Acute urticaria

Acute urticaria: Description, Causes and Risk FactorsAlternative Name: Febrile urticaria, angioedema.Acute urticaria is defined as the presence of momentary wheals, which mostly resolve within 6 weeks. If they remain for a longer period, it is chronic urticaria. It is believed that 15-20% of the population suffers acute urticaria at some point in their lives.Acute urticaria is a common condition, caused by multiple factors:
  • Food allergies such as allergies to nuts, strawberries, citrus fruit, egg, food additives, spices, chocolate, or shellfish. Sometimes you can develop an allergy to a food even if you have eaten it without any problem many times before.
  • Allergies to insect bites and stings.
  • Allergies to medicines such as penicillin, aspirin, anti-inflammatory painkillers, etc.
  • Viral infection such as a cold or 'flu can trigger an urticarial rash in some people. A mild viral infection which causes few other symptoms is probably a common trigger of an urticarial rash that develops without an apparent cause.
  • Skin contact with 'sensitizers' causes a local area of urticaria in some people. For example, chemicals, latex, cosmetics, plants, ointments, nettle stings, etc.
  • Physical urticaria. This is when a localized rash appears when the skin is physically stimulated. The most common is called dermographism when a rash develops over areas of skin, which are firmly stroked. Sometimes an urticarial rash is caused by heat, cold, emotion, exercise, or strong sunlight. See separate leaflet called 'Physical Urticaria'.
The rash usually appears suddenly and can affect any area of skin. Small raised areas called weals develop on the skin. The weals look like mild blisters and they are itchy. Each weal is white or red and is usually surrounded by a small red area of skin which is called a flare. The 'weal and flare' rash of urticaria looks similar to the rash caused by a nettle sting.The weals are commonly 1-2 cm across but can vary in size. There may be just a few but sometimes many develop over various parts of the body, sometimes weals that are next to each other join together to form larger ones. The weals can be any shape but are often circular.As a weal fades, the surrounding flare remains for a while. This makes the affected area of skin look blotchy and red. The blotches then fade gradually and the skin returns to normal.Each weal usually lasts less than 24 hours. However, as some fade away, others may appear. It can then seem as if the rash is moving around the body. The rash may appear quite dramatic if many areas of skin are suddenly affected.Symptoms:
  • Most people with acute urticaria do not feel 'ill', but the appearance of the rash and the itch can be troublesome.
  • In some cases a condition called angioedema develops at the same time as urticaria. In this condition some fluid also leaks into deeper tissues under the skin which causes the tissues to swell.
  • The swelling of angioedema can occur anywhere in the body but most commonly affects the eyelids, lips and genitals.
  • Sometimes the tongue and throat are affected and become swollen. The swelling sometimes becomes bad enough to cause difficulty breathing.
  • Symptoms of angioedema tend to last longer than urticarial weals. It may take up to three days for the swollen areas to subside and go.
  • A variation called 'vasculitic urticaria' occurs in a small number of cases. In this condition the weals last more than 24 hours, they are often painful, may become dark red, and may leave a red pigmented mark on the skin when the weal goes.Acute urticaria
Diagnosis:A GP can easily diagnose acute urticaria by examining the rash on the skin. The doctor will attempt to find out what the trigger was, as this may help the patient prevent recurrences.The specific evaluation of a patient presenting with acute urticaria and/or angioedema should focus on the findings suggested by the clinical history and physical examination. Patients with a specific food, drug or insect hypersensitivity should be evaluated with appropriate diagnostic tests. For instance, a patient presenting with acute urticaria in temporal relationship to a specific food, insect sting/bite or drug may warrant in vivo or in vitro assessment of specific IgE (if available) to that particular allergen in a controlled setting where the expertise and equipment needed to treat an anaphylactic reaction are available. If acute mononucleosis is suspected, appropriate tests for Epstein-Barr virus (eg, Monospot™) could be confirmatory. The association of other infections with acute urticaria has not been sufficiently documented to recommend specific diagnostic tests. A patient presenting with recurrent episodes of acute angioedema of the face, tongue or lips, in association with bouts of severe abdominal discomfort without associated urticaria should be evaluated with specific complement studies to exclude hereditary or acquired C1 esterase inhibitor deficiency. Acute urticaria in association with the administration of penicillin or a related beta-lactam ?-Lactamantibiotic may warrant diagnostic evaluation with penicillin skin testing. Allergen skin testing and/or in vitro tests for detection of specific IgE antibody to inhalants (eg, animal danders, pollens, molds, etc) may be useful when the history reveals that urticaria/angioedema occurs after direct contact with a suspected allergen such as direct contact with animals, weeds, and grass. Physical findings of weight loss, lymphadenopathy, and visceromegaly would warrant a further medical evaluation to exclude an underlying lymphoreticular malignancy.If the urticaria continues for more than six weeks the likelihood of there being some external trigger factor. If the physician suspects any underlying causes for the chronic urticaria then he/she may order the following tests:
  • A blood test to find out whether the patient is suffering from anemia.
  • A stool sample to check for parasites.
  • ESR (erythrocyte sedimentation rate) test - this can identify problems with the patient's immune system.
  • Thyroid function test - this identifies either hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).
  • Liver function tests - these can identify whether the patient has any liver problems.
Treatment:
  • If a trigger can be identified, avoidance is the most effective form of management. This would include any food, medication, physical agent, or other factor that triggers the urticaria
  • A cool bath or shower may ease the itch.
  • Antihistamine tablets can ease symptoms. Antihistamines block the action of histamine which is involved in causing urticaria. You can get antihistamines on prescription.
  • A short course of steroid tablets is sometimes prescribed in severe cases to help reduce swelling in the skin.
Home Remedies: Haridra or haldi has long been recognized as the best remedy for urticaria. Regular use of it can prevent attacks of urticaria. A paste made of haridra ground with a little water, may be given to the patient in two teaspoonful doses thrice a day. If the patient finds it unpalatable, it may be mixed with milk and sugar. he affected parts should be rubbed with mustard oil with which powdered rock salt has been mixed. The body should then be exposed to the sun and rubbed with a piece of copper.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care. 

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