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| {{Infobox Disease | | | __NOTOC__ |
| Name = Urticaria |
| | {{Urticaria}} |
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| DiseasesDB = 13606 |
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| ICD10 = {{ICD10|L|50| |l|50}} |
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| ICD9 = {{ICD9|708}} |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = D014581 |
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| }} | |
| '''For the WikiPatient page for this topic, click [[Urticaria (patient information)|here]]''' | | '''For the WikiPatient page for this topic, click [[Urticaria (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}};{{AE}} {{Anahita}}{{KS}} |
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| {{Editor Help}} | | {{SK}} Weal; welt; wheals; hives |
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| [http://cougar.eb.com/soundc11/u/urtica01.wav '''Urticaria'''] (or [http://cougar.eb.com/soundc11/h/hives001.wav '''hives''']) is a skin condition, commonly caused by an allergic reaction, that is characterized by raised red skin [[welt (medicine) |welts]]. It is also known as ''[[nettle]] rash'' or ''uredo''. Welts from hives can appear anywhere on the body, including the face, lips, tongue, throat, and ears. Welts may vary in size from about 5 mm (0.2 inches) in diameter to the size of a dinner plate; they typically [[itch]] severely, sting, or burn, and often have a pale border. Urticaria is generally caused by direct contact with an allergenic substance, or an immune response to food or some other [[allergen]], but can also appear for other reasons, notably emotional stress. The rash can be triggered by quite innocent events, such as mere rubbing or exposure to cold. | | == [[Urticaria overview|Overview]] == |
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| ==Pathophysiology== | | == [[Urticaria classification|Classification]] == |
| [[Image:Urticaria 2.jpg|thumb|right|150px|Allergic urticaria on the shin induced by an antibiotic]] | |
| The skin lesions of urticarial disease are caused by an inflammatory reaction in the skin, causing leakage of capillaries in the [[dermis]], and resulting in an [[oedema]] which persists until the interstitial fluid is absorbed into the surrounding cells.
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| Urticarial disease is thought to be caused by the release of [[histamine]] and other mediators of inflammation (cytokines) from cells in the skin. This process can be the result of an allergic or non-allergic reaction, differing in the eliciting mechanism of histamine release.
| | == [[Urticaria pathophysiology|Pathophysiology]] == |
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| [[Image:Urticaria_arm.jpg|thumb|right|150px|Allergic urticaria on the arm]] | | == [[Urticaria causes|Causes]] == |
| ; Allergic urticaria : Histamine and other pro-inflammatory substances are released from [[mast cells]] in the skin and tissues in response to the binding of [[allergen]]-bound [[IgE]] antibodies to high affinity cell surface receptors. Basophils and other inflammatory cells are also seen to release histamine and other mediators, and are thought to play an important role, especially in chronic urticarial diseases.
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| ; Non-allergic urticaria : Mechanisms other than allergen-antibody interactions are known to cause histamine release from mast cells. Many drugs, for example [[morphine]], can induce direct histamine release not involving any [[immunoglobulin]] molecule. Also, a diverse group of signaling substances called [[neuropeptides]] have been found to be involved in emotionally induced urticaria. Dominantly inherited cutaneous and neurocutaneous porphyrias (porphyria cutanea tarda, hereditary coproporphyria, variegate porphyria and erythropoietic protoporphyria) have been associated with solar urticaria. The occurrence of drug-induced solar urticaria may be associated with porphyrias. This may be caused by IgG binding not IgE.
| | == [[Differentiating urticaria from other diseases|Differentiating Urticaria from other Diseases]] == |
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| ==Differential Diagnosis of Underlying Causes of Urticaria== | | == [[Urticaria epidemiology and demographics|Epidemiology and Demographics]] == |
| * Angioedema-urticaria-eosinophilia syndrome
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| * Chronic Urticaria
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| * Cutaneous [[mastocytosis]]/urticaria pigementosa
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| * [[Drugs]]
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| * Hereditary or acquired deficiency of complment factor C1
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| * Idiopathic urticaria without [[angioedema]]
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| * [[Malignancy]]
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| * Thyroid Disease
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| * Toxins / poisons / irritants
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| * Urticaria secondary to physical stimuli
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| * Urticarial [[vasculitis]]
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| ==Urticaria vs. poison ivy contact dermatitis== | | == [[Urticaria risk factors|Risk Factors]] == |
| The rash that develops from poison ivy, poison oak, and poison sumac contact is commonly mistaken for urticaria. This rash is caused by contact with [[urushiol]] and results in a form of [[contact dermatitis]] called [[Urushiol-induced contact dermatitis]]. Urushiol is spread by contact, but can be washed off with a strong grease/oil dissolving detergent and cool water.
