Urticaria: Symptoms, Causes, Diagnosis and Treatment

Urticaria, commonly known as hives, is a skin condition that affects a significant number of people worldwide. Characterised by red, itchy welts, urticaria can be a source of discomfort and distress. It can affect anyone, regardless of age or gender, and can significantly impact daily life.

Urticaria is a skin reaction that results in red, raised, itchy bumps. These bumps, or hives, can appear anywhere on the body and vary in size. They can be as small as a pencil eraser or as large as a dinner plate, and they often join together to form larger areas known as plaques.

Symptoms

The primary symptom of urticaria is the appearance of red or skin-coloured welts that are usually itchy. Other symptoms can include a burning or stinging sensation, swelling under the skin (known as angioedema), and in severe cases, difficulty breathing.

Causes

Urticaria is often a response to the body's release of histamine and other chemicals into the bloodstream. This can be triggered by a variety of factors, including allergies to food or medication, infections, insect bites, exposure to sunlight, stress, or even exercise. However, in many cases, the exact cause of urticaria is unknown.

"Urticaria is a common illness affecting up to 20% of people (one in 5 people) at some point in their lives." - British Association of Dermatologists

Impact and Complications

If left untreated, urticaria can lead to significant discomfort and can interfere with sleep and daily activities. In severe cases, swelling caused by urticaria can lead to life-threatening complications, such as difficulty breathing and anaphylaxis which requires immediate medical attention.

At risk groups

While urticaria can affect anyone, certain groups are more at risk. These include individuals with a history of allergies, those with existing autoimmune diseases, and individuals who have recently experienced a viral infection or illness.

Importance of Treatment

Treatment is crucial to manage the symptoms of urticaria and to prevent potential complications. It can also improve the quality of life for individuals living with this condition.

Diagnosis

The most important investigations for diagnosing urticaria (hives) typically include:
1. A thorough medical history and physical examination to identify possible triggers.
2. Allergy testing, such as skin prick tests or blood tests for specific IgE antibodies, to identify potential allergens.
3. Full blood count (FBC) to check for signs of infection or anaemia.
4. Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) tests to assess for inflammation.
5. Thyroid function tests and an autoimmune screen if an autoimmune cause is suspected.
6. Occasionally, a skin biopsy may be performed to rule out other conditions.

"The key to managing urticaria is understanding and avoiding triggers." - Mayo Clinic

Treatment Options

The recommended treatments for urticaria, in the order they are generally trialed, include:
1. Avoidance of known triggers.
2. Antihistamines, such as cetirizine, loratadine, or fexofenadine, to reduce itching and rash.
3. H2 blockers, like famotidine, may be used in combination with antihistamines.
4. Oral corticosteroids for short-term relief in severe cases.
5. Leukotriene receptor antagonists, such as montelukast, for chronic urticaria.
6. Immunosuppressants or biologic therapies, such as omalizumab for chronic or unresponsive cases.

Doctors and Specialists Likely To Be Involved In The Patient’s Care

• General Practitioner
• Allergist/Immunologist
• Dermatologist
• Gastroenterologist (if associated with food allergies or intolerances)
• Endocrinologist (if a thyroid disorder is suspected)

Related Conditions or Complications

Urticaria can be associated with other conditions, such as thyroid disease or lupus. It can also lead to complications like anaphylaxis, a severe allergic reaction that requires immediate medical attention.

Outlook and Prognosis

The prognosis for urticaria is generally good. Most cases of acute urticaria resolve within a few days or weeks. Chronic urticaria, which lasts longer than six weeks, can be more challenging to manage but is typically not life-threatening.

"Treatment for urticaria can help manage symptoms and prevent complications." - NHS

Practical Tips & Coping Strategies

• Keep a symptom diary to help identify potential triggers.
• Wear loose, light clothing to avoid irritating the skin.
• Try to manage stress, as it can exacerbate symptoms.
• Use over-the-counter antihistamines for allergic reactions.
• Consider urticaria natural remedies, such as applying a cool compress to affected areas.