Urticaria: The Itchy Reality You Never Knew About!
What is Urticaria?[1]
"My hands are currently swollen and covered in raised bumps, making it difficult for me to close them completely”
"I couldn’t sleep at night, my whole body was so itchy.”
"Why are there raised bumps on my hands?”
Have you ever been in a similar situation? Well, If you have been experiencing sudden itching, raised welts or bumps on your skin, it is possible that you may have been dealing with a condition called Urticaria?
Urticaria, also known as hives, is a skin condition characterised by the development of itchy raised areas called wheals. These wheals are typically pale or skin-coloured and are surrounded by redness or inflammation known as erythematous flares.
Approximately 15% to 23% of adults have experienced at some degree in their lifetime of acute urticaria. Are you one of them? The discomfort and itch from any episode of urticaria is undoubtedly unforgettable! There is nothing to feel embarrassed about as it happens to little kids up to older adults.
Not known to many, the name ‘urticaria’ is derived from the European stinging nettle plant, Urtica dioica due to its resemblance of skin reactions to the stings of this plant.
Urticaria can take different forms, including acute or chronic cases, as well as spontaneous or inducible occurrences. Weals, the defining feature of urticaria, are superficial swellings that appear on the skin. They can vary in size and shape and last from a few minutes to up to 24 hours. Along with the itching sensation, the skin around the weal may appear red or inflamed.
Urticaria
Image credit: Freepik
Signs and symptoms of urticaria
The skin of the entire body or a part of the body may be affected by wheals. These wheals range in size from tiny pinpoint-like bumps to large plate-sized ones. They exhibit a dynamic nature, as they can change shape, shift locations, merge together, fade away, and reappear within short time intervals.[2]
These are typical characteristics of urticaria (wheals): [2]
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Raised, red, welt-like bumps
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Well-defined borders
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Itching (can be intense and often worse at night)
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Burning or stinging
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Blanch (whiten) when pressed
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When resolve, they leave no scarring or tissue damage
In general, they do not come with accompanying symptoms such as fever, nausea, muscle aches, joint pain, or headaches, unless there is an underlying infection involved.[2] Also, hives tend to appear more frequently in the evening or early morning, often right after waking up.
Causes of urticaria[2]
Primarily, urticaria is caused by allergies and infections but it can also be triggered by factors like stress, vibration, or sudden environmental changes. This condition occurs when there is an abnormal immune response that leads to the leakage of fluid from blood vessels into the middle layer of the skin, known as the dermis. This results in the formation of raised, red, welt-like bumps, which are the characteristic hives.
Acute VS chronic urticaria?
Generally, there are two types of urticaria, namely acute and chronic urticaria. Acute urticaria refers to episodes that persist for less than six weeks and typically resolve within hours to a few days and it is more frequently observed in children and young adults. The majority of cases of acute urticaria are considered idiopathic, meaning that the exact cause is unknown. In some instances where a cause is identified, it is commonly attributed to factors such as infections, insect bites, or allergic reactions to medications or foods.[3]
[4]
Chronic urticaria, on the other hand, lasts for more than six weeks and is characterised by the presence of daily or episodic weals and often lacks a known cause and can recur intermittently for months or even years. Chronic urticaria can further be classified into two types: spontaneous and inducible. Spontaneous chronic urticaria occurs without any identifiable trigger, while inducible chronic urticaria is provoked by specific stimuli such as pressure, temperature, or exercise.[5]
However, it is important to note that both types of chronic urticaria can coexist, meaning a person may experience symptoms from both spontaneous and inducible triggers simultaneously.
How is Urticaria diagnosed?[1]
The diagnosis of urticaria involves evaluating individuals with a history of wheals that persist for less than 24 hours, with or without angioedema (swelling beneath the skin). It is important to gather information about medication use and family history. A comprehensive physical examination should also be conducted.
The most important step in diagnosing urticaria would be history taking, and then a physical examination of the patient. Documentation or photographing of your skin changes would be extremely helpful in your diagnosis. Comprehensive physical examination may or may not be required in cases of acute urticaria as long as potential triggers are identified.
In chronic urticaria in which autoinflammatory diseases are suspected, a comprehensive physical examination could be conducted as below;
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Skin prick tests or blood tests like radioallergosorbent tests (RAST) or CAP fluoroimmunoassay may be requested (In cases of acute urticaria where a drug, latex, or food allergy is suspected)
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Complete blood count (CBC) and C-reactive protein (CRP) (For chronic spontaneous urticaria, there are no routine diagnostic tests and further investigations may be conducted if an underlying disorder is suspected)
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Autologous serum skin test (In some instances of chronic spontaneous urticaria. A positive result is indicated when injecting the patient's serum under the skin leads to the development of a red weal)
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Scratching the skin for dermographism or applying an ice cube for suspected cold urticaria (For Inducible urticaria)
Additionally, in some cases where there is fever, joint or bone pain, and malaise in urticaria patients, investigations for a systemic condition or autoinflammatory disease should be considered. Individuals experiencing angioedema without weals should be asked about their use of ACE inhibitor drugs and tested for complement C4 levels, C1-INH levels, function, and antibodies, as well as C1q levels.
Biopsy of urticaria may not yield specific results. Pathological examination typically shows edema in the dermis, dilated blood vessels, and a varied mixed inflammatory infiltrate. Evidence of vessel-wall damage indicates the presence of urticarial vasculitis.
Want to know more about urticaria from DOC2US? Stay tuned for our next articles where we debunk myths related to urticaria and dive deeper into its management!
A WORD FROM DOC2US
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REFERENCE
1. Urticaria – an overview | DermNet NZ [Internet]. dermnetnz.org. Available from: https://dermnetnz.org/topics/urticaria-an-overview
2. Kanani A, Schellenberg R, Warrington R. Urticaria and angioedema. Allergy Asthma Clin Immunol [Internet]. 2011 7(S1):S9. Available from: http://dx.doi.org/10.1186/1710-1492-7-s1-s9
3. Fine LM, Bernstein JA. Guideline of chronic urticaria beyond. Allergy Asthma Immunol Res. 2016;8(5):396-403. doi:10.4168/aair.2016.8.5.396
4. Zuberbier T et al. Allergy 2014;69(7):868–887
5. Boyden SE, Desai A, Cruse G, et al. Vibratory urticaria associated with a missense variant in ADGRE2. N Engl J Med. 2016;374(7):656-63. doi:10.1056/NEJMoa1500611
