Urticaria

Author: Orsolya Toth MD

What is urticaria?

It is a very common dermatological disease, it develops at least once in almost one quarter of the population in the course of their life. In lucky cases, only when coming directly in contact with the plant from which one of its names is derived, since the symptoms resemble a nettle-sting. Its course is fluctuating, and the majority of cases heal spontaneously. It is twice as common in women. It severely reduces quality of life, and can have an impact on performance at work or school.

What are the symptoms of urticaria?

Severely itching, differently sized red nettle spots that very much resemble mosquito bites and stand out from the level of the skin can appear on the entire surface of the body. One of their characteristics is that they develop quickly, in a few minutes, and they change their location, come and go between the areas of the body. Usually they recede within 24 hours without any trace, but some types can even remain beyond 24 hours.  The symptoms are most prevalent on areas affected by pressure, and near the curves. A side effect of urticaria can be edema of the lips, eyelids and tongue, which is called angioneurotic edema.
 
According to the longevity of the presence of symptoms, we differentiate between acute and chronic urticaria. While acute urticaria has mainly dermatological significance, in lingering cases it is necessary to rule out systemic diseases and those of the internal organs.

What might be the reasons behind urticaria?

The nettle spot is the edema of the middle layer of the skin, which is the consequence of the increased permeability of the skin vessels. A matter named histamine plays a part in their development, which is freed from the mast cells, a process which can be triggered by various impulses. 
It is most often caused by an acute viral or bacterial infection, or perhaps an endoparasite, however, physical impulses that come into contact with the skin can also be in the background (scrubbing, pressing, cold, heat, sunshine).
 
If it lasts longer than 6 weeks, chronic plexus infection (e.g. a bad root canal treatment, chronic tonsil inflammation, chronic gynecological infection), autoimmune reaction, or pseudo-allergic reaction (medication, food) can be in the background.

How is urticaria diagnosed?

Urticaria itself is easy to diagnose based on the symptoms, and their changing location is also telling. To identify the cause(s), it is necessary to compile a detailed medical history, which needs to include the beginning of the disease, its chronological course, frequency, accompanying subjective symptoms, the presence of any disease or inflammation, implants, medications, and also emotional impulses. In many cases, the reason behind urticaria remains unidentified, it can happen that it is caused simply by stress or other psychological factors.

What kinds of examinations might be necessary in case of chronic urticaria?

Urticaria needs to be examined if it lasts for more than 6 weeks, by which time it is considered chronic. In this case, laboratory examination is very important (sedimentation rate, inflammatory parameters). If the results confirm an inflammation, then it is necessary to initiate the identification of the plexus by ruling out tooth ulcer, sinusitis, gall-bladder inflammation, gynecological infection, Helicobacter pylori stomach infection, and thyroid function and anti-thyroid antibodies also need to be examined.

How do we treat urticaria?

In most cases, it subsides within 24 hours, thus in mild instances, its treatment is not necessary.
 
If the cause is identified, then the targeted removal of that factor is the key of therapy (discontinuing taking a medication, treating an inflammation). In the meantime, for treating the symptoms, the first choice are the new generation antihistamines, that do not cause drowsiness. As a supplement, we often employ the mediator-free diet, during which it is not allowed to eat fresh vegetables, fruits, smoked meats, fish and offals.