urticaria

Urticaria (Hives) – Overview

Urticaria, commonly known as hives, is a skin condition characterized by the sudden appearance of itchy, red or skin-colored welts (also called wheals) on the skin. These welts can vary in size and shape and may appear anywhere on the body.

Causes of Urticaria

Urticaria can be triggered by a wide range of factors. These include:

• Allergic reactions to:
• • Foods (e.g., nuts, shellfish, eggs)
  • Medications (e.g., antibiotics, NSAIDs)
  • Insect stings or bites
• Physical triggers:
• • Pressure
  • Cold
  • Heat
  • Sunlight
  • Vibration
• Infections (viral, bacterial, or parasitic)
• Stress or anxiety
• Autoimmune disorders
• In some cases, the cause remains idiopathic (unknown).

Types of Urticaria

1. Acute Urticaria
2. • Lasts less than 6 weeks
   • Often linked to allergic triggers or infections
2. Chronic Urticaria
3. • Persists for more than 6 weeks
   • May be spontaneous or induced by specific triggers
3. Physical Urticaria
4. • Triggered by physical stimuli (e.g., heat, cold, pressure)
4. Chronic Spontaneous Urticaria (CSU)
5. • No identifiable trigger
   • Often associated with autoimmune factors

Symptoms

• Itchy welts or hives
• Red or skin-colored raised bumps
• Swelling (angioedema), especially around eyes, lips, hands, or feet
• Welts that change shape, size, and location
• Burning or stinging sensation

Diagnosis

Diagnosis is usually based on clinical history and physical examination. Additional tests may include:

• Allergy testing
• Blood tests
• Skin biopsy (rarely)

Treatment Options

Treatment depends on the severity and cause:

First-line Treatment:

• Antihistamines (e.g., cetirizine, loratadine)

Second-line or adjunct treatments:

• Corticosteroids (short-term use)
• Leukotriene receptor antagonists
• Omalizumab (for chronic spontaneous urticaria)
• Avoidance of known triggers

Prognosis

• Acute urticaria usually resolves within a few days to weeks.
• Chronic urticaria may last months or years, but many cases eventually improve or resolve.

🚩 Red Flag Symptoms in Urticaria (Need Referral or Emergency Care)

⚠ Urgent Referral or Emergency Care (Possible anaphylaxis or airway compromise):

1. Angioedema involving the lips, tongue, or airway
2. • Swelling that threatens breathing or swallowing
2. Signs of anaphylaxis (systemic allergic reaction):
3. • Difficulty breathing or wheezing
   • Hypotension or dizziness/syncope
   • Tachycardia
   • Nausea, vomiting, or abdominal pain
   • Generalized flushing or warmth with respiratory/GI/cardiovascular symptoms
3. Persistent or worsening urticaria despite high-dose antihistamines
4. Recurrent urticaria with systemic symptoms, such as:
5. • Fever
   • Arthralgia or arthritis
   • Malaise or fatigue
   • Weight loss

✅ Key Points to Remember

• Urticaria is not contagious.
• It often resolves on its own or with medication.
• Identifying and avoiding triggers is key to management.
• Chronic forms may require long-term therapy.
• MCQ 1:

:

Which of the following is the most common symptom of urticaria?

○ A. Blisters

○ B. Non-itchy nodules

○ C. Itchy, raised wheals

○ D. Bruising

MCQ 2:

Urticaria persisting for more than 6 weeks is classified as:

○ A. Acute urticaria

○ B. Recurrent urticaria

○ C. Chronic urticaria

○ D. Persistent dermatitis

MCQ 3:

Which of the following is a common trigger for physical urticaria?

○ A. Dairy products

○ B. Sunlight

○ C. Pollen

○ D. Pet dander

MCQ 4:

Which class of drugs is first-line treatment for urticaria?

○ A. Antibiotics

○ B. Antivirals

○ C. Antihistamines

○ D. Corticosteroids

MCQ 5:

Angioedema is commonly associated with urticaria and typically affects the:

○ A. Fingernails and toenails

○ B. Joints

○ C. Deeper skin layers, lips, and eyelids

○ D. Hair follicles

MCQ 6:

Which of the following is true regarding chronic spontaneous urticaria (CSU)?

○ A. It is always caused by a food allergy

○ B. It has no identifiable trigger in many cases

○ C. It lasts less than 6 weeks

○ D. It is contagious