What are the common triggers for hives and facial swelling. How can you identify and treat hives effectively. What are the key differences between hives and other skin conditions. When should you seek medical attention for hives.

Understanding Hives: Causes and Characteristics

Hives, medically known as urticaria, are raised, itchy welts that can appear suddenly on various parts of the body, including the face. These non-contagious skin reactions occur when the body releases histamine in response to an allergen or irritant, causing inflammation and the distinctive rash.

The appearance of hives can vary significantly among individuals and may look different depending on skin color. They can manifest as tiny raised bumps or larger welts of various shapes and sizes. A key characteristic of hives is that pressing down on a welt will turn its center white, although this effect may be less noticeable on darker skin tones.

Common Triggers for Hives

• Food and food additive allergies
• Medications, particularly antibiotics
• Extreme temperatures (cold or heat)
• Sunlight exposure
• Stress
• Pressure on the skin
• Certain chemicals

In some cases, the cause of hives remains unknown, with no obvious trigger identified. It’s important to note that hives can also be a symptom of underlying autoimmune disorders or, less commonly, certain malignancies.

Facial Hives: Why the Face is Particularly Susceptible

The face is a common location for hives due to its sensitive skin and frequent exposure to potential allergens and irritants. Facial hives can be particularly distressing for individuals, as they are highly visible and can cause significant discomfort.

Why is facial skin more prone to hives? The skin on the face is thinner and more delicate than other parts of the body, making it more reactive to environmental factors and allergens. Additionally, the face is often exposed to various products, such as cosmetics, skincare items, and fragrances, which can potentially trigger allergic reactions.

Differentiating Hives from Other Skin Conditions

While hives share similarities with other skin conditions, it’s crucial to distinguish them for proper treatment. Two conditions often confused with hives are contact dermatitis and angioedema.

Hives vs. Contact Dermatitis

Contact dermatitis and hives both result from skin contact with irritants or allergens. However, there are key differences:

• Onset: Hives appear suddenly, while contact dermatitis may take 1-2 days to develop after exposure
• Duration: Hives typically last for a few hours, whereas contact dermatitis can persist for days or weeks
• Appearance: Hives are raised welts, while contact dermatitis often presents as a flat, red, itchy rash

Hives vs. Angioedema

Angioedema is closely related to hives and often occurs alongside them. However, it involves swelling deeper in the skin and can affect different areas:

• Facial swelling around the mouth or eyes
• Swelling of the throat
• Swelling of the extremities
• Potential breathing difficulties
• Stomach cramps

Effective Treatment Strategies for Hives

The primary approach to treating hives involves avoiding known triggers and managing symptoms. While hives often resolve on their own within a short time, the itching can be intensely uncomfortable. Here are some effective treatment strategies:

1. Apply cold compresses to affected areas (except in cases of cold-induced hives)
2. Use over-the-counter antihistamine medications to relieve itching
3. Apply OTC topical corticosteroids for localized relief
4. In severe cases, doctors may prescribe stronger corticosteroids for quick relief

For individuals with chronic hives, additional steps can help minimize symptoms:

• Avoid overheating
• Keep skin well-moisturized
• Use fragrance-free, non-irritating skincare products
• Identify and avoid personal triggers

When to Seek Medical Attention for Hives

While most cases of hives are not dangerous, there are situations where medical attention is necessary. It’s crucial to recognize the signs of a severe allergic reaction, known as anaphylaxis, which can be life-threatening.

Seek immediate medical care if you experience hives along with any of the following symptoms:

• Difficulty breathing
• Tightness in the throat
• Dizziness
• A sense of impending doom
• Rapid swelling, especially of the face, tongue, or throat

Additionally, consult a healthcare provider if:

• Hives persist for more than a few days
• You experience frequent or recurring hives without an apparent cause
• Severe itching leads to skin damage or signs of infection
• Hives interfere with daily activities or sleep

Prevention Strategies and Risk Factors for Hives

While it’s not always possible to prevent hives, understanding your personal triggers and risk factors can help minimize outbreaks. Some individuals are more prone to developing hives due to certain risk factors:

• Asthma or a family history of asthma
• Eczema
• Hay fever
• History of allergies

To reduce the likelihood of hives, especially on the face, consider the following prevention strategies:

1. Identify and avoid known allergens and triggers
2. Use gentle, fragrance-free skincare products
3. Protect your skin from extreme temperatures and direct sunlight
4. Manage stress through relaxation techniques or counseling
5. Keep a diary to track potential triggers and patterns in hive outbreaks
6. Consult with an allergist to identify less obvious allergens

The Impact of Hives on Quality of Life

Hives, particularly when chronic or recurring, can significantly impact an individual’s quality of life. The visible nature of facial hives can lead to self-consciousness and social anxiety. Additionally, the intense itching associated with hives can disrupt sleep and daily activities.

