URTICARIA

Urticaria also known as hives are red, itchy skin rashes that are sometimes caused by an allergen. Normally, when you witness an allergic reaction, the body releases a protein called histamine. When histamine is released, the tiny blood vessels tend to leak fluid. The fluid accumulates and causes skin rashes. Hives is not contagious in nature. Some of the known triggers of urticaria include consumption of antibiotics and anti-inflammatory drugs, bacterial infection, intestinal parasites, high body temperature etc.

Urticaria - Clinical Presentation

Pink to erythematous urticarial wheals that come and go within 24 hours. Angioedema involves deeper dermis and subcutaneous tissues and may lead to anaphylaxis.

Causes of Urticaria:

1. Infection

• Bacterial (Cholecystitis, Cystitis, Dental Abscess, Helicobacter Pylori)
• Fungal (Tinea, Candida)
• Others (Scabies, Helminth, Protozoa, Trichomonas, Syphilis)

2. Drugs & Chemicals (Salicylates, NSAIDS, Opiates, Radiocontrast Material, Douches, Ear drop or Eye drops)

3. Food (Nuts, Berries, Fish, Seafood, Bananas, Grapes, Tomatoes, Eggs, Cheese)

4. Inhalants (Animal dander, Pollen)

5. Systemic Disease (Rheumatic Fever, Juvenile Rheumatoid Arthritis, Leukemia)

6. Endocrinopathies (Thyroid disease, Diabetes Mellitus, Pregnancy, Menstruation, Menopause)

7. Physical Stimuli (Light, Pressure, Heat, Cold, Water, Vibration)

8. Contactants (Wool, Silk, Occupational Exposures, Potatoes, Antibiotics, Cosmetics)

9. Familial Disorder (Hereditary Angioedema, Muckle-well Syndrome)

TYPES:

A. Physical Urticarias:

Due to mechanical stimuli - Sites of friction (collars, cuffs of clothes), after scratching

•  Delayed pressure urticarial - deep erythematous swellings at sites of sustained pressure to the skin (elastic of socks, under bra, in genital area after intercourse), after a delay of 30 min to12 h. Usually painful , pruritic, or both. Patient may get systemic features.

B. Urticaria due to Temperature Changes:

• Heat and stress exposure – Usually occurs within 15 minutes of sweat, induced stimuli such as moving from hot to cold room, drinking alcohol, spicy foods in hot weather etc.
• Exercise-induced urticarial or anaphylaxis – It is produced by exercise.
• Adrenergic urticarial - Presence of blanched skin surrounding pink wheals induced by sudden stress.
• Localized heat contact urticarial - It is very rare. Lesions develop within minutes of coming into contact with any heat source. Systemic symptoms may occur.
• Primary cold contact urticaria - May follow respiratory infection, bites/stings, HIV. It is seen commonly in young adults. Itching, burning, and whealing can be experienced in cold-exposed areas minutes after rewarming the skin. May occur after contact with cold object such as ice cubes. Mean duration is 6-9 years.
• Secondary cold contact urticarial - Extremely rare! Due to serum abnormalities such as cryoglobulins or cryofibrinogenemia, hepatitis B or C, mononucleosis or lymphoproliferative disease.
• Reflex cold urticaria - Generalized cooling induces widespread whealing. Affected person can experience life-threatening reactions by diving into a cold lake.
• Familial cold urticarial -Muckle-Wells, burning, itching plaques etc. that can last for up to 48 hrs.

C. Urticaria due to other exposures:

• Solar urticarial - Itching and whealing with UV exposure. Wheals last for less than an hour but can cause headache, syncope.
• Aquagenic urticarial - Contact with water of any temperature induces lesions.
• Uriticarial vasculitis - Lesions may leave behind bruising because of vessel damage and may last longer than 24 hours. Lesions are painful and pruritic.

If you wish to go for urticaria treatment in Chandigarh, then you can take the first step forward with the following lab investigations: CBC, renal function, LFTs, thyroid function, iron, B12, folate, ANA, dsdna, rheumatoid factor, ESR, C3, C4. You can then consult urticaria specialist in Chandigarh for choosing the best urticaria skin disease treatment for you.

Treatments for Urticaria in Chandigarh:

• Antihistamines
• Leukotriene Receptor Antagonists
• Mast Cell Stabilizers
• Biologics