to contact with factors of the external or internal environment causes the development of allergies. If the human immune system has reacted incorrectly to irritants, a cough, choking, an allergic rash, and other non-standard reactions appear. It is they who most often become the first symptom of malfunctions in the immune system.

Causes

Skin allergies often manifest as a rash. These are small blisters, flaky spots, itchy redness, which are visualized on the face, head, body. The affected areas can be pinpoint or affect large areas. More often defects appear in children, less often in adults.

Skin allergic rash, causes and provoking factors:

• genetic predisposition;

• contact with dust, chemicals, plant pollen;

• ingestion of food and drugs to which a person has a certain sensitivity;

• parasite metabolites;

• sun and cold;

• animal hair;

• cosmetics, etc.

In many people, the reaction occurs as a result of metal contact (nickel, silver), latex, insect bites, use of perfume, wearing natural wool, or contact with domestic/wild animals.

Until now, the exact causes of the disease are being studied, but scientists are confident that the genetic predisposition or sensitivity of the immune system to certain substances, as well as a violation of the properties and functions of the epidermis in infancy, underlie the development of pathology.

Skin allergies, symptoms

Depending on the nature of the lesions and symptoms, there are different types of allergies on the body. It is important to correctly identify the disease in order to prescribe effective treatment and eliminate the causes.

Dermatitis

Allocate contact, atopic and photodermatitis. It is manifested by flaky spots, blisters, accompanied by itching, swelling and swelling. Occurs as an immediate reaction to a contract with an allergen or after a few hours / days with a food irritant. In a child of the first year of life, such symptoms indicate intolerance to milk protein. Photodermatitis – the reaction of the epidermis to the sun’s rays with a special susceptibility or climate change. An allergic rash on the face can also be the result of dermatitis.

Eczema

A disease of a neuro-allergic nature, which is complex in terms of the mechanism of development. Symptoms:

• extensive redness;

• multiple small vesicles;

• dryness or weeping;

• crust formation.

It often occurs in adults who are regularly exposed to stress. The affected areas are the folds of the limbs, folds on the neck and body.

Urticaria

By the nature of the manifestation, it resembles a burn after contact with nettle leaves. Red spots and blisters appear on the body that itch. Allergic rash urticaria is the result of an instantaneous response of the body to food, medicine, heat, physical stress, insect bite. It lasts from several hours to several days, it can be chronic.

Quincke’s edema

The most severe form of allergy. Affects soft tissues and can pass to the mucous membranes. Edema can be determined by swelling and swelling of the face, lips, neck, eyelids. Develops rapidly as a response to medications, certain foods (eggs, seafood, nuts), latex contract, chemicals, wasp stings, bee stings, etc. Requires rapid emergency medical attention due to the high risk of suffocation as a result of laryngeal edema.

Diagnostics

In addition to a visual examination and analysis of the patient’s complaints, the doctor usually prescribes the following examinations:

• general and biochemical blood test;

• blood test for specific IgE antibodies;

• scarification tests.

Diagnosis may also include a review of the diet, especially if the problem is in a young child.

Treatment

An integrated approach to the disease is the basis for effective treatment of allergic manifestations on the skin. The main thing is to identify the cause, prevent recurrence and relieve unpleasant symptoms in the acute period. To do this, use oral antihistamines, corticosteroids, creams, lotions and ointments for external use.

Ointments are different according to their functions:

The most effective for quickly eliminating itching and redness are hormonal (for example, Advantan). They are used in doses, in the acute phase, as directed by a doctor.

Children and adults with atopic dermatitis are shown special caring ointments (Topicrem), which help retain moisture, help restore the integrity of the skin during scratching and damage, relieve itching, inflammation, restore local microflora, and increase immunity.

A good effect in the treatment is given by antihistamines (for example, Fenistil). They are designed to block histamine h2 receptors, which helps to reduce the manifestations of itching, inflammation and redness for the next few hours.

Ointments with D-panthenol (Bepanten) also alleviate the course of the disease and are considered the safest drugs that can be used on the body and face. Shown as an additional remedy for diseases of moderate severity and as the main one for mild allergies.

If a fungal or bacterial infection is suspected or diagnosed, combined ointments, for example, Triderm, give an excellent therapeutic effect. They contain broad-spectrum antibiotics, antifungal components, antipruritic, anti-inflammatory and anti-allergic. The application is shown in courses, the effect comes quickly.