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| ==Types== | | == [[Urticaria natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
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| *''Acute urticaria'' usually show up a few minutes after contact with the allergen and can last a few hours to several weeks. Food allergic reactions typically fit in this category. Common causes of reaction include consumption of shellfish, nuts, eggs, fish, [[acid]] derivatives, [[dye]], or a combination of these.
| | ==Diagnosis== |
| *''Chronic urticaria'' refers to hives that persists for 6 weeks or more. There are no visual differences between acute and chronic urticaria. Some of the more severe chronic cases have lasted more than 20 years. A survey indicated that chronic urticaria lasted a year or more in more than 50% of sufferers and 20 years or more in 20% of them. Of course this does mean that in almost half the people it clears up within a year and in 80% it clears up within 20 years or less.<ref name="pmid5801331">{{cite journal |author=Champion RH, Roberts SO, Carpenter RG, Roger JH |title=Urticaria and angio-oedema. A review of 554 patients |journal=Br. J. Dermatol. |volume=81 |issue=8 |pages=588–97 |year=1969 |pmid=5801331 |doi=}}</ref>
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| *''Drug-induced urticaria'' has been known to result in severe cardiorespiratory failure. The anti-diabetic [[Sulfonylurea|sulphonylurea]] [[glimepiride]] (trade name Amaryl®), in particular, has been documented to induce allergic reactions manifesting as urticaria. Other cases include [[dextroamphetamine]]<ref name=dxl57>{{cite web |title=Prescribing Information Dexedrine |date=June 2006 |url=http://dailymed.nlm.nih.gov/dailymed/fdaDrugXsl.cfm?id=1215&type=display |publisher=GlaxoSmithKline}}</ref>, [[aspirin]], [[penicillin]], [[clotrimazole]], [[sulfonamide]]s and [[anticonvulsant]]s.
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| *''Physical urticarias'' are often categorized into the following.
| | [[Urticaria history and symptoms|History and Symptoms]] | [[Urticaria physical examination|Physical Examination]] | [[Urticaria laboratory findings|Laboratory Findings]] | [[Urticaria other diagnostic studies|Other Diagnostic Studies]] |
| **[[Water urticaria|Aquagenic:]] Reaction to water (rare)
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| **[[Cholinergic urticaria|Cholinergic]]: Reaction to body heat, such as when [[Exercise urticaria|exercising]] or after a hot shower
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| **Cold ([[Chronic cold urticaria]]): Reaction to cold, such as ice, cold air or water
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| **Delayed Pressure: Reaction to standing for long periods, bra-straps, panty or thong bands, belts
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| **[[Dermatographic urticaria|Dermatographic]]: Reaction when skin is scratched (very common)
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| **Heat: Reaction to hot food or objects (rare)
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| **Solar: Reaction to direct sunlight (rare)
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| **Vibration: Reaction to vibration (rare)
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| **Adrenergic: Reaction to adrenaline / noradrenaline (extremely rare)
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| ==Related conditions== | | ==Treatment== |
| [[Angioedema]] is related to urticaria. In angioedema, the swelling occurs in a lower layer of the dermis than it does in urticaria.<ref>{{cite web | url = http://www.webmd.com/allergies/guide/hives-urticaria-angioedema | title = Hives (Urticaria and Angioedema) | date = 2006-03-01 | accessdate = 2007-08-24}}</ref> This swelling can occur around the mouth, in the throat, in the abdomen, or in other locations. Urticaria and angioedema sometimes occur together in response to an [[allergen]] and is a concern in severe cases as angioedema of the throat can be fatal. | | [[Urticaria medical therapy|Medical Therapy]] | [[Urticaria primary prevention|Primary Prevention]] | [[Urticaria cost-effectiveness of therapy|Cost-Effectiveness of Therpy]] | [[Urticaria future or investigational therapies|Future or Investigational Therapies]] |
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| ==Treatment and management== | | ==Case Studies== |
| Urticarias can be very difficult to treat. There are no guaranteed treatments or means of controlling attacks, and some sub-populations are treatment resistant, with medications spontaneously losing their effectiveness and requiring new medications to control attacks. It can be difficult to determine appropriate medications since some such as [[loratadine]] require a day or two to build up to effective levels, and since the condition is intermittent and outbreaks typically clear up without any treatment.
| | [[Urticaria case study one|Case #1]] |
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| Most treatment plans for urticaria involve being aware of one's triggers, but this can be difficult since there are several different forms of urticaria and people often exhibit more than one type. Also, since symptoms are often [[idiopathic]] there might not be any clear trigger. If one's triggers can be identified then outbreaks can often be managed by limiting one's exposure to these situations.
