A change in temperature, autoimmune conditions, friction of the skin against the tissue and even a spontaneous trigger can be the origin of skin lesions, making it more difficult to avoid the causative agent.
What is hives?
Urticaria is a skin irritation characterized by red and slightly swollen lesions , such as welts, that appear on the skin and itch a lot.
These lesions can appear in any area of the body, be small, isolated or join and form large reddish plaques, with varied designs and shapes, always accompanied by itching.
They appear in outbreaks, and can appear at any time of the day or night, lasting for hours and disappearing without leaving marks on the skin.
It is not always simple to identify the factor that triggers the symptoms, as the lesions can appear suddenly.
In the same way, they can disappear without the use of ointments or medications, appearing in another region of the skin, almost as if they changed places.
After the appearance of wheals, the condition can assume two behaviors: disappear in a short time (about 2 hours) or last up to 48 hours.
The next 6 weeks will determine the type of hives. If the symptoms exceed this period, the disease is of the chronic type, if it is less than 6 weeks, it is of the acute type.
Angioedema (deeper swelling of the skin) may be accompanied by hives or other symptoms such as wheezing (bronchospasm), tachycardia, drop in pressure and syncope (loss of consciousness).
The most affected areas are the lips, eyelids, genital area, palms and soles.
The condition is less frequent and the improvement is slower, and may only regress after 48 hours.
In general, patients have an isolated episode of urticaria, being affected only once during their lives and usually with rapid improvements (after medications, the symptoms do not return).
But there are cases that compromise the patient’s routine more intensively and are called chronic urticaria or persistent urticaria.
About 30% of patients with urticaria have chronic urticaria. In this case, some tests are requested and it may be necessary to investigate autoimmune diseases or rare syndromes that can cause or be associated with the condition.
Chronic urticaria may be accompanied by physical urticaria, which is caused by external agents such as heat, cold, physical exercise, sun, etc.), as well as being associated with rare syndromes, systemic autoimmune diseases and connective tissue diseases – lupus , dermatomyositis , Sjogren’s syndrome.
What is the CID of urticaria?
In ICD10, the skin disease is classified with the code L50 – Urticaria, being subcategorized according to the type:
- L50.0 – Allergic urticaria;
- L50.1 – Idiopathic urticaria;
- L50.2 – Urticaria due to cold and heat;
- L50.3 – Dermatographic urticaria;
- L50.4 – Vibratory urticaria;
- L50.5 – Cholinergic urticaria;
- L50.6 – Contact urticaria;
- L50.8 – Other hives;
- L50.9 – Urticaria, unspecified;
- L56.3 – Solar urticaria.
What are allergies?
Allergies are exaggerated reactions by the body to some substance or external agent, usually harmless (such as food).
When external agents come into contact with the organism, either through ingestion or through skin contact, the immune system starts a defense process.
Most people respond normally to external infection, but others develop an exaggerated or hypersensitive response.
It is not known how to determine exactly why some people are allergic to certain substances and others, sometimes from the same family, normally respond to the component.
What is certain is that allergies are quite uncomfortable and, depending on the degree of sensitivity of the patient, can bring risks to health and life.
Are hives allergies?
Not necessarily . Allergy is the immune system’s response to some factor, usually external (such as animal hair, pollen, mites, food), that stimulate a type of cell called mast cell to release histamine – the itchy hormone.
This process of histamine release is involved in chronic urticaria, but the triggering agent can be difficult to be identified, often being spontaneous (when the triggering factor does not exist).
Thus, the disease is not always considered an allergy.
Types and classifications of urticaria
The most common classifications of urticaria are by time (acute and chronic) and by cause (spontaneous and induced) . But there are other ways to classify the disease, according to the intensity of the symptoms, for example.
Time and cause
In general, acute urticaria is one that is triggered by an external allergenic agent and in which symptoms improve quickly, lasting a maximum of 6 weeks.
Chronic urticaria, on the other hand, is commonly characterized by prolonged and persistent manifestations of skin lesions, sometimes by autoimmune causes. Symptoms last for more than 6 weeks and can last for years.
Therefore, according to the Brazilian Society of Dermatology (SBD), as to time, the hives are divided between:
- Acute urticaria : symptoms last a maximum of 6 weeks;
- Chronic urticaria : symptoms persist for more than 6 weeks.
Chronic urticaria can be further divided into:
- Induced urticaria : when a factor is identified, such as drugs, food, infections, physical stimuli (heat, cold, sun, water, pressure).
- Spontaneous urticaria : when the disease occurs without an identified cause, also called idiopathic urticaria.