Ointments for the treatment of allergies are one of the most effective means for relieving unpleasant symptoms – itching and burning. In addition, they prevent skin damage, promote tissue repair, and have a caring effect. They can be both the main and auxiliary means of treating a rash.

Allergic rash (Urticaria; urticarial rash) – Ministry of Health of the PMR

Allergic rash

(Urticaria; urticarial rash)

Allergic rash is a red, itchy, slightly raised swelling. Itching may be severe. An allergic rash may have well-defined borders and a pale area in the center. As a rule, hives eruptions come and go. One nodule may persist for several hours, then disappear, and later another may appear elsewhere. After the nodule disappears, the skin usually looks completely normal. The swelling is caused by the release of chemicals (such as histamine) from mast cells in the skin, which cause fluid to temporarily leak from small blood vessels.

Angioedema

Allergic rash can develop with Quincke’s edema, which, like an allergic rash, is accompanied by swelling. However, the swelling caused by angioedema is under the skin, not on its surface. Sometimes Quincke’s edema affects the face, lips, throat, tongue, and airways. It can be life-threatening if the swelling interferes with breathing.

Causes of allergic rash

Urticaria and Quincke’s edema are common allergic reactions.

Urticaria can be caused by inhaling, consuming, squirting, or touching certain chemicals. These chemicals may be present in the environment, food, drugs, insects, plants, or other sources. For most people, they are harmless. However, if people are sensitive to them, these chemicals (called triggers or allergens) can trigger an allergic reaction. This means that the immune system reacts to chemicals.

However, urticaria is not always part of an allergic reaction. For example, it can occur as a result of autoimmune diseases. In these diseases, dysfunction of the immune system causes the body’s own tissues to be misrecognised as foreign and attacked. In addition, some drugs directly cause hives without causing an allergic reaction. Emotional stress and certain physical stimuli (such as heat or light) can trigger hives for reasons that are not well understood.

Urticaria usually lasts less than 6 weeks and is classified as acute. If the urticaria lasts more than 6 weeks, then it is classified as chronic.

Acute urticaria most commonly caused by:

Allergic reactions are often caused by foods, particularly eggs, fish, shellfish, nuts and fruits, or insect bites. Eating even small amounts of certain foods can suddenly cause hives. But when eating other foods (for example, strawberries), an allergic reaction occurs only after eating them in large quantities. Many medications, especially antibiotics, can cause hives. Immediate allergic reactions can also occur when a substance comes into direct contact with the skin (such as latex), after an insect bite, or as a reaction to a substance that is inhaled into the lungs or through the nose.

Non-allergic causes of allergic rashes include infections, certain drugs, certain physical stimuli (such as pressure or cold), some emotional stimuli (such as stress), and certain dietary supplements.

Although acute urticaria usually has specific causes, in half of the cases the cause cannot be identified.

Chronic urticaria most commonly caused by:

Sometimes the cause is easily overlooked, such as when people consistently consume a food that is not known to be the cause of the reaction (such as a preservative or coloring in foods or penicillin in milk). Often, despite best efforts, the cause remains unidentified.

Chronic urticaria can last from several months to several years, sometimes disappearing for no apparent reason.

Evaluation of allergic rash

Not every episode of urticaria requires immediate medical attention. The following information can help you decide if you need to see a doctor and what to expect when you see a doctor.

Warning signs

Some symptoms and characteristics are cause for concern:

• Swelling of the face, lips, throat, tongue or airways (angioedema)

• Difficulty breathing, including wheezing

• Urticaria that is intensely colored, with open sores, or lasting more than 48 hours

• Fever, swollen lymph nodes, jaundice, weight loss and other symptoms of a general (systemic) illness

When to see a doctor

Call an ambulance if:

Call the emergency room or doctor’s office as soon as possible if:

• Symptoms are severe.

• The person feels increasing weakness or dizziness, or has a severe fever or chills.

• The person develops vomiting or abdominal pain or diarrhea.

Seek medical attention if:

• Bee sting causes urticaria (for treatment advice if another bee sting occurs).

• The person has other symptoms such as fever, joint pain, weight loss, swollen lymph nodes, or night sweats.

• Urticaria recurs without exposure to a provocative factor.

• Symptoms persist for more than 2 days.

