Urticaria (hives) is a skin disease characterized by itchy and red bumps located in various parts of the body. About 20% of people experience an attack of urticaria at least once in their lifetime.
Cases that last less than six weeks are called acute, and those that last longer than six weeks are called chronic spontaneous urticaria. Acute urticaria is usually seen in young people, while chronic urticaria is more common in middle-aged women. The disease has subtypes such as solar urticaria (due to sunlight), aquagenic urticaria (due to water), pressure urticaria, and cold urticaria triggered by physical factors.
CAUSES OF URTICARE
Urticaria occurs as a result of the release of a substance called histamine from mast cells. This can be triggered by some drugs, foods, infections, insect bites, exercise, pressure on the skin, and stress. In most of the patients, the cause of urticaria cannot be found.
Urticaria lesions are raised, itchy, reddened and disappearing plaques from the skin that appear anywhere on the body. The size of the lesions can vary from 1-2 mm to 5-10 cm. The plaques may merge with each other and have a large, irregular appearance. Lesions usually disappear without a trace within 24-48 hours.
Later, new lesions may occur in different places. Sometimes, swelling of the eyelids, lips and tongue, called angioedema, may accompany urticaria lesions.
DIAGNOSIS OF URTICARE
The diagnosis of urticaria is made based on the patient’s history and the physician’s physical examination findings. There is no specific laboratory test to identify the disease. If necessary, tests for triggering factors can be performed.
In the treatment of urticaria, if agents that trigger the disease have been identified, they should be avoided. Especially painkillers, cold medicines, antibiotics, alcohol, tight clothing, extreme heat or cold are the main triggers. In cases where acute urticaria is accompanied by angioedema, if there are symptoms such as tongue-throat swelling and shortness of breath, a healthcare provider should be consulted urgently, despite the possibility of anaphylactic shock.
Antihistamines: The first treatment option in urticaria cases is the use of antihistamine drugs. It is usually used as a single daily dose. In cases where adequate response is not achieved with a single dose, the dose of the drug can be increased by the doctor, the current drug can be replaced with another antihistamine or used together. Antihistamines are divided into first generation and second generation. First generation antihistamines cause drowsiness. While second generation drugs are generally preferred in treatment; First generation drugs are preferred in cases where the disease causes sleep disturbance or is triggered by stress.
Systemic Corticosteroids: They are used for a short time to suppress the exacerbation period in cases where there is no response to antihistamines or when the disease is severe. As the disease improves, the dose of the drug is reduced and discontinued by the doctor. In long-term use, it can cause side effects such as high blood sugar, high blood pressure, high eye pressure, cataracts.
Cyclosporine: It is a drug that can be preferred in patients who do not respond to antihistamines. Due to its side effects, blood tests and blood pressure measurements should be performed at regular intervals.
Omalizumab : This drug, which has recently been used in the treatment of urticaria, is a good option for patients with chronic urticaria who do not respond to high-dose antihistamines. Basically, reports are written in the Dermatology Departments of the Faculty hospitals. It is used in the form of monthly injections. Depending on the patient’s needs, antihistamines can also be used together. No serious side effects have been identified so far.
Other Treatments:Drugs such as dapsone, leukotriene receptor antagonists, sulfasalazine, intravenous immunoglobulin and treatment methods such as phototherapy and plasmapheresis can be used in resistant patients.
PROGRESS OF URTICARE
If the factor causing urticaria is determined and exposure is prevented, urticaria attacks can be prevented. However, in chronic urticaria, the cause is often unclear and these cases are considered idiopathic. Chronic spontaneous urticaria can persist for a long time, so regular treatment is required to suppress the disease.