Immune and non-immune
One of the ways adopted to classify urticaria is through the triggering factors. You can separate the disease among the causes immune and nonimmune .
For immune cases, they are:
- Association between chronic urticaria and thyroid autoimmunity (presence of autoantibodies, which are cells that attack the hormones themselves);
- Presence of serum autoantibodies;
- Basophils as target cells for autoantibodies (basophils are blood cells that, in this case, provide inflammation);
- Deficiency of some substances (C1 esterase inhibitor).
Nonimmune conditions correspond to most medicated (pseudoallergic) and food urticaria. They occur by toxic effect directly on the mast cell.
Degree of intensity
The classification of urticaria still occurs through the observation of skin lesions, which are classified between 0 and 3 degrees.
- Grade 0 : has no wheals or itching;
- Grade 1 – Mild : up to 20 wheals in the 24-hour period and mild itching;
- Grade 2 – Moderate : between 21 and 50 wheals in 24 hours and moderate itching;
- Grade 3 – Severe : more than 50 wheals in 24 hours and severe itching.
In acute urticaria the lesions result from exposures to allergenic agents, because the organism has a hypersensitivity or an allergic reaction to the component.
It is usually triggered by the ingestion of some foods, medications or those components that are closely related to allergies, such as animal hair and perfumes.
It is estimated that approximately half of the acute cases have an infectious origin, mainly infections of the respiratory tract. During childhood, this value rises to up to 80% of cases resulting from infectious conditions.
The agents most attributed to the manifestation of urticaria are:
- Unknown causes;
- Food (strawberry, seafood, nuts, milk products , chocolate, tea and condiments);
- Medicines (antibiotics , penicillins, sulfonamides , acetylsalicylic acid, anti-inflammatories, morphine and codeine);
- Insect bites (bee and wasp);
- Infections caused by viruses and febrile illnesses;
- Substances for radiation tests.
- Blood products (blood therapies).
The acute type is a self-limited and transient episode, as the skin reaction lasts for a maximum of 6 weeks.
Although in that period the wheals may disappear and reappear, the skin’s recovery is complete and, generally, there are no signs of the disease.
As the condition is isolated, usually caused by a factor that is easily recognized (such as eating some food other than usual), it tends to show a good response to the initial treatment.
Thus, the use of antihistamines in low doses is sufficient for most cases.
Approximately 30% of urticaria diagnoses are of the chronic type, which is defined when symptoms persist for more than 6 weeks and can last for several years.
Some patients respond well to the use of antiallergic agents (antihistamines), as they have mild degrees of urticaria.
However, others may be affected by a more severe condition, with inefficiency of conventional drugs.
Spontaneous chronic urticaria (ECU)
According to a survey carried out by researchers in the dermatological area of USP, when there are diseases associated with chronic urticaria, some of the related ones can be genetic, immune or hematological, such as:
- Muckle-Wells syndrome;
- Familial autoimmune syndrome to cold;
- Familial Mediterranean syndrome;
- Hyper IgD syndrome;
- Chronic Infantile Neurological Cutaneous Joint Syndrome (CINCA);
- Neonatal Onset Multisystem Inflammatory Disease (NOMID);
- Prier and Griscelli syndrome;
- Systemic lupus erythematosus;
- Sjogren’s syndrome;
- Still’s disease;
- Rheumatoid arthritis;
- Serum disease;
- Paroxysmal hemoglobinuria;
- Polycythemia Vera (Vasquez disease);
- Hypereosinophilic syndrome;
- Schnitzler syndrome.
Chronic induced urticaria
According to Letícia Sousa and Patricia Karla de Souza, dermatologists at GUIA (Urticaria Group – Information and Support), chronic urticaria induced (when the disease is not autoimmune) can be triggered by physical agents, with the following subcategories:
The skin is extremely sensitive and tends to show pressure injuries. That is, when lightly scratching the skin, pressing or even wearing very tight clothing, the skin starts to itch and presents a cutaneous elevation in the area.
The name dermographism refers to something close to “writing on the skin”, because the surface is demarcated exactly where the contact occurred, almost like scratches or drawings.
In general, the elevations of the skin disappear in about 2 hours.
Cold urticaria is caused when the skin is exposed to cold and cold conditions. Generally, when the person is in contact with low temperatures, the wheals appear in a more reduced and limited way.
However, if the contact is direct (such as touching cold objects or taking cold baths), the symptoms can be more comprehensive, spreading the skin lesions throughout the body.
In addition, headaches, pressure drop and even loss of consciousness can occur.
Sensitivity to cold occurs more in young adults and, at least half of the patients, show complete or partial improvement within 5 years of the first manifestations.