How can individuals cope with the psychological impact of hives? Consider these strategies:

• Join support groups or online communities for individuals with chronic hives
• Practice stress-reduction techniques such as meditation or yoga
• Seek counseling if hives are causing significant emotional distress
• Educate friends and family about your condition to foster understanding and support
• Work with a dermatologist or allergist to develop a comprehensive management plan

Emerging Research and Future Treatments for Hives

The field of hives research is constantly evolving, with scientists exploring new treatments and gaining a deeper understanding of the condition. Some promising areas of research include:

Biological Therapies

Researchers are investigating the use of monoclonal antibodies to target specific components of the immune system involved in hive formation. These targeted therapies may offer relief for individuals with chronic hives that don’t respond to traditional treatments.

Gut Microbiome and Hives

Emerging evidence suggests a potential link between gut health and skin conditions, including hives. Studies are exploring how modifying the gut microbiome through probiotics or dietary changes might influence hive occurrence and severity.

Personalized Medicine Approaches

As our understanding of the genetic and immunological factors underlying hives improves, researchers are working towards more personalized treatment approaches. This may involve genetic testing to predict an individual’s response to specific therapies or identify potential triggers.

What potential breakthroughs might we see in hives treatment in the coming years? While it’s difficult to predict with certainty, some possibilities include:

• Development of long-acting antihistamines with fewer side effects
• Novel immunomodulatory drugs that target specific pathways involved in hive formation
• Advanced diagnostic tools to quickly identify underlying causes of chronic hives
• Improved understanding of the relationship between hives and other autoimmune conditions

Living with Chronic Hives: Management Strategies for Long-Term Success

For individuals dealing with chronic hives, developing a comprehensive management strategy is crucial for long-term success and improved quality of life. Here are some key components of an effective management plan:

Medication Management

Work closely with your healthcare provider to find the optimal medication regimen. This may involve:

• Experimenting with different antihistamines to find the most effective option
• Considering long-term use of anti-inflammatory medications
• Exploring the potential benefits of leukotriene modifiers or other alternative treatments

Lifestyle Modifications

Making certain lifestyle changes can help reduce the frequency and severity of hive outbreaks:

1. Maintain a consistent sleep schedule to support immune function
2. Engage in regular, moderate exercise to reduce stress and inflammation
3. Practice good skincare habits, including gentle cleansing and moisturizing
4. Avoid known triggers, such as certain foods, medications, or environmental factors

Stress Management

Chronic stress can exacerbate hives, making stress management an essential component of long-term care:

• Explore relaxation techniques such as deep breathing, progressive muscle relaxation, or guided imagery
• Consider cognitive-behavioral therapy to develop coping strategies
• Engage in hobbies or activities that promote relaxation and well-being

Regular Medical Follow-ups

Maintaining open communication with your healthcare provider is crucial for managing chronic hives effectively:

• Schedule regular check-ups to assess treatment efficacy and make necessary adjustments
• Discuss any new symptoms or concerns promptly
• Stay informed about new treatment options or clinical trials that may be relevant to your condition

By implementing these strategies and working closely with healthcare professionals, individuals with chronic hives can significantly improve their quality of life and reduce the impact of this challenging condition.

Hives in Special Populations: Considerations for Children and Pregnant Women

While hives can affect anyone, certain populations may require special considerations in terms of diagnosis, treatment, and management. Two such groups are children and pregnant women.

