Urticaria

Definition

Urticaria is also known as hives. It is a temporary swelling of the skin, caused by a localised collection of fluid in the dermis due to leakage from blood vessels. It can result from any of the following: Allergy to foods, pollens and drugs. Change in the temperature. Infections, including the presence of worms. Emotional upsets.

Urticaria (hives) is classified into two categories according to fact how long it has been present.

• Acute urticaria is of recent onset.
• Chronic urticaria has persisted for several months or years.

Symptoms of Hives

• On areas like lips, eyelid and groins, edematous swellings may erupt because of the looseness of subcutaneous tissue where a large amount of fluid can accumulate.
• Weals are often accompanied by itching, pale or pink, edematous, raised lesions resembling those caused by the sting of a nettle.
• Urticaria (or hives) is an eruption of weals.
• Urticaria is a reaction pattern of the skin which can be caused by a number of factors.
• They last for a short time of a few hours only, but reappear at the same or different sites.

Causes of Hives

Causes of urticaria or hives are as follows:

1. Physical factors like cold, heat, exertion, ultraviolet radiation and pressure can cause hives in sensitive individuals.
2. Psychological stress resulting from sex problems and problems regarding employment, family and finances have been known to cause hives in some persons.
3. Allergic hives is the commonest allergy condition of the skin. Substances which cause allergic hives enter the body by inhalation or injections. Drugs like penicillin, sulphonamides, aspirin, tetracyclines and even B complex vitamins are among the commonest causes of hives. Aspirin can also cause hives by non-allergic means. Many foods like fish, pork, eggs, mushroom, milk, wheat, rice and pulses, etc., can also cause hives. Pollens, dust, horse dander, etc., can be inhaled and cause hives, though more frequently they are a cause of naso-respiratory allergy. Vaccines and anti-toxin injections can also cause hives. Some parasitic infections of the intestines and the stings of mosquitoes, wasps and bees can also cause widespread allergic urticaria. At times a focus of infection in the throat, sinuses, ears, teeth or kidney may be the cause of urticaria.

All cases of urticaria, while observing the history of hives, it has been observed especially with regard to drug intake, relationship of urticaria with ingestion of any particular food or any of the physical factors mentioned above. A psychological assessment of the patient is also made. A physical examination is important to exclude or confirm the presence of a focus of infection or some other underlying disease. Microscopic stool examination is done to detect any intestinal worm infestation. The prick and intradermal tests on the skin, used for identification of allergy in asthma, are generally unless in urticaria.

Treatment of Hives

• All these drugs cause varying degrees of drowsiness, hence driving, operating machines and other jobs which require mental alertness should be avoided while undergoing treatment.
• Urticaria, if not responsive to oral antihistamines, may have to be treated with injections of adrenaline or steroids especially for patients 'complaining of a choking sensation in the throat which occurs due to swelling in the respiratory passage.
• Suppressive treatment of urticaria is carried out by administering antihistaminic drugs like Chloropheneramine (Avil) triprolidine hydrochloride, Actidil and Cyproheptadine hydrochloride (Periactin). The dose and the frequency should be adjusted to give adequate coverage for 24 hours.