The condition is rare and is characterized when the skin comes into direct contact with hot objects or substances.
The body takes up to 5 minutes to trigger the skin reaction, which softens after approximately 1 hour. Itching, mild burning and swelling may occur in the region.
In addition, the patient may also have other symptoms, such as headache , dizziness, abdominal pain and even fainting.
Solar urticaria occurs in less than 1% of cases and about 30% of patients improve spontaneously in a few years. Unlike heat urticaria, the solar type requires direct skin exposure to the sun.
When the skin is exposed to the sun, the reaction manifests immediately or within 30 minutes, and begins to improve between 15 minutes and 3 hours.
But the condition is not restricted to natural light, as the monochromatic incidence or artificial simulators can also trigger the symptoms.
Delayed pressure urticaria
Most cases are related to chronic urticaria and occur when the skin receives mechanical pressure, for example tight clothing, scratches or any physical stimulus. However, lesions or edema take between 4 and 8 hours to appear.
Skin lesions can be triggered by activities such as running, jumping or coming into contact with vibrating devices (such as electrostimulators, blenders, massagers).
The type is quite rare and has a higher prevalence in childhood. Symptoms tend to appear after contact with vibration and take, on average, 1 to 2 hours to ameliorate.
A study published in the United States medical journal, The New England Journal of Medicine , points out that there are mutations in patients’ genes, causing an exaggerated cell response.
In this urticaria, lesions appear in the region where there was contact with an allergenic agent. The most common are plants, animals, cosmetics, latex, fabrics and chemicals, but skin reactions can have different causes.
Normally, symptoms appear quickly after contact. But if the sensitivity to the component is low, it is possible that the symptoms appear only with frequent contact with the component.
In this type of urticaria, skin manifestations occur when there is a stimulus that raises body temperature.
Despite being associated with high temperatures, as well as heat urticaria, the cholinergic type occurs when the body temperature is elevated by any factor.
Physical exercises are the most recurrent conditions, however, hot baths, fever , ingestion of thermogenic foods (pepper) and even elevation of body temperature due to emotional factors ( anxiety , for example) can trigger wheals.
The lesions usually start in the chest and close to the neck, and may or may not spread to other regions of the skin.
Cholinergic urticaria is an uncommon type of chronic urticaria and is prevalent in late adolescence, presenting itself frequently in young adults. Some more severe cases may show respiratory changes during the onset of symptoms.
The condition is uncommon and tends to be limited, that is, it lasts for a few months or years.
In this type of urticaria, the patient has skin reactions upon contact with water, regardless of temperature. Thus, bathing, rain and even excessive air humidity (after rain, for example), can trigger reactions.
It is not difficult to hear about nervous urticaria. However, the term, which is quite popular, needs to be used with caution.
A few years ago, there was even a belief that there would be a type of nervous urticaria – initiated and caused only by stress or anxiety.
But in fact, you need to know that, although emotional factors can aggravate the manifestations of some types of hives, they are not the cause .
That is, if there is an association of facilitating conditions, the skin change may arise, for example, genetic predisposition and contact with some allergenic substance.
So, if the patient goes through moments of nervousness, the reddish plaques appear, but that does not mean that stress is going to be the cause.
In addition, reference centers in the treatment of spontaneous chronic urticaria emphasize that this does not apply to this type of urticaria.
There is even a relationship between the disease and emotional factors, but it is the opposite: it is the manifestation of symptoms that aggravates the emotional state , generating anxiety and stress, and not the other way around.
Can acute urticaria become chronic?
The difference between the acute and chronic type is the duration of the manifestations. Therefore, initially the patient may receive a diagnosis of acute urticaria, but if it exceeds 6 weeks, it will be classified as chronic.
Causes: What can cause hives?
The appearance of symptoms, mainly itching and wheals, occurs through histamine that is released into the blood.
Briefly, when it comes into contact with a substance, the organism responds to the external agent trying to fight it.
These substances are normally not at risk and, in some cases, should not activate the immune system, as is the case with heat urticaria. The immune system mobilizes cells, causing a release of histamine in the blood.
The skin has swelling and bumps because histamine promotes dilation of blood vessels so that lymphocytes (defense cells) are concentrated in the infected region.
However, determining what causes histamine release is not always simple, as allergic agents are diverse and, sometimes, there may not be a trigger.
Main causes of acute urticaria
The causes that trigger urticaria are not always known, but among the main ones are:
Insect bites are among the most common causes of acute urticaria, especially those of wasps and bees, causing injuries close to the bite.
However, several insects can cause allergic reactions and, in up to 5% of cases, result in a generalized urticaria.