Hives in Children

Hives in children can be particularly challenging to manage due to their potential impact on daily activities and the difficulty in identifying triggers. Key considerations for pediatric hives include:

• Age-appropriate explanation of the condition to help children understand and cope
• Careful selection of medications, considering potential side effects and age restrictions
• Working with schools to ensure proper management during school hours
• Monitoring for signs of associated conditions, such as asthma or food allergies

How can parents effectively manage their child’s hives? Consider these strategies:

1. Keep a detailed diary of potential triggers, including foods, activities, and environmental factors
2. Use child-friendly techniques to relieve itching, such as cool baths or wet compresses
3. Consult with a pediatric dermatologist or allergist for specialized care
4. Educate caregivers and teachers about the child’s condition and necessary precautions

Hives During Pregnancy

Pregnancy can sometimes trigger hives or exacerbate existing chronic hives. Managing hives during pregnancy requires careful consideration of treatment options to ensure the safety of both mother and baby. Key points to consider include:

• Some antihistamines may be safe during pregnancy, but always consult with a healthcare provider before use
• Topical treatments may be preferred over oral medications when possible
• Monitoring for signs of more serious conditions, such as pemphigoid gestationis, which can cause hive-like symptoms
• Addressing any underlying health issues that may be contributing to hives

What are safe and effective ways to manage hives during pregnancy? Consider these approaches:

1. Use cool compresses or oatmeal baths to relieve itching
2. Wear loose, breathable clothing to minimize skin irritation
3. Practice stress-reduction techniques, as stress can exacerbate hives
4. Work closely with an obstetrician and dermatologist to develop a safe treatment plan

By taking these special considerations into account, children and pregnant women with hives can receive appropriate care and management, minimizing the impact of this condition on their overall health and well-being.

Treatments, symptoms, causes, and outlook

Hives can appear all over the body, including the face. Allergens and environmental factors can often trigger an outbreak of hives. Hives are not usually dangerous, but anyone who thinks that they may be having a severe allergic reaction should contact a doctor.

Hives are raised, itchy welts that vary in size and can appear suddenly. This type of rash, also known as urticaria, is not contagious.

As the skin on the face is very sensitive, it is a common area of the body for hives to affect.

Hives can occur due to irritation and allergies or because of certain physical triggers, such as pressure.

This article looks at the symptoms, causes, and treatment of hives. It also considers the outlook for someone experiencing hives and explains when to contact a doctor.

Hives do not only affect the face, but the face is a common location for hives because the skin there often comes into contact with allergens and other irritants.

Hives happen when the body releases histamine in response to an allergen. This chemical release causes inflammation and the distinctive rash.

The appearance of hives can vary among individuals, and they can look different depending on the color of the skin.

Sometimes, they appear as tiny raised bumps. In other cases, hives look like raised welts that have different shapes. The welts or bumps can be big or small.

Hives are usually very itchy and often come on suddenly. The rash typically lasts only a few hours, but people with chronic hives can have flare-ups on a regular basis.

A telltale sign of hives is that pressing down on a welt will turn its center white. However, this effect may be less apparent in people with darker skin tones.

Learn about the appearance and diagnosis of hives on Black skin here.

According to the American Academy of Dermatology (AAD), hives can appear because of:

• an allergic reaction
• a physical trigger, including exposure to cold or hot temperatures
• a medical condition

The AAD note that known triggers for hives include:

• food and food additive allergies
• medications, such as antibiotics
• cold
• heat
• sunlight
• stress
• pressure
• certain chemicals

Sometimes, there is no obvious trigger, and the cause of hives remains unknown.

Treating hives involves avoiding contact with or exposure to the offending trigger or allergen.

Hives usually go away on their own and only last a short time. However, the itchy sensation can be very uncomfortable.

The AAD recommend that people relieve itching by using a cold compress (except in the case of cold-related hives) or applying over-the-counter (OTC) anti-itch medication that contains antihistamines.

People may also find OTC topical corticosteroids useful. In some cases, doctors may prescribe stronger corticosteroids to treat flare-ups quickly.

People with chronic hives may wish to take extra steps to minimize the symptoms. These can include:

• avoiding overheating
• keeping the skin moisturized
• using fragrance-free, non-irritating skin care products

Hives can be a symptom of some autoimmune disorders and, less commonly, certain malignancies.

People can also get hives when they have a severe allergic reaction, known as anaphylaxis. Anaphylaxis does not subside on its own and requires emergency treatment. Anyone experiencing the signs and symptoms of this reaction — which can include difficulty breathing, tightness of the throat, dizziness, and a sense of impending doom — should seek medical care immediately.

