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Urticaria in adults

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Urticaria in adults

panthermedia

Itchy skin

Urticaria is a syndrome of disease manifested by the appearance of characteristic blisters accompanied by pruritus. It affects more than 20% of the population, at least once in their lifetime. Treatment is based primarily on the elimination of the triggering agent and pharmacotherapy with antihistamines, which quickly and effectively reduce symptoms.

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Table of contents:

  1. Urticaria - what does it have to do with nettle?
  2. Where do the blisters come from?
  3. Diagnosis
  4. How to treat?

Urticaria - what does it have to do with nettle?

Urticaria, a heterogeneous syndrome of the skin and subcutaneous tissue characterised by itchy blisters (similar to those that occur after a nettle burn) and/or angioedema. Similar to nettle burn, urticarial blisters usually occur shortly after contact with the causative agent. Allergic reactions involving mainly mast cells and basophils - elements of the immune system - are mainly involved in the pathomechanism. Urticaria may also have a non-immune basis.

The duration of urticaria varies, and can last from a few days to several weeks. A distinction can be made between acute urticaria, in which symptoms last up to six weeks, and chronic urticaria, in which symptoms persist for more than six weeks. It is estimated that almost 25% of adults have experienced urticaria at least once in their lifetime. Urticaria more often affects the female population, while there is no difference in frequency between urban and rural residents. Much more often, urticaria has an acute course in the form of a single episode, very often provoked by a viral or bacterial infection.

When symptoms last for a few hours or days, this does not pose major problems for patients, especially as we have drugs that effectively reduce the severity of urticaria. The biggest challenge becomes urticaria that is chronic, causing intractable symptoms over a long period of time, disrupting the patient's daily functioning. Symptoms then also occur at night, preventing effective sleep, which translates into fatigue and irritability during the day. Often, the severity of the symptoms does not allow participation in school activities, work or physical activity.

Where do these blisters come from?

In a nutshell: the reaction that produces urticarial blisters involves the activation of cells of the immune system - mast cells and basophils - resulting in the release of substances (so-called pro-inflammatory mediators) from within them. Inflammatory mediators include histamine, prostaglandins, cytokines and neuropeptides, which are responsible for the induction of the inflammatory response in various systems and organs. Some induce vasodilatation, others swelling and redness, and others irritation of sensory receptors, resulting in pruritus. Mast cell activation occurs as a result of a stimulus - a different type of allergen or environmental factor. The allergen then binds to IgE immunoglobulin, which then activates mast cells from which pro-inflammatory mediators are released, leading to the formation of an urticarial bulla. There are many factors that can trigger the above reaction cascade.

Among the most common are:

  • contact allergens (metals, chemical compounds),
  • food allergens (fruit, nuts, seafood, eggs, fish),
  • venom of hymenopterous insects,
  • medications (antibiotics, non-steroidal anti-inflammatory drugs, e.g. ibuprofen),
  • infections (bacterial, parasitic, fungal, viral),
  • physical factors (increase/decrease in temperature, light, vibration),
  • pseudoallergens contained in food, cleaning products, preservatives.

Antihistamines, Bubble, UrticariaUrticaria, photo: panthermedia

An urticarial wheal is characterised by elevation in the centre of the lesion and is surrounded by erythema. The lesions are accompanied by bothersome itching and sometimes burning. The blisters develop quite quickly, within minutes after the triggering factor. They then disappear within a few hours as the allergen ceases to act and without leaving a trace on the skin. Most often, urticaria has a mild, localised course that passes in a short time. In some situations, the reaction can take a more severe course involving the dermis and subcutaneous tissue. This is called angioedema and is a life-threatening reaction. The oedema may involve the subcutaneous tissue in the neck, occupying the mucous membranes of the glottis or larynx. Such a situation is dangerous and may threaten to close the airway, leading to suffocation. Angioedema requires immediate medical provision in the form of intramuscular adrenaline.

Diagnostics

The medical history plays an important role in the diagnosis of urticaria. Important information concerns the timing, frequency and duration of symptoms. Family history and allergic comorbidities are important. The history should include information on medications taken, cleaning products used, and endocrine disorders. Sometimes, urticaria symptoms may be related to work or hobbies (symptoms may appear or disappear only at the weekend). In cases of acute ur ticaria, additional investigations are not necessary. Most often the symptoms withdraw quickly and only appear once. When symptoms recur and reduce the comfort of life, in-depth diagnostics may be necessary. A complementary test is the determination of specific IgE antibodies in serum to detect the sensitising agent. Diagnosis of chronic urticaria is carried out by dermatologists and allergologists.

How to treat?

Treatment consists primarily of identifying and eliminating the triggering agent. However, this is not always possible. Medications that are used with great efficacy can help. All recommendations base pharmacological treatment on a group of second-generation H1 receptor-blocking antihistamines. These drugs are safe and devoid of many of the side effects that the first-generation drugs contained. Treatment begins after diagnosis in the GP's office, who determines the dose of the drug and the specific preparation best suited to the patient's age. We have medicines from other groups that are most commonly used to treat chronic urticaria, where second-generation antihistamines do not improve. However, this treatment should include a specialist consultation and extended diagnostics.