Reactions to medications are quite frequent and manifest mucocutaneous responses that may be milder or more intense, depending on the level of sensitivity, the substance and the amount ingested.
There is evidence that allergies and urticaria triggered by medications may also have an inherited condition.
The reactions can occur due to several interactions of the medication with the organism, for example, they can cause changes in the immunological mechanism (by direct action of the chemical component in the organism, by intoxication or by high sensitivity of the patient).
While urticaria caused by antibiotics is more recurrent, other drugs account for about 10% of cases.
The occurrences are, more frequently, in women, the elderly and people with weakened immunity. In general, reactions can occur immediately after dosing or up to 10 days later.
Among the medications that most trigger urticaria are:
- Anti-inflammatory drugs;
- Penicillin or sulfa antibiotics;
- Iodinated contrast;
- Codeine and morphine;
- Polymyxin b .
Tartrazine yellow dye
Tartrazine is an artificial color widely used in the food industry. Reactions to the product are generally not immediate and can manifest hours after ingestion.
In addition, the greater the amount ingested, the greater the chances of urticaria symptoms to appear.
Food is a very recurrent cause of urticaria and can manifest itself through ingestion or just through contact with the skin (characterizing a contact urticaria).
In addition, between 5% and 10% of children under 3 years of age have allergies to some food, with symptoms such as wheals and angioedemas. In some cases, the condition may worsen for anaphylactic shock.
The list of the most common allergy-related foods includes:
- Milk and dairy products;
- Fruits, especially red ones;
Infectious conditions resulting mainly from viruses or bacteria, can cause manifestations of hives. These are quite common conditions, along with allergic responses to food and affect mostly children.
In some cases, patients may develop skin reactions when experiencing emotional changes, such as anxiety, fear or euphoria.
According to the dermatologists at GUIA (Urticaria Group – Information and Support), Letícia Sousa and Patricia de Souza, stress can trigger or aggravate symptoms, but they are not factors that cause urticaria.
Main causes of chronic urticaria
The main causes of induced urticaria are the physical agents:
Remembering that spontaneous chronic urticaria is not triggered by external factors, as it is a reaction of the organism itself. But there are also the following causes:
There are indications that chronic urticaria can be caused by autoimmune conditions.
Generally, patients have different autoantibodies. These proteins are produced by the body and attack the cells, organs and tissues themselves, causing immune dysfunctions.
Studies that associate autoimmune diseases as triggers of urticaria mainly point to thyroiditis or autoantibodies to thyroiditis (when the body tries to defend itself from the hormones produced by the gland), systemic lupus erythematosus and rheumatological diseases.
Review studies indicate that there is no consensus among researchers about the hormonal relationship, however, some patients report that the most intense attacks of urticaria occur when any rate of hormones is altered.
Hives can be a manifestation due to infections by bacteria, fungi or viruses. Different studies indicate that, possibly, there is an association between chronic urticaria and infections:
- Vaginal candidiasis;
- Fungal urinary infections;
- Dental infections;
- Gastrointestinal changes caused by H. pylori bacteria ;
- Hepatitis A, B and C;
- Infectious mononucleosis;
- Chronic sinusitis.
Read more: Remedies for Sinusitis: what are the options?
Is hives contagious?
No . Urticaria is a response of the organism that tries to defend itself against an aggressive agent – even if there is not always one, as is the case of spontaneous urticaria.
It is not a communicable condition, even when symptoms are manifesting, as skin reactions are only a response to the action of immune cells.
Therefore, being close to or touching the wheals – red plaques that appear on the skin – is not dangerous.
What are the symptoms of hives?
The most common symptom is itching (also called itching), but injuries can cause a burning or burning sensation.
The itching caused by hives is usually very intense and disrupts patients’ lives, impairing their activities in several aspects, such as work and sleep.
The signs and symptoms of hives can reappear at any time, for hours, days or months.
Rapid, intense and localized swelling can occur, which normally affects the eyelids, lips, tongue and throat.
This swelling is called angioedema and sometimes makes breathing difficult and life-threatening. Angioedema lesions can last for more than 24 hours.
There is also a complication called anaphylaxis , in which the reaction involves the whole body, causing nausea, vomiting, drop in blood pressure and swelling of the glottis (throat) with difficulty breathing.
These cases are serious and need emergency care.
The symptoms that affect most patients are:
Better known as intense itching, itching results from the release of histamine.
If there was contact with any allergenic agent, the body sends defense cells to the location – or to several locations – to fight this invader.
If there is no apparent or known cause, the process is quite similar: for some reason, the immune system starts to act exaggeratedly.