Contact dermatitis and hives are similar but not the same. Both can happen when the skin touches an irritant or allergen. However, a contact dermatitis rash may not appear until 1–2 days after the contact, and it can take time to heal.

Angioedema is another condition that is very similar to hives. It often results from an allergic reaction. Symptoms include:

• facial swelling around the mouth or eyes
• breathing trouble
• stomach cramps
• swelling of the extremities
• swelling of the throat

If hives happen alongside other symptoms, such as swelling and difficulty breathing, a person should seek emergency medical attention. They may be having a severe allergic reaction.

Severe itching can cause a person to scratch hard and break the skin. As a result, bacteria can enter the body and cause an infection.

People should also see a doctor if they notice any skin changes that may signal an infection, such as discoloration or the area feeling warm to the touch.

In about 5% percent of people who experience hives, it can be a sign of an underlying condition such as liver or thyroid disease.

Some risk factors for hives include having:

• asthma or a family history of asthma
• eczema
• hay fever

Staying away from triggers can help prevent future rashes from developing.

For example, people with sensitive facial skin should avoid products with fragrances. Gentle, non-irritating products can sometimes still cause hives, though. To avoid unexpected reactions, people can perform patch tests to check for potential skin reactions.

However, it is not always possible to avoid triggers. Sometimes, people cannot identify what has triggered a flare-up.

Some triggers are also challenging to avoid. Steering clear of cold weather, for example, is difficult for someone who lives in a cold climate. Wearing facial protection such as a scarf or neck gaiter may help, but it will not guarantee that hives will never occur.

Hives are not usually severe, and the rash will typically resolve on its own. Most people can avoid any known triggers fairly easily.

If a person does not know what is triggering the hives rash on their face, they may be unable to prevent it, but managing the symptoms is relatively simple.

Hives can happen almost anywhere on the body, including the face. Some people may feel self-conscious about hives on the face, and they can be uncomfortable.

As hives sometimes happen due to an allergic reaction, people with chronic facial hives should see a doctor or allergist.

It is possible for hives to develop into a severe allergic reaction.

Not all cases of hives have an easily detectable cause. In some people with hives, there is no clear trigger of the rash. However, various treatments and home remedies can help treat the symptoms.

Treatments, symptoms, causes, and outlook

Hives can appear all over the body, including the face. Allergens and environmental factors can often trigger an outbreak of hives. Hives are not usually dangerous, but anyone who thinks that they may be having a severe allergic reaction should contact a doctor.

Hives are raised, itchy welts that vary in size and can appear suddenly. This type of rash, also known as urticaria, is not contagious.

As the skin on the face is very sensitive, it is a common area of the body for hives to affect.

Hives can occur due to irritation and allergies or because of certain physical triggers, such as pressure.

This article looks at the symptoms, causes, and treatment of hives. It also considers the outlook for someone experiencing hives and explains when to contact a doctor.

Hives do not only affect the face, but the face is a common location for hives because the skin there often comes into contact with allergens and other irritants.

Hives happen when the body releases histamine in response to an allergen. This chemical release causes inflammation and the distinctive rash.

The appearance of hives can vary among individuals, and they can look different depending on the color of the skin.

Sometimes, they appear as tiny raised bumps. In other cases, hives look like raised welts that have different shapes. The welts or bumps can be big or small.

Hives are usually very itchy and often come on suddenly. The rash typically lasts only a few hours, but people with chronic hives can have flare-ups on a regular basis.

A telltale sign of hives is that pressing down on a welt will turn its center white. However, this effect may be less apparent in people with darker skin tones.

Learn about the appearance and diagnosis of hives on Black skin here.

According to the American Academy of Dermatology (AAD), hives can appear because of:

• an allergic reaction
• a physical trigger, including exposure to cold or hot temperatures
• a medical condition

The AAD note that known triggers for hives include:

• food and food additive allergies
• medications, such as antibiotics
• cold
• heat
• sunlight
• stress
• pressure
• certain chemicals

Sometimes, there is no obvious trigger, and the cause of hives remains unknown.

Treating hives involves avoiding contact with or exposure to the offending trigger or allergen.

Hives usually go away on their own and only last a short time. However, the itchy sensation can be very uncomfortable.

The AAD recommend that people relieve itching by using a cold compress (except in the case of cold-related hives) or applying over-the-counter (OTC) anti-itch medication that contains antihistamines.