If a child has urticaria that comes on suddenly, disappears quickly, and does not recur, a medical examination is usually not required. The cause is usually a viral infection.

What the doctor does

Doctors first ask questions about symptoms and medical history. Then they do a physical examination. Typically, a history and physical examination can identify a possible cause and determine what tests are needed.

Doctors ask the person to describe in detail each episode of hives and any other symptoms (eg, itching, difficulty breathing, or swelling of the face and tongue) that have occurred. They ask about the person’s activities before and during the episode and possible exposure to substances that can cause allergic reactions, including medications they take. The person is also asked about specific symptoms that might indicate a cause, previous allergic reactions, and recent travel.

The precipitating factor cannot always be determined from the medical history (often because the precipitating factor is something that may have been transferred before).

During a physical examination, doctors first check to see if the patient has swelling of the lips, tongue, throat, or airways. In the presence of edema, treatment is started immediately. Doctors then pay attention to what the hives look like, determine which parts of the body are affected, and check for other symptoms that may help confirm the diagnosis. Doctors can use a variety of physical stimuli to see if they can trigger hives. For example, they may apply light pressure, heat and cold to the skin, or stroke the skin.

Testing

Generally, testing is not required for a single episode of urticaria unless symptoms indicate a specific disorder that requires treatment (eg, some infections). However, if the urticaria has unusual characteristics, recurs, or persists, investigations are usually done.

Tests typically include a complete blood count and blood tests to measure electrolytes, sugar (glucose), and thyroid-stimulating hormone levels and determine how well your kidneys and liver are functioning. Skin testing, such as a skin prick test, is done by an allergist (a doctor who specializes in allergic conditions) to identify specific allergens. Imaging studies and other blood tests are performed based on the results of the medical history and physical examination. If the results suggest that the cause is a disease that affects the whole body, then a thorough examination is necessary to identify it.

Skin biopsy is performed if the diagnosis is unclear or if the rash persists for more than 48 hours.

Allergic rash treatment

• Avoidance of triggers

• Remedies for itching

• Medicinal preparations

Urticaria often resolves without intervention in a day or two. If the cause is obvious, or if a doctor identifies a cause, people should avoid it if possible. If the cause is not obvious, people should stop taking all non-essential medications until the hives resolve.

Symptoms can be relieved by bathing and showering with cool water only, avoiding scratching and wearing loose clothing.

Medicines

antihistamines taken by mouth are used to treat allergic rashes. These drugs partially relieve itching and reduce swelling. To achieve the effect, they should be taken regularly, and not as needed. Some antihistamines, including cetirizine, diphenhydramine, and loratadine, are available without a prescription. Diphenhydramine is the oldest drug that is more likely to cause drowsiness than the other two. Other antihistamines include desloratidine, fexofenadine, hydroxyzine, and levocetirizine. Creams and lotions containing antihistamines are generally not used because they can make the skin more sensitive and itch more

If symptoms are severe and other treatments fail, use oral corticosteroids (such as prednisone). They are taken for the shortest possible period of time. When taken by mouth for more than 3 to 4 weeks, corticosteroids cause many, including sometimes serious, unwanted effects (see Corticosteroid Uses and Side Effects). Corticosteroid creams do not help.

People admitted to the hospital with severe reactions or angioedema are given epinephrine . People with these severe reactions should have an epinephrine self-injection pen (epinephrine self-injection syringe) and should use it immediately if a reaction occurs.

About half of people with chronic urticaria go away without treatment within 2 years. In some adults, the antidepressant doxepin, which is also a powerful antihistamine, helps relieve chronic hives. Omalizumab, a monoclonal antibody, can be used in people with chronic allergic rashes that reappear despite other treatments.

Essential information for older people: Allergic rash

Older people are more likely to develop adverse effects when they take older antihistamines (eg, hydroxyzine and diphenhydramine). In addition to drowsiness, these drugs can cause confusion and delirium, and can also cause difficulty starting and passing urine. Generally, older people should not take these drugs to relieve hives.

KEY POINTS

• Urticaria may or may not be an allergic reaction.

• If urticaria has lasted less than 6 weeks, the cause is usually an allergic reaction to a specific substance, an acute infection, or a non-allergic reaction to a specific substance.

• If the urticaria has lasted 6 weeks or more, the cause usually cannot be identified (idiopathic) or the cause is an autoimmune disease.