If there is no apparent or known cause, the process is quite similar: for some reason, the immune system starts to act exaggeratedly.
As mast cells release histamine, symptoms start to occur, including itching.
Burning and burning
Like itching, burning and burning are the result of the action of histamine. One of the histamine receptors in the body, H1, is especially related to these symptoms.
Elevation or swelling
The release of histamine causes vasodilation (enlargement of the blood vessel wall), causing a change in their permeability.
This causes the plasma to pass through the walls, accumulating in the most superficial tissue, close to the skin. The result is swelling of the site.
Swelling of mucous membranes
Histamine can act on several parts of the body, including the mucous membranes, such as the tongue, mouth and eyelids.
The mechanism is similar to swelling of the skin and, in more severe cases, patients may experience difficulty breathing, palpitations and difficulties in speaking, swallowing or chewing.
Erythema is characterized by redness or flushing of the skin. It results from the vasodilation promoted by histamine, which increases blood flow to the skin surface.
Some patients with chronic urticaria have angioedemas together with the appearance of wheals. The condition is more severe and affects up to 40% of people with the chronic disease.
Swelling occurs quite quickly and affects the deepest tissues of the skin, and is usually quite painful.
The presence of angioedema associated with urticaria indicates a worse prognosis, with 75% of patients having recurrent episodes for more than 5 years. The symptom should be investigated, as it may have a malignancy involved.
In cases of urticaria, patients with ECU may develop only wheals, only angioedema, or wheals and angioedema together.
Professionals such as the dermatologist, general practitioner, allergist and infectious disease are the main doctors to diagnose and monitor urticaria.
The condition is diagnosed through physical examination, with the observation of skin lesions, associated with the clinical survey of the patient.
In this regard, the doctor may question about the activities performed recently, food eaten, different environments that the patient has attended, in addition to the use of medications and diseases.
To complement the diagnosis, the doctor can order blood tests and reaction tests (skin tests), which help to determine the agents that trigger the urticaria.
However, even when it is not possible to identify the causative agent, the diagnosis is maintained through physical and clinical observation.
Some of the points that the doctor can raise are:
- The time of symptoms;
- Frequency and duration of skin lesions;
- Other symptoms, such as burning, burning and breathing difficulties;
- Other hives in the family;
- Eating habits;
- Changing environments (eg travel);
- Drug treatments or change of medication;
- Stress and emotional condition.
There are different diseases and conditions that can affect the body and, initially, it is very similar to urticaria. However, a thorough examination of the skin, added to the patient’s medical history, is capable of indicating the differential diagnosis.
Among the conditions that can cause confusion are:
- Itching stropule (insect bites);
- Polymorphic erythema;
- Bullous pemphigoid;
- Vasculitis and polyarthritis;
- Eruptions caused by drug use;
- Muckle-Wells syndrome;
- Schnitzler syndrome;
- Minor morbidiform erythema;
- Viral rash;
- Hypersensitivity to hidden allergens;
- Solar pleomorphic erythema;
- Contact eczema (contact dermatitis);
- Fixed erythema medicated.
Some physical exams can be used to determine, exclude or confirm the diagnosis and the type of hives.
Skin tests may be ordered to try to identify which allergenic agent. As there are numerous elements that can cause allergies, the test is usually requested when there are suspicions about what can cause hives.
Solutions are prepared with various extracts, such as flower pollen, dust mites, animal hair, insect venom, food or medicines. The solution is applied to the skin and a small prick is made with the needle, to then check the skin responses.
The doctor may order blood tests, such as blood count , blood glucose, electrolyte levels and TSH to check the condition of the organism. Although the results are not directly associated with urticaria, they can help in the composition of the diagnosis, as well as verify other dysfunctions of the organism.
The test can be performed to differentiate urticaria from other skin diseases or when the condition is difficult to control or stabilize.
Pressure is applied to the skin, usually on the back of the hand, with a dermograph (a slightly pointed instrument that does not damage the skin of the healthy person).
Some pressure can also be exerted on the skin and analyze the following minutes. If there is elevation or swelling of the region, with marked redness in the entire pressed area, the diagnosis is confirmed.
Cold contact urticaria
In general, a frozen component (gel or water) is applied to the skin or the patient’s hand is inserted in the cold water to observe the organism’s reaction.
The patient can be exposed to the sun or a solar simulator. The exposure time is generally short.
Delayed pressure urticaria
Pressure is applied or the patient is indicated to hold weight for a few minutes so that skin manifestations and reactions are evaluated. In general, a 7 kg weight is used, attached by straps that are placed on the patient’s shoulders.