People may also find OTC topical corticosteroids useful. In some cases, doctors may prescribe stronger corticosteroids to treat flare-ups quickly.

People with chronic hives may wish to take extra steps to minimize the symptoms. These can include:

• avoiding overheating
• keeping the skin moisturized
• using fragrance-free, non-irritating skin care products

Hives can be a symptom of some autoimmune disorders and, less commonly, certain malignancies.

People can also get hives when they have a severe allergic reaction, known as anaphylaxis. Anaphylaxis does not subside on its own and requires emergency treatment. Anyone experiencing the signs and symptoms of this reaction — which can include difficulty breathing, tightness of the throat, dizziness, and a sense of impending doom — should seek medical care immediately.

Contact dermatitis and hives are similar but not the same. Both can happen when the skin touches an irritant or allergen. However, a contact dermatitis rash may not appear until 1–2 days after the contact, and it can take time to heal.

Angioedema is another condition that is very similar to hives. It often results from an allergic reaction. Symptoms include:

• facial swelling around the mouth or eyes
• breathing trouble
• stomach cramps
• swelling of the extremities
• swelling of the throat

If hives happen alongside other symptoms, such as swelling and difficulty breathing, a person should seek emergency medical attention. They may be having a severe allergic reaction.

Severe itching can cause a person to scratch hard and break the skin. As a result, bacteria can enter the body and cause an infection.

People should also see a doctor if they notice any skin changes that may signal an infection, such as discoloration or the area feeling warm to the touch.

In about 5% percent of people who experience hives, it can be a sign of an underlying condition such as liver or thyroid disease.

Some risk factors for hives include having:

• asthma or a family history of asthma
• eczema
• hay fever

Staying away from triggers can help prevent future rashes from developing.

For example, people with sensitive facial skin should avoid products with fragrances. Gentle, non-irritating products can sometimes still cause hives, though. To avoid unexpected reactions, people can perform patch tests to check for potential skin reactions.

However, it is not always possible to avoid triggers. Sometimes, people cannot identify what has triggered a flare-up.

Some triggers are also challenging to avoid. Steering clear of cold weather, for example, is difficult for someone who lives in a cold climate. Wearing facial protection such as a scarf or neck gaiter may help, but it will not guarantee that hives will never occur.

Hives are not usually severe, and the rash will typically resolve on its own. Most people can avoid any known triggers fairly easily.

If a person does not know what is triggering the hives rash on their face, they may be unable to prevent it, but managing the symptoms is relatively simple.

Hives can happen almost anywhere on the body, including the face. Some people may feel self-conscious about hives on the face, and they can be uncomfortable.

As hives sometimes happen due to an allergic reaction, people with chronic facial hives should see a doctor or allergist.

It is possible for hives to develop into a severe allergic reaction.

Not all cases of hives have an easily detectable cause. In some people with hives, there is no clear trigger of the rash. However, various treatments and home remedies can help treat the symptoms.

urticaria and angioedema | Nurmukhametova E.

Urticaria and angioedema, which are a reaction of skin vessels, can develop together or separately. If the edema covers both the skin and subcutaneous tissues, this condition is defined as angioedema. With urticaria, only the surface layers of the skin are involved in the process. It has been established that urticaria affects approximately 15% of the population, with women more often. The disease can develop at any age, but the peak falls on the period from the second to the fourth decade of life. Approximately half of the patients have simultaneous development of urticaria and angioedema; 40% develop only urticaria and 10% develop isolated angioedema. In most cases, urticaria is acute. But if the manifestations of the disease persist for more than 6 weeks, they speak of a chronic form of the disease.