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| ===Histamine antagonists===
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| Drug treatment is typically in the form of [[Antihistamine]]s such as [[diphenhydramine]], [[hydroxyzine]], [[cetirizine]] and other [[histamine receptor|H<sub>1</sub> receptor]] antagonists.<ref name="pmid18094952">{{cite journal |author=Greaves MW, Tan KT |title=Chronic Urticaria: Recent Advances |journal=Clin Rev Allergy Immunol |volume=33 |issue=1-2 |pages=134–143 |year=2007 |pmid=18094952 |doi=10.1007/s12016-007-0038-3}}</ref> These are taken on a regular basis to protective effect, lessening or halting attacks. While the disease is obviously physiological in origin, psychological treatments such as [[stress management]] can sometimes lessen severity and occurrence. Additionally, methods similar to psychological pain management can be used to shift focus away from the discomfort and itchiness during an attack.
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| The [[H2-receptor antagonist|H<sub>2</sub>-receptor antagonist]]s such as [[cimetidine]] and [[ranitidine]] may help control symptoms either [[prophylactic]]ally or by lessening symptoms during an attack occurs.<ref name="pmid11702618">{{cite journal |author=Lee EE, Maibach HI |title=Treatment of urticaria. An evidence-based evaluation of antihistamines |journal=Am J Clin Dermatol |volume=2 |issue=1 |pages=27–32 |year=2001 |pmid=11702618 |doi=}}</ref> When taken in combination with a H<sub>1</sub> antagonist it has been shown to have a synergistic effect which is more effective than either treatment alone.{{Fact|date=December 2007}} The use of ranitidine (or other H<sub>2</sub> antagonist) for urticaria is considered an off-label use, since these drugs are primarily used for the treatment of [[peptic ulcer]] disease and [[gastroesophageal reflux]] disease.
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| ===Other===
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| [[Tricyclic antidepressant]]s such as [[doxepin]], also are often potent H<sub>1</sub> and H<sub>2</sub> antagonists and may have a role in therapy, although side effects limit their use. For very severe outbreaks, an oral [[corticosteroid]] such as [[Prednisone]] is sometimes prescribed. However this form of treatment is controversial because of the extensive side effects common with corticosteroids and as such is not a recommended long-term treatment option.
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| As of 2008 an Australian company is performing [[clinical trial]]s with an analogue of alpha-[[melanocyte-stimulating hormone]] called [[Melanotan]] (CUV1647) for the treatment of solar urticaria,<ref name="Australian_Life_Scientist">{{Cite web | url = http://www.biotechnews.com.au/index.php/id;444900667 | title = Tackling skin cancer in organ transplant patients | accessdate = 2007-12-24 | publisher=Australian Life Scientist | date = 2007-04-13 | last = McDonald | first = Kate }}</ref> a type of urticaria that develops in response to exposure to specific wavelengths of light.<ref>{{cite web | url = http://www.emedicine.com/derm/topic448.htm | title = Urticaria, Solar | accessdate = 2007-12-26 | date =2007-03-29 | last = Baron | first = ED | coauthors = Taylor, CR | publisher = [[WebMD]] }}</ref>
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| == See also ==
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| | == Related Chapters == |
| * [[Anti-itch drug]] | | * [[Anti-itch drug]] |
| * [[Chronic cold urticaria]] | | * [[Chronic cold urticaria]] |
| * [[Urticaria pigmentosa]] | | * [[Urticaria pigmentosa]] |
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| == References ==
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| {{reflist|2}}
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| ==External links==
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| *[http://www.users.globalnet.co.uk/~aair/urticaria.htm Urticaria conditions and descriptions]
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| * [http://www.emedicine.com/med/topic3014.htm eMedicine: Urticaria]
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| *[http://www.dermnet.com/moduleIndex.cfm?moduleID=19 Urticaria photo library at Dermnet]
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| *[http://www.wrongdiagnosis.com/h/hives/causes.htm causes]
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| {{Diseases of the skin and subcutaneous tissue}} | | {{Diseases of the skin and subcutaneous tissue}} |
| [[Category:Dermatology]]
| | {{WH}} |
| [[Category:Allergology]]
| | {{WS}} |
| [[Category:Immunology]]
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| [[da:Urticaria]] | | [[da:Urticaria]] |
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| [[zh:荨麻疹]] | | [[zh:荨麻疹]] |
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