There are also options of cylinders up to 5 kg that can be placed on the shoulders, thigh, forearm or back for up to 15 minutes. The skin evaluation takes place for the next 6 hours, at least.
Vibratory stimuli of 1000 rpm (rotations per minute) are applied to the forearm region for approximately 10 minutes.
In general, a cotton or gauze moistened with water at 37 degrees is applied to the skin for approximately 20 minutes or bathing the patient in water at body temperature.
The patient can be submitted to physical exercises until his body temperature rises. Hand immersion in 42 degrees hot water for 10 minutes can also be used .
Does hives have a cure?
No . There is a control of symptoms, and in most cases the symptoms will not persist for a lifetime.
In acute urticaria, reactions disappear within 6 weeks and, for most patients, do not occur again.
For patients with the chronic condition, it is necessary to control the disease and avoid contact with the causative agent (when it is possible to identify it).
It is estimated that up to half of the chronic cases resolve themselves in approximately 6 months.
In prolonged cases, the patient can alleviate the symptoms through adaptations of the routine that aim to reduce the manifestations of the disease, however, it cannot be cured.
What is the treatment?
Treatment for urticaria may include therapeutic and pharmacological measures.
Medicines are indicated to control the symptoms and prevent the onset of wheals. For example, when in contact with the allergenic agent, the patient can resort to medications to prevent symptoms from manifesting.
The remedies must be indicated by the doctor, who will assess the condition of each patient, as there are different active principles to control and alleviate the symptoms.
Therapeutic measures aim to improve the condition of the condition. If the agents that cause urticaria are known, it is necessary to avoid or minimize contact.
Food diary or crisis diary
Keeping a record of your routine and diet can be very effective in helping with treatment. This is because writing down the foods, the different activities and the times when the urticaria attacks occurred can be decisive to indicate the causes and the type.
The diary consists of recording the routine to identify patterns close to the symptomatic manifestations.
In some cases, using medications is important to control the manifestations of hives.
In acute types where it is not possible to reduce contact with the triggering agent, or the trigger is not known, keeping antihistamines prescribed by the doctor nearby can be important.
In addition, if the seizures are frequent or the diagnosis is spontaneous urticaria, using medications for the control may be necessary, as long as prescribed by the doctor.
Remedies for hives
Medicines for urticaria are determined according to the body’s response.
There are drugs assigned as first-line treatment. This means that, in general, they are the first to be prescribed, as they have better responses or fewer side effects.
If the patient does not respond well or effectively to first-line treatment, even with dosage adjustments, second-line drugs are tested.
There is also the third and fourth line, which are aimed at the most serious cases and with a difficult response to previous remedies.
Recently, new drugs are being approved and put into circulation, such as the case of omalizumab, approved in 2015 by Anvisa.
Its action is immunobiological and is intended for severe spontaneous chronic urticaria that does not respond well to conventional treatments.
Between 40% and 91% of patients with chronic urticaria respond well to treatments with oral antihistamines.
The drugs called 1st generation were the first to be developed and commercialized.
Although they are still used, the recommendation of the global guideline for the management of urticaria is that they should be avoided, especially by children.
New formulas, represented by 2nd generation antihistamines, can cause fewer side effects and act in a more controlled manner.
They are non-sedative or slightly sedative drugs, which do not cause so much interference in the routine (as they do not make the person sleepy). Among those that can be prescribed are:
- Cetirizine dihydrochloride ;
- Fexofenadine Hydrochloride ;
- Loratadine ,
- Levocetirizine dihydrochloride ;
In addition to 2nd generation antihistamines, it is possible that corticosteroids are prescribed. However, due to the possible side effects, they should be used in short periods, of a maximum of 10 days.
In some cases, leukotriene inhibitors may also be prescribed, which are used in combination with other drugs. They may involve:
- Montelukast ;
- Prednisone .
Currently, UCARES (Spontaneous Urticaria Reference Centers) indicate the possibility of treating spontaneous urticaria with Omalizumab- type histamine blockers .
The drug is relatively recent, but it has good results.
According to Dr. Hannah Grohs, a dermatologist, the treatment consists of “a humanized monoclonal antibody against a part of the IgE receptor, capable of decreasing the concentrations of IgE and the stimulation of mast cells and basophils, two stem cells involved in the release of histamine ”.
This type of treatment is indicated for patients with severe disease and with a high frequency of wheals and itching, who do not respond well to previous treatments or who have urticaria as an autoimmune cause.
Immunosuppressants or immunomodulators such as Cyclosporine are administered.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Ointment for urticaria
As with oral medications, ointments should be prescribed by the doctor after an assessment of the condition.
