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The urticaria is a type of skin lesion appears with edema (swelling) of the dermis, resulting in vasodilation and increased permeability of blood vessels and is manifested as a wheal (skin lifting, as in bites of insects), erythema (redness), pain in rare cases and itching (itching or stinging), which can interrupt sleep, rest and daily activities of the individual, affecting the quality of life.

Epidemiology

The urticarial affects approximately 1% of the population, chronically, with twice as many cases in proportion to the woman being more prevalent in productive ages (30 to 60 years).

Despite having a low prevalence, urticaria can significantly and negatively undermine the health and mood of the patient, due to its various psychosocial effects such as anxiety, depression and misunderstanding; originated by the lack of diagnosis and timely effective treatment.

Classification

The urticaria is classified as acute or chronic. Its acute form is very frequent and can be suffered by anyone, with episodes that are usually of short duration (hours to a few days). Chronic is defined by recurrent episodes (4 to 5 times a week), of erythematous (reddish), hilly, pruritic (itchy) lesions, lasting at least 6 weeks or longer, even lasting years in some cases.

In a significant number of cases, they may also present angioedema (inflammation of the mucosa, such as the respiratory system), which in a smaller group constitutes the only manifestation. The hives (acute and chronic) can be categorized as time of onset and spontaneous or induced that can be generated by physical means such as cold, heat, compression, vibration, sunlight or contact (latex), food ( nuts, fish and crustaceans, among others), chemical substances (formaldehyde, cosmetics, etc.).

Evolution of urticaria

The urticaria chronic spontaneous onset begins one day without knowing well its origin and then continues, being related to autoimmune diseases with factors that can worsen, such as fever or stress. If we compare the acute one with the chronic spontaneous one, the clinical manifestation will be identical, but the cause and the development are totally different.

Causes of hives

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It is important to know that the cause that produces it is not yet fully known, since it is not known until now how it starts, or why it starts, and most strikingly, why, at a certain moment, it stops in the same way it started.

Some specialists, trying to determine the etiological origin of urticaria, break it down into non-immunological and immunological. The first occurs with various causes that could be physical agents such as medications (penicillin, aspirin, NSAIDs, antidepressants, anti-hypertensives, etc.) or it could also be produced by foods or components of these, such as dyes, egg white, shellfish, etc.

The immune system, on the other hand, is mediated by immunoglobulins (Ig E) that bind to the mast cell (a type of white blood cell that acts in inflammatory reactions), inducing its degranulation and release of histamine, which turns out to be a powerful mediator of the secondary pro-inflammatory response to immediate and allergic hypersensitivity reactions.

The causes that can generate this type of immune response are multiple: by food, by infections (either viruses, bacteria or parasites); due to insect bites and, most importantly, in the case of autoimmune urticaria , which represents 30 to 50% of chronic urticaria, which can be associated with other autoimmune diseases, requiring specific tests for diagnosis in specialized centers.

The urticaria autoimmune may occur in association with other autoimmune diseases and secondary to this, as in the case of type 1 diabetes, Hashimoto’s thyroiditis or disease, celiac disease, systemic lupus erythematosus, vasculitis, etc., or by the presence autoantibodies.

Prevention

After defining the diagnosis, the way to treat this pathology initially consists of general measures such as avoiding the triggering factor, whenever it has been determined(allergen, physical factor, etc.), as well as avoiding aggravating factors or triggers of urticaria, such as medications, alcohol, cigarettes, stress, etc., to continue treating the underlying disease, in the event that the urticaria has a secondary nature, for example, thyroiditis.

Treatment

Pharmacological treatment will consist, in the first line, with anti allergic drugs, which constitute the basis of symptomatic treatment in most patients. Other options, oral or intravenous steroids may be necessary in difficult-to-manage patients and, when urticaria is of autoimmune origin, it may be necessary to complement it with more complex treatments indicated by the internist or rheumatologist.

 

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