Etiology
The cause of the development of urticaria are various factors; often the etiology of the disease remains unclear. Urticaria can develop after the administration of serum, ingestion of certain foods, inhalation of volatile allergens, insect bites, contact with any substances; this pathology is often associated with connective tissue diseases, neoplasms, infectious and endocrine diseases. Urticaria can be caused by various physical factors (cold, heat, sunlight, pressure, etc.). Factors that stimulate adrenergic and cholinergic reactions also play a role in the occurrence of the disease. The literature describes a case of increased plasma concentrations of noradrenaline, adrenaline and dopamine under stress, which led to the development of urticaria. Hereditary angioedema is characterized by recurrent, self-limiting exacerbations. The disease is inherited in an autosomal dominant manner with incomplete penetrance. In addition to the manifestation in childhood and a burdened family history, a test for the presence and activity of an inhibitor of Cl-esterase, which is one of the components of the complement system, can be used to diagnose this pathology. In cases where the cause of the disease cannot be established (70 – 80%), they speak of idiopathic urticaria.
Pathogenesis
To explain the pathogenesis of urticaria and angioedema, five mechanisms have been proposed: increased IgE synthesis, complement activation, the action of factors that cause the release of biologically active substances from mast cells, impaired arachidonic acid metabolism, and an idiopathic mechanism. A skin biopsy in the affected area shows swelling of the upper layers of the dermis, vasodilation, lymphocytic infiltrates around small vessels, which are formed due to an increase in the permeability of the latter. In chronic urticaria, infiltrates are predominantly represented by T-lymphocytes. The content of mast cells in the skin is increased. It has been established that histamine, synthesized and deposited by skin mast cells, plays a key role in the development of characteristic manifestations of the disease. When mast cells are activated, histamine and a number of other vasoactive substances are released, including kinins, leukotrienes, and prostaglandins. Kinins are vasoactive peptides and may play an important role in the development of urticaria. They reduce the contractility of smooth muscles, cause vasodilation and increase the permeability of the vascular wall. Antibodies of the IgE class, as well as complement-linked antibodies, interact with receptors on the surface of mast cells, causing the release of histamine. The release of histamine can be caused by certain substances (radiocontrast, chemicals) and medications (for example, opiates).
Diagnosis and clinical manifestations
When diagnosing, it is necessary to conduct a thorough history taking with a detailed description of the manifestations of the disease, taking into account provoking factors, the duration of the presence of blisters, associated symptoms, and the patient’s tendency to atopy. It is important to establish or reject a connection with any food, volatile or injectable substances, the presence of contact reactions, systemic diseases, hormonal influences, the influence of emotional factors, infections. Even if the driving mechanism is unknown, the listed factors are often triggers. Thus, about half of patients with idiopathic urticaria worsen when taking aspirin or non-steroidal anti-inflammatory drugs. Urticaria is associated with thyroid disease, lymphoma, and systemic lupus erythematosus.
Skin lesions in urticaria have the appearance of limited, hyperemic, itchy blisters ranging in size from 1 – 2 mm to several centimeters. The lesion may be localized or generalized. The existence of individual bubbles is limited to 24-48 hours, but they are replaced by new elements. Some patients develop angioedema, which is characterized by the involvement of deeper layers of the skin and subcutaneous structures, which, however, is not accompanied by itching. Some patients may experience respiratory, gastrointestinal, and cardiovascular symptoms. The value of laboratory tests and skin tests in diagnosing and establishing the cause of the disease is limited.
Treatment
Therapy for urticaria should be based on the identification and elimination of the cause of the disease. Unfortunately, as already mentioned, in most cases this is impossible, since either the cause cannot be established, or the disease is provoked by many factors. Therefore, the goal of treatment is usually to inactivate effector cells and block the release of inflammatory mediators. Specific receptors localized in cells and microvessels of the skin can also serve as a target for therapy.
Antihistamines (H ₁ receptor antagonists) are effective in about 65 to 70% of patients with urticaria or angioedema. The drugs of this group prevent the effects of histamine to a greater extent than contribute to the relief of already developed manifestations. In patients not responding to antihistamines, involvement of other inflammatory mediators in the pathological process should be suspected. Currently used H ₁ receptor antagonists (for example, loratadine) have approximately the same efficacy, but differ in the strength of sedative, cholinergic effects and tolerability. The choice of a particular drug may be determined by its side effect profile (eg, sedation may or may not be desirable) or pharmacokinetic characteristics. If any drug is ineffective or the patient does not tolerate it well, a drug of another chemical group may be prescribed. Possible combination of blockers H ₁ receptors (for example, during the day – a drug that does not have a sedative effect, and at night – a sedative drug). If treatment with H ₁ receptor antagonists is effective, the dose of the drug should be reduced gradually to avoid exacerbation of the disease.
H ₁ receptor antagonists can be combined with H ₂ receptor antagonists. The results of some studies indicate the feasibility of such a combination. As monotherapy, H 9 blockers0022 2 receptors are not effective enough. The appointment of these drugs is advisable only for certain types of urticaria and angioedema. In refractory cases, it is necessary to select a combination of drugs. Doses of cimetidine in various studies range from 400 to 1600 mg/day. Ranitidine is used in standard doses.
In addition to the above drugs, it is possible to use tricyclic antidepressants (for example, doxepin), b-agonists (terbutaline, etc.) and calcium channel blockers (nifedipine, etc.). These drugs, according to some reports, were effective in patients with chronic idiopathic urticaria. However, the available data are very few, so the use of these agents should be limited to refractory cases of the disease until more convincing results are obtained.