For topical use, the products should be applied to the skin, in the wheal areas, according to medical advice.
Among the options are Histamin cream , Alergomine cream , Polaramine cream . It is also possible to find dexchlorferinamine maleate (generic).
In some cases, dexamethasone, such as Dexason cream and Cortitop , or promethazine, such as Fenergan cream , may be indicated .
Home options and therapies can be combined with clinical treatments to help relieve symptoms – when present – and then control the onset of a crisis.
Home care can include simple measures, but they make a big difference in the routine of those who deal with urticaria:
- Avoid letting the animals sleep or move around the beds and sofas, as well as taking care of the hygiene and hair grooming routine is necessary;
- Cold compresses and warm baths can help to soothe the skin, reducing itching and aggravation of red plaques;
- Avoid overheating the skin, then avoid heavy blankets, very hot clothes, very hot environments, as the heat increases the release of histamine and consequently worsens the itch;
- Moisturize the skin – this lowers the itch threshold, especially if the body moisturizer is stored for a short time in the refrigerator, giving a relief to the skin. It is important to avoid this measure if you have cold-induced hives;
- Take quick, warm baths to avoid excessive dryness of the skin. Opt for soap-free soaps that keep your skin more hydrated;
- Avoid alcoholic beverages.
Along with this, having an adequate routine and a balanced diet is fundamental for well-being. However, food also deserves attention.
A good tip is to use food in favor of the body. Even though a tea may not necessarily help to alleviate an allergic attack, it helps to calm and reduce anxiety.
Living together: tips and how to relieve symptoms
Living with urticaria will depend on the degree of manifestation of the disease and the discovery of the causative agent.
If the patient knows the causes of the symptoms, it is usually simpler to alleviate the crises. But it is not always possible to completely isolate yourself from the allergenic agent, causing some episodes of urticaria to happen (for example, pollen allergies).
When the causes are known, it is necessary to plan the routine and organize the activities in order to minimize the exposure to the agent.
Simple measures can prevent the onset of symptoms. For example, changing your diet and taking care when eating outside the home, when symptoms are caused by eating some food.
Information is combined with routine and living with the disease. Therefore, knowing more about urticaria, the causes and treatments can bring better results to the treatment, which, as far as possible, aims to provide a life without restrictions to the person with urticaria.
To assist patients and families, providing clarifications and updating on news related to the disease, there is the GUIA portal (Urticaria Group – Information and Support) , which aims to provide informational support to the community.
Facilitate the identification of the disease
You can walk around with bracelets or cards that indicate substance allergy. Especially in cases of allergy to medications, early warning can be quite effective in emergency cases.
For patients with spontaneous urticaria or without known cause, there is no way to predict crises. In that case, you need to be aware of the possibility of episodes appearing at any time.
Therefore, taking the medication prescribed and keeping friends and family informed is essential.
When urticaria develops, it is important to reduce the discomfort that is usually present. Therefore, opting for light clothes and softer fabrics prevents the skin from becoming even more irritated.
As the lesions usually itch and have a natural temperature rise in the region, it is necessary to prevent the clothes from hurting, tightening or further heating the region.
It is important not to scratch or scratch the skin and, to relieve discomfort, it is possible to use ointments that refresh the skin to also reduce burning.
Although they do not resolve the symptoms, menthol-based moisturizers and cold compresses can provide more relief to the patient.
Read more: Skin Hydration: importance, how to moisturize, products and tips
Monitors your indexes
There are options to monitor urticaria manifestations. They are especially indicated for cases of spontaneous or frequent chronic urticaria.
Among the options, one can find the Dermatology Quality of Life Index (DLQI) and the Urticaria Activity Score (UAS7) . Both questionnaires are ideal for tracing the behavior of the organism to the treatment and consists of a daily filling in of the intensity of the hives.
UAS7 must be completed evaluating the number of injuries and the occurrence of itching every day, during the week before the consultation.
These tools act like manual journals and make it easy to visualize the evolution of the situation through self-monitoring.
This allows the patient to record the days the crisis started, the intensity of the itch, the foods consumed, the activities performed and various other information that will help the doctor and the person to guide the treatment.
Take care of the food
Food deserves attention at times when urticaria is manifesting. It is ideal to avoid foods that raise your body temperature, such as peppers and condiments.
Choosing lighter foods and drinking plenty of water can bring more well-being.
There is not necessarily an explicit indication to avoid dyes, preservatives or foods popularly linked to allergies, so care must involve well-being and self-observation.
Do physical activities
No matter what type of exercise, they all have numerous health benefits as a whole.
