Urticaria : What Is It ? Causes, Management and Advice For Patient
Causes
● Idiopathic, food (e.g. nuts, sesame seeds, shellfish, dairy products), drugs (e.g. penicillin, contrast media, non-steroidal anti-inflammatory drugs (NSAIDs), morphine, angiotensin-converting enzyme inhibitors (ACE-i)), insect bites, contact (e.g. latex), viral or parasitic infections, autoimmune, and hereditary (in some cases of angioedema)
Description
● Urticaria is due to a local increase in permeability of capillaries and small venules. A large number of inflammatory mediators (including prostaglandins, leukotrienes, and chemotactic factors) play a role but histamine derived from skin mast cells appears to be the major mediator. Local mediator release from mast cells can be induced by immunological or non-immunological mechanisms.
Presentation
● Urticaria (swelling involving the superficial dermis, raising the epidermis): itchy wheals
● Angioedema (deeper swelling involving the dermis and subcutaneous tissues): swelling of tongue and lips
● Anaphylaxis (also known as anaphylactic shock): bronchospasm, facial and laryngeal oedema, hypotension; can present initially with urticaria and angioedema
Management
● Antihistamines for urticaria
● Corticosteroids for severe acute urticaria and angioedema
● Adrenaline, corticosteroids and antihistamines for anaphylaxis
Complications
● Urticaria is normally uncomplicated
● Angioedema and anaphylaxis can lead to asphyxia, cardiac arrest and death
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