References:

Amerson AB “Allergic and drug-induced skin disease”. In: Herfindal T, Gourley DR Textbook of therapeutics. drug and disease management. Sixth edition, 1996. P. 882-4. Types, causes, symptoms, signs, diagnosis, first aid, treatment 0002 Treatment

Prevention

Urticaria is a common allergic disease characterized by the formation of a rash in the form of blisters or urticaria. Rashes with urticaria are localized mainly on the skin of the neck, face, body and hands. But there are cases when blisters appeared on the mucous membranes.

The disease affects 25% of the world’s population. Urticaria can appear in both children and adults. Signs are noted more often by women than men. The onset of the disease falls on middle age, namely about 35–40 years. 5% of patients are pediatric patients.

Classification

Depending on the duration of the course of the disease, modern medicine distinguishes the following types of urticaria:

1. Acute urticaria is a condition that is characterized by the manifestation of symptoms for at least 6 weeks. Patients also report headache and fever.
2. Acute recurrent – a type of disease with an exacerbation duration of up to 6 weeks. The difference is the duration of remission for 6 weeks.
3. Chronic urticaria is a disease that lasts longer than 6 weeks. This type can be viral, allergic or autoimmune in nature.

The following degrees are distinguished according to the rate of development of the disease:

1. Mild degree, which is characterized by the appearance of rashes in the amount of less than 20 pieces during the day. In this case, patients note a slight itching, which does not bring much discomfort.
2. The average degree of urticaria, characterized by noticeable itching of the skin and increased formation of urticaria (approximately 30-50 pieces per day).
3. Intensive degree. Itchy sensations disrupt daily life, and the number of rashes exceeds 50 pieces.

Depending on the mechanism of development of pathology, such types of diseases are distinguished as:

• allergic urticaria, which is provoked by immune processes. For example, the secretion of pathogen-specific immunoglobulins or the production of cytokine proteins that enhance the inflammatory response;
• non-allergic, in the development of which immune mechanisms are not involved;
• food, the provoking factor of which are certain foods;
• viral;
• solar, the cause of which is direct contact with the sun’s rays. This type of disease is mainly affected by women with liver pathologies and impaired pigment metabolism;
• contact, which occurs when the skin comes into contact with chemical materials, such as latex or silicone;
• aquagenic – an autoimmune form of the disease associated with interaction with water;
• cold. Occurs when the skin is exposed to low temperature;
• viral, caused by a viral infection;
• idiopathic urticaria is a disease whose cause remains unclear.

Causes and risk factors

The manifestation of an allergic disease can have a different etiology. For example, a clear provocateur of the disease is an insect bite or the use of certain drugs, including antibiotics. Blood transfusion, vaccination, and direct interaction with the allergen through food can also provoke the condition.

Other causes of hives include:

• contact with chemicals such as powders, lotions, home cleaning solutions;
• increased sensitivity of the skin to mechanical stress;
• allergies to cold, sun and heat;
• the use of cosmetics, including shampoos, eyelash and eyebrow dyes, as well as components of formulations used in nail extensions;
• exposure to pollen from flowers and plants, which can provoke an allergic reaction, including rhinitis or hay fever.

Despite the fact that many factors provoking the disease are known, the cause of about 30% of cases of the disease cannot be established.

In addition, many chronic non-allergic diseases can cause urticaria. These include lymphoma, thyroid pathologies, diabetes mellitus, and diseases of the gastrointestinal tract.

Symptoms

The main symptom of urticaria is the appearance on the mucous membranes and skin of rashes in the form of blisters. Urticaria are purplish, pinkish or pale pink in color. As a rule, formations rise above the surface of the skin. The condition is often accompanied by unbearable itching. In exceptional cases, soreness appears in the places of localization of the rash.