There are modalities that work more stretching, like yoga and pilates , and bring less impact to the joints. These activities work with balance, improve circulation and can also bring benefits to concentration, breathing and relaxation.
But it is possible to combine more dynamic activities, such as walking, cycling, dance classes, sports or fights.
These exercises involve more intense, faster movements and bring benefits to the body, such as muscle strengthening and caloric expenditure. At the same time, they favor socialization and can help with mental health .
Take care of the emotional
Some patients may have very severe skin manifestations, which end up compromising their daily activities. Not only because of the pain, itching or irritation of the skin, but also because of the emotional aspects.
When wheals are intense and frequent, it can be difficult to maintain social relationships due to apprehension or shame. In addition, anxiety and low self-esteem can also present, becoming aggravating for the person.
Therefore, it is necessary that the patient has the support of those close to him and avoid stressful situations, which can aggravate the injuries in cases of emotional urticaria.
Practicing relaxing activities, light physical exercises and keeping your emotions under control helps throughout the body and prevents the condition from worsening.
Read more: The mental (and physical) benefits of deep breathing
At the first consultation, it is important to be prepared to give the doctor as much information as possible, such as the date of the first crisis, the use of medications, the degree and duration of the injuries.
Constant medical monitoring is essential to maintain a good quality of life.
It is worth remembering that drugs should always be prescribed by this professional and used according to the recommendation.
You should also not interrupt treatment or change dosages or medication on your own.
Sometimes, providing multidisciplinary care can be quite efficient in improving the patient’s condition.
For example, combining consultations with the dermatologist and the nutritionist can bring more promising results.
Most people have acute urticaria, which lasts less than 6 weeks and usually occurs in isolated episodes (once in a lifetime).
Chronic urticaria cases are less frequent and, more rarely, are severe cases.
In general, chronic patients who perform the treatment correctly tend to progress well, reducing the manifestations of hives or controlling them without major complications when they occur.
According to dermatologist Dr. Hannah Grohs, ” among patients with urticaria, 50% will continue to present the disease one year after the initial visit to the doctor, and 20% will continue to experience episodes of the disease for more than 20 years “.
Hives do not tend to have many complications. Although uncommon, the patient may experience shortness of breath, difficulty swallowing and speaking. In severe cases, there may be a major impediment to breathing, which is life-threatening.
Chronic cases that are related to diseases are the ones with the greatest complications, as they have other associated organic dysfunctions, but they occur infrequently.
In general, it is necessary to investigate the causes of urticaria and, if there are associated immunological or genetic factors, treat the dysfunction to avoid complications to the body.
Problems can include:
Although the symptom is a relatively common manifestation associated with urticaria, when the condition is severe, it can represent health risks. In general, angioedema appears on the eyelids, tongue, throat, hands, feet and genitals.
If it is a very pronounced manifestation, the patient may have difficulty speaking, chewing and swallowing.
Anaphylaxis is a serious allergic manifestation, which compromises breathing and can cause fainting and lead to death. Hives can be a manifestation of anaphylaxis.
If you have any sign of severity together with hives or angioedema (eg wheezing, drop in pressure, difficulty swallowing, speaking, breathing, severe diarrhea ), seek emergency service immediately!
The greatest risks and complications of urticaria are related to emotional factors.
Generally, when there are frequent manifestations of wheals, the patient tends to worsen his mental state, feeling depressed, anxious, with low self-esteem and moving away from social activities.
How to prevent hives?
There is no way to prevent the onset or first appearance of hives.
After symptoms start, prevention occurs by avoiding the agent that causes urticaria.
If the cause is unknown, prevention should follow general procedures, such as avoiding tight clothing, fabrics that irritate the skin, medications and substances that favor allergies.
Food is also an important point during hives.
It is important to avoid the consumption of products such as chocolate, eggs, soft drinks, canned goods and sausages.
The preservatives, dyes and components that are associated with allergies can aggravate the crises or make it difficult to stabilize the condition.
In addition, it is important to warn friends and family about the factors that can trigger hives and what measures to take in case of a crisis.
Skin problems and changes are relatively common conditions. Wheals can occur at any time in life without apparent or known causes.
The vast majority of patients affected by urticaria show complete improvement, without complications and, generally, without recurrence. However, there are cases in which it is necessary to carry out more intense monitoring for the problem.
Although skin disease does not represent health risks in most cases, the activities and routines of the patient are highly impacted, and can bring numerous obstacles to life.
Performing the correct medical follow-up and preventing known causes are essential to alleviate the condition. In addition, the daily care and support of those close to you makes the routine of patients suffering from urticaria simpler and more comfortable.