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Urticaria an Angioedema
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Urticaria and angioedema are allergic reactions that can happen to your body. Urticaria is also called hives and involves raised, red and itchy wheals that can appear and disappear on the skin. Angioedema is related to urticaria but involves welts deeper within the skin and is common around the lips and around the eyes. Both conditions are generally not dangerous and don't leave scars as long as you don't deeply scratch your skin. Both conditions respond to antihistamines. Angioedema can sometimes lead to anaphylactic shock, which can subsequently lead to death.
Symptoms of hives can include the following findings. You can get raised, red or pale wheals or welts on the body that can cover large areas of the body. The wheals can disappear and new ones can occur in other areas of the body making it appear as though the rash is moving to other body areas. The itching in hives can be really severe. Hives can be acute hives or chronic hives. If it lasts up to six weeks or less, it is considered acute. If it lasts for months or years, it is considered chronic.
The symptoms and signs of angioedema are like urticaria but happen deep within the skin. The signs and symptoms include skin swelling, thick and firm welts which are larger than hives. There can be blisters of the skin and warmth in the areas affected by angioedema. Angioedema can be painful and you can have difficulty breathing or even swallowing when it becomes severe. Angioedema can affect the face, genitalia, hands, or feet. It can even occur within the throat.
There is a condition known as hereditary angioedema which is rare but serious. It causes advanced swelling of the above affected areas as well as the airways and digestive tract. The signs of hereditary angioedema include sudden facial swelling, arm, leg, hand or feet swelling or airway swelling. You can get abdominal cramping if the digestive tract swells. You can have difficulty breathing due to airway swelling.
Both urticaria and angioedema are caused by skin inflammation and is triggered by mast cells in the skin that release histamine and related chemicals into the skin and bloodstream. The reaction can be due to an allergy to foods or food additives, such as chocolate, milk, fish, shellfish, nuts and eggs. Various medications can lead to hives. Other allergens include those things like animal dander, latex, bug stings or pollen.
Some physical factors can lead to angioedema or hives, such as heat, sunlight, water, skin pressure, exercise, cold, and emotional distress. Dermatographia is hives that occur when the skin is touched or scratched. The pattern of dermatographia is the exact pattern that the scratching or touching occurred at.
Autoantibodies can lead to hives or urticaria. This can be things like lupus, Hashimoto's thyroiditis or cancer. Infections like hepatitis or even an upper respiratory infection can lead to urticaria or angioedema.
There is a condition called hereditary angioedema that results from inheriting a low level of C1 inhibitors-blood proteins that regulate the immune system. This results in hives that have very little reason behind them.
Risk factors for angioedema or hives include having had the disease before, having a history of other types of allergic reactions, having a disorder that makes one prone to angioedema or having a family history of hereditary angioedema or hives.
Complications of urticaria or angioedema include problems breathing, loss of consciousness or true anaphylactic shock. This can affect the blood pressure and heart function and can make it difficult to oxygenate the lungs.
Testing for hives or angioedema can involve just being able to see when the condition is active. Because the lesions and symptoms can come and go, this is often difficult. Pin prick testing for allergens can determine if you are allergic to an item. Intracutaneous testing involves injecting the substance beneath the skin to see if the allergen is penicillin or venom from an insect. A patch test uses an allergen applied to the skin to see if a reaction happens to the skin upon application of the substance to the skin.
Treatment may not be necessary if the symptoms are mild. The most basic treatment for urticaria and angioedema includes antihistamine therapy. These include diphenhydramine in Benadryl, chlorpheniramine, loratidine or Zyrtec (cetirizine). Some cause drowsiness and some do not.
Treatment for hereditary angioedema includes the use of long term use of androgens, including Danazol. These medications regulate the various blood proteins and prevent attacks of urticaria or angioedema.
In emergency situations-when angioedema is severe, for example-you may need an immediate dose of epinephrine via an Epi-Pen or other device that stops angioedema complications.