Some patients also report symptoms of urticaria such as:

• fever;
• general weakness;
• body aches;
• lowering blood pressure;
• tearing and redness of the eyes;
• severe swelling of the eyelids;
• loss of appetite.

In the case of an allergic type of urticaria, patients develop nasal discharge and nasal congestion, the sense of smell decreases and breathing through the nose is disturbed. These changes often lead to a change in hearing.

The severity of cold symptoms varies from patient to patient and may include skin redness, swelling and itching.

To understand what urticaria looks like in children, just look at the skin. In pediatric patients, the symptoms are similar to those in adults: itching, blisters up to 3 mm in size, redness. But, in addition to general signs, digestive disorders appear in the form of vomiting, diarrhea and abdominal pain.

When sick, blisters disappear without a trace 1–2 days after they appear. This is a feature of the disease that distinguishes it from other allergic pathologies.

Complications

Like any allergic disease, hives can lead to complications. Rashes in children often turn into ulcers. This is due to the constant scratching of blisters and infection.

Quincke’s edema is the most serious complication of the pathology. At the same time, patients have swelling of the larynx and face, which as a result can lead to respiratory failure. This is a critical situation that requires immediate medical attention.

Anaphylactic shock, which is often accompanied by a decrease in pressure, clouding in the eyes and heart rhythm disturbance, is another possible complication of the pathology.

Diagnosis

Diagnosis and treatment of urticaria is carried out by a group of doctors, depending on the cause of the disease. A physical examination for visible symptoms is done by a therapist. At the initial examination of the patient, the doctor measures blood pressure, body temperature, heart rate and feels the abdomen and lymph nodes. In the case of an allergic type of disease, an allergist-immunologist and a dermatologist are involved in the treatment.

Depending on the severity of the signs and characteristics of the course of the disease in the patient, the doctor may prescribe one or more diagnostic tests:

1. Complete blood count.
2. Immunoglobulin lgE general.
3. Allergotest.
4. Fecal analysis.
5. Gastroscopy.
6. Ultrasound of the abdominal organs.
7. Ultrasound of the pancreas.
8. Ultrasound of the thyroid gland.
9. Chest x-ray.
10. X-ray of the stomach.

In most cases, the disease stops within the first 14 days, so a special study is not required. After the provoking factor is established, laboratory diagnostics is prescribed.

Treatment

If signs of urticaria appear, it is important for the patient to provide first aid before contacting a doctor. To do this, calm the victim, unbutton the top button of the clothing and give a glass of mineral water to drink.

Symptoms of the disease can appear at any time when interacting with the allergen. Therefore, it is good to have anti-allergic drugs in the form of tablets and drops in the first-aid kit, which must be given to the patient. A cold compress should be applied to the swelling site.

Treatment of urticaria consists of several stages:

1. Exclusion of the allergen – the causative agent of the disease. To do this, you must stop taking medications that could cause pathology. You should also avoid hypothermia and overheating of the body.
2. Detection of foci of infection and their elimination.
3. Compliance with the diet for urticaria. It is important to exclude from the diet foods that can cause allergies: nuts, coffee, chocolate, honey, citrus fruits. The food plate should be filled with hypoallergenic foods, such as vegetable soups, low-fat broth, cereals from cereals, low-fat cottage cheese and yogurt, apples.
4. Use of medications, including antihistamines, immunosuppressants, and antidepressants. It should be remembered that medicines for the treatment of urticaria should be taken only as directed by a doctor.

With the onset of asphyxia against the background of Quincke’s edema, the patient is urgently prescribed a tracheostomy.

Topical ointments and creams for urticaria have not been shown to be effective. Therefore, the use of only these funds will not lead to a complete recovery.

Prophylaxis

In order to prevent urticaria, doctors advise to adhere to the following recommendations:

• in case of a tendency to develop allergies, contact with possible allergens should be avoided;
• it is important to treat diseases in a timely manner in order to avoid complications;
• a balanced diet is recommended;
• It is worth minimizing the physical and chemical effects on the skin.

The rate of recovery of a patient with urticaria is affected by age, cause of the disease, gender and individual characteristics of the organism. With timely access to a doctor, serious consequences can be avoided.

The author of the article:

Ivanova Natalya Vladimirovna

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