It is a disease characterized by red and edematous swellings or plaques. It can occur against many different stimuli. The most important feature is that the lesions appear suddenly and disappear suddenly. It is popularly known as “hives”. About 20% of the individuals in the community experience at least one attack of urticaria (hives) in their lifetime.
It is examined in two groups as acute and chronic. If the lesions persist for more than six weeks, it is called chronic urticaria. While it is easier to find the etiologic agent in acute urticaria, the cause cannot be determined in three-quarters of chronic urticaria cases. Chronic urticaria is often seen in middle-aged women.
Classification:
I. Immunological urticaria
bound to Ig E
atopy
Other
? Specific antigen susceptibility
? physical urticaria
? contact urticaria
? cholinergic urticaria
B. Not bound to IgE
Due to cytotoxic reactions
Due to immune complex formation
dependent on complement
II. Non-immunological urticaria
Due to urticariogenic agents
Those that directly affect the mast cell
Those that affect arachidonic acid metabolism
B. Physical urticaria
C. Contact urticaria
D. Cholinergic urticaria
E. Complement-related urticaria
III. Secondary urticaria
IV. idiopathic urticaria
Urticaria due to IgE is mostly seen in acute form and with a personal / familial history of allergic constitution. Ig E type antibodies can be shown in the cases. Only 3-4% of chronic urticarias occur by this mechanism.
10-20% of urticaria occurs with physical stimuli.
physical urticaria:
? Pressure urticaria: Occurs in areas exposed to pressure
? Dermographic urticaria: It occurs in a linear style in pressure places such as belts.
? Cold urticaria: It can be familial or acquired. Secondarily, it can be seen in infectious diseases such as dysglobulinemia, collagen-vascular diseases, leukemia, liver diseases, malignancies and infectious mononucleosis.
? Solar urticaria: It develops due to visible light and UV rays.
? Aquagenic urticaria: Rare. Urticaria lesions appear about 30 minutes after contact with water.
Urticariogenic agents can produce urticaria without a specific antibody. Drugs, plants, insects, jellyfish cause histamine release directly from mast cells. Aspirin and non-steroidal anti-inflammatories affect arachidonic acid metabolism. In this way, direct urticaria may occur.
Etiological and provocative factors in urticaria:
Medicines:codeine, cocaine, morphine, radiocontrast agents
Foods:Fish, chocolate, eggs, milk, cheese, strawberries, bananas, grapes, tomatoes, nuts, spices, coffee, tea, wine.
Additives:Tartrazine, azo dyes, benzoate, sulfites.
Infections:Viral, bacterial, fungal, parasitic.
Gastrointestinal system diseases:gastritis, enteritis, colitis, achlorhydria, constipation, pancreatic diseases.
Respiratory allergens:pollen, animal dander, dust mite
Systemic diseases:SLE, RA, dermatomyositis, lymphoma, leukemia, renal diseases
– Endocrine disorders:Hyper / hypothyroidism, menstruation, pregnancy, diabetes mellitus.
– Skin diseases:Pemphigoid, amyloidosis, DH, id reactions
psychogenic factorsis .
Treatment :
Avoidance of trigger factors (alcohol, aspirin)
H1 antihistamines (one or, if not enough, two antihistamines from different groups)
Combination of H1 and H2 receptor blockers
Beta adrenergic agents (ephedrine, adrenaline)
tranquilizers
corticosteroids
Mast cell stabilizers (ketotifen, sodium cromoglycate)
– Danazol in hereditary angioedema
– Elimination if the cause can be found (skin tests may be applied)
– In urticarial vasculitis: – H1 antihistamines (H2 if necessary)
H1 blocker + NSAID
Colchicine (0.6mgx2)
Dapsone (50-200mg)
Hydroxychloroquine (200-400mg)
systemic corticosteroid
exp. Dr. Nezih KARACA
