What are the common causes of hives and facial swelling. How can you identify the symptoms of hives on different skin tones. What are the most effective treatments for managing hives and angioedema. When should you seek medical attention for hives and facial swelling.

Understanding Hives: The Itchy Skin Condition

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 rashes vary in size and can be triggered by allergens, environmental factors, or even physical stimuli. The face, being particularly sensitive, is a common area for hives to manifest.

But what exactly causes hives? The body releases histamine in response to an allergen or trigger, leading to inflammation and the characteristic rash. This reaction can occur due to various factors, ranging from food allergies to stress.

Identifying Hives on Different Skin Tones

The appearance of hives can vary among individuals and may look different depending on skin color. On lighter skin tones, hives often appear as red or pink raised welts. On darker skin tones, the contrast may be less obvious, but the raised nature of the welts remains consistent.

A unique characteristic of hives is that pressing down on a welt will turn its center white, a phenomenon known as blanching. However, this effect may be less noticeable on darker skin tones, making diagnosis potentially more challenging.

Common Triggers and Causes of Hives

Understanding the triggers of hives is crucial for effective management and prevention. According to the American Academy of Dermatology (AAD), hives can be caused by:

• Allergic reactions
• Physical triggers (e.g., exposure to extreme temperatures)
• Underlying medical conditions

Some specific triggers include:

1. Food and food additive allergies
2. Medications, particularly antibiotics
3. Exposure to cold or heat
4. Sunlight
5. Stress
6. Pressure on the skin
7. Certain chemicals

In some cases, the cause of hives remains unknown, which can be frustrating for those seeking relief.

Hives vs. Other Skin Conditions: Spot the Difference

While hives are distinctive, they can sometimes be confused with other skin conditions. How do hives differ from contact dermatitis? Both can occur when skin touches an irritant or allergen, but contact dermatitis typically takes 1-2 days to appear after exposure and may take longer to heal.

Another condition often associated with hives is angioedema. This condition involves swelling beneath the skin, often around the eyes, lips, hands, or feet. While angioedema can occur alongside hives, it can also happen independently.

Key Differences Between Hives and Angioedema

• Hives: Raised, itchy welts on the skin’s surface
• Angioedema: Deeper swelling beneath the skin, often less itchy

Effective Treatments for Hives and Facial Swelling

How can you effectively manage hives and associated facial swelling? The primary approach involves avoiding known triggers. However, when hives do occur, several treatment options are available:

1. Cold compresses (except for cold-induced hives)
2. Over-the-counter antihistamines
3. Topical corticosteroids
4. Prescription-strength corticosteroids for severe cases

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

• Avoiding overheating
• Keeping skin well-moisturized
• Using fragrance-free, non-irritating skincare products

When to Seek Medical Attention for Hives

While hives are often harmless and resolve on their own, there are instances where medical attention is necessary. When should you be concerned about hives?

• If hives persist for more than six weeks
• If they’re accompanied by symptoms of anaphylaxis (difficulty breathing, throat tightness, dizziness)
• If severe itching leads to skin breakage and potential infection
• If hives are accompanied by unexplained weight loss, fever, or joint pain

In about 5% of cases, hives can be a sign of an underlying condition such as liver or thyroid disease. Therefore, persistent or recurring hives warrant a medical evaluation.

Risk Factors and Prevention of Hives

Are certain individuals more prone to developing hives? Indeed, some risk factors can increase the likelihood of experiencing hives:

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

Prevention is key in managing hives. This involves identifying and avoiding triggers. For those with sensitive facial skin, using gentle, fragrance-free products can help prevent outbreaks. Keeping a diary of hive occurrences and potential triggers can also be beneficial in identifying patterns and preventing future episodes.

The Impact of Hives on Quality of Life

How do hives affect daily life? While often temporary, hives can significantly impact a person’s quality of life, especially when chronic. The intense itching can disrupt sleep, cause discomfort, and even lead to embarrassment or social anxiety when visible on the face or other exposed areas.

For those with chronic hives, the unpredictability of outbreaks can be particularly challenging. It may affect work, social interactions, and overall well-being. Understanding the condition, its triggers, and effective management strategies is crucial in minimizing this impact.

Coping Strategies for Living with Chronic Hives

• Educate yourself about the condition
• Join support groups or online communities
• Practice stress-reduction techniques
• Maintain open communication with healthcare providers
• Explore potential lifestyle modifications

Emerging Research and Future Treatments for Hives

What does the future hold for hives treatment? Ongoing research is exploring new avenues for managing this condition. Some areas of focus include:

1. Biologics: Medications that target specific parts of the immune system
2. Immunotherapy: Training the immune system to be less reactive to triggers
3. Gut microbiome studies: Investigating the relationship between gut health and hives
4. Personalized medicine: Tailoring treatments based on individual genetic profiles

While these areas show promise, it’s important to note that research is ongoing, and new treatments may take time to become widely available.

The Role of Diet in Managing Hives

Can dietary changes help manage hives? While not a cure-all, some individuals find that certain dietary modifications can help reduce the frequency or severity of hive outbreaks. This may involve:

• Identifying and eliminating food allergens
• Reducing intake of histamine-rich foods
• Increasing consumption of anti-inflammatory foods
• Staying well-hydrated

It’s important to note that dietary changes should be made under the guidance of a healthcare professional to ensure nutritional needs are met.

Hives in Special Populations: Children and Pregnant Women

How do hives affect children and pregnant women differently? In children, hives are often acute and related to viral infections or food allergies. They can be particularly distressing for both the child and parents, but typically resolve quickly with appropriate management.

For pregnant women, hormonal changes can sometimes trigger hives or exacerbate existing chronic hives. While many treatments are safe during pregnancy, it’s crucial to consult with a healthcare provider before using any medications.

Managing Hives in Children

• Keep fingernails short to prevent scratching and skin damage
• Use cool, wet compresses to soothe itching
• Consider child-friendly antihistamine formulations
• Maintain a consistent skincare routine with gentle products

By understanding the nuances of hives in different populations, individuals can better manage this condition and improve their overall quality of life. Remember, while hives can be frustrating and uncomfortable, with proper care and management, most people can effectively control their symptoms and minimize the impact on their daily lives.

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.

types, causes, symptoms, signs, diagnosis, first aid, treatment

Classification

Causes and risk factors

Symptoms

Complications

Diagnosis

Treatment

Prevention teak

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.

According to the rate of development of the disease, the following degrees are distinguished:

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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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 blockers0318 2 receptors are not effective enough.