HIVES

Urticaria. What is it

Urticaria is a skin disease very frequently characterized by three fundamental aspects: 1) the itching, 2) the presence of "bumps" that is, of rilevatezze the skin of varying shape and size, or sometimes pale pinkish in color, 3) the fugacity of these hives that more or less rapidly disappear and then reappear in poussèes, accompanied by itching, body site diverse.La transience of the elements and their reappearance in subsequent throw is a characteristic element so that the rash is probably ' only skin disease for which it is possible, in front of the story elements itchy that disappear and reappear, diagnosis remotely.
In some cases and in particular sites (eyes, ears, scrotum, hands, feet) can coexist with the hives hives swelling also remarkable tissue (angioedema), which, on the contrary is not very or not at all itchy, and sometimes even accompanies pain. The two rashes, urticaria and angioedema, are two sides of the same disease that, in fact, is more properly called urticaria-angioedema (O-AE).
There are two main forms of urticaria distinguished by the duration of the disease: acute urticaria, when the disease persists for a period of less than 6 weeks, and chronic urticaria in which the cast of itchy bumps are repeated over 6 weeks.

Urticaria is an allergic disease ever?

And 'This is a very widespread opinion, even among physicians, but wrong. Parents of children with urticaria usually turn to the doctor urging allergy testing, especially for food and drugs, often driven by medical colleagues for which equivalence = hives allergy is an absolute principle. In fact it is not, indeed it can be said with confidence that very rarely allergic rash is an event that is probably much more just always think that it is not unless there was evidence to the contrary. In cases where the rash is related to a mechanism (allergic to food or drugs mainly) the relationship between the intake of food or drug and the appearance of the eruption itching is very clear: if the rash is an allergic rash appears immediately after, maximum within 15-20 minutes of taking them by the child. The relationship is as net which is usually the mother to the diagnosis and to identify the food or the drug responsible.
In most cases, however, as mentioned, the cause is different. For acute urticaria the most common cause is infection, particularly against viruses but also bacteria, also occurred in the two weeks prior to the eruption. Therefore faced with a rash does not appear in the closest relationship to time with the use of drugs and food, the first thing to look for is the presence of an infection, respiratory or intestinal even past. Often it is in a competition game of factors: the virus may act synergistically with the drugs and their additives (preservatives, coloring agents, sweeteners etc.)
in chronic, ie in the form that continues over time, the motive is not practically allergic never cause: allergy testing that are always executed in the young patient with a rash that persists over the fateful six weeks are almost always negative, so it is basically useless to run them. The reasons for chronic urticaria are often not detectable (so-called idiopathic urticaria) for those tests to be performed. Other times are present in chronic "autoantibodies", ie antibodies which improperly the body produces against its own components, for which the chronic urticaria is not so much an allergic disease since, at least in these cases, a disease so-called "autoimmune ". In the latter case sometimes chronic urticaria is accompanied by other autoimmune diseases such as thyroiditis or celiac disease. A proportion of chronic urticaria (but also those acute) is also represented by the so-called hives "physical" (cold urticaria, acquagenica, by pressure, by heat, by "dermographism" that is, in the simplest words possible, by particular susceptibility to contact). Sometimes, finally, chronic urticaria is connected to outbreaks of infection dental or of the paranasal sinuses or of the urinary tract or, finally, of the gastrointestinal tract.

They are useful tests and what tests should be performed?

On the occasion of the first episode of acute urticaria is not usually necessary, for the reasons previously said and for the fact that it is a benign disease with a tendency to spontaneous resolution in a short time, run any diagnostic assessment. Investigations allergy are executable in those cases, a minority, in which, as explained just now, is suspected allergic origin. In other cases, when the medical history of the child is indicative in this sense can be made ??of the specific tests of physical urticaria (ice cubes for cold urticaria, pressure urticaria weights, running or other for hives by heat, stimulation of the skin with a blunt tip for dermographism etc.).
In the case of chronic allergy as said the findings, which are usually well executed, are almost always negative. You can run, once excluded with a thorough and careful collection of medical history of the child the hives by physical factors, a number of investigations in search of hidden foci of infection, intestinal parasites, germs such as Helicobacter pylori as not all are in agreement that intestinal parasites and Helicobacter may be responsible for urticaria. Sometimes they also perform provocation tests (practice tests in the absence of laboratory tests available) with food additives in food additives are not as frequently responsible for chronic urticaria as once thought. Finally, the big slice of chronic urticaria autoantibodies can perform skin testing with serum derived from the same patient's blood (Test dell'autosiero) and evaluate, with specific tests, the possible coexistence of thyroid disease or celiac disease.
Tests do not always, however, to identify the cause of urticaria and independently of the knowledge of the cause to the doctor plan treatment that competes, if well managed, can be decisive.

Urticaria is dangerous?

Urticaria is rarely dangerous and in any case is never dangerous hives isolated, without other disorders. Often parents of young patients are scared because they are afraid that the hives can evolve to the obstruction of the airways (glottis edema, asthma) or to anaphylactic shock. This is what is often told by their doctors making a dramatic condition that in reality, regardless of the annoying itching and the psychological aspects that involves chronic form, it is not serious and is in most cases trivial.
Urticaria is dangerous only when it is inserted, from the outset, in a general framework of anaphylactic allergic reaction. That is, when a rash itself has the characters allergic urticaria (sudden onset in close temporal relationship with the intake of a drug, a food, a bee sting or a wasp, with the administration of a vaccine, with the execution of physical exertion) and since its appearance is accompanied by symptoms affecting the respiratory system (in a low voice, cough, obstruction in the throat, shortness of breath, wheezing) and / or the cardiovascular system ( feeling sick, feeling of faintness, sweating, pallor, rapid pulse). In these cases, of course, the rash is a symptom of anaphylaxis that can sometimes help to interpret as a severe allergic reaction to the more important symptoms of the respiratory and blood circulation.
Truly, then, the nell'anafilassi 'hives when there is a late event and follows other symptoms so you might say that when the rash appears in the anaphylactic reaction itself is ending and the danger of life is probably gone.
Apart from this particular situation therefore hives isolated, that is what we see currently in our studies and in our emergency department, is never dangerous and never occurs as isolated rash can, over time, result in the most dangerous symptoms. Urticaria is dangerous if it is right away, otherwise it is not anymore.

The relief of

It 'obvious that if the rash is one of the symptoms of acute allergic reaction of anaphylactic therapy will be that of anaphylaxis with oxygen, intravenous fluids, adrenaline, steroids, antihistamines iniettivi.Negli other cases the treatment of the election of 'hives are antihistamines by mouth. Cortisone medication, which probably is abused in the ER, is a drug of great utility but its use should be limited to special conditions such as the presence of angioedema or, for short periods, in chronic.
Nell'orticaria Acute using usually only one antihistamine for a period of time of 7-15 days. It 'important that parents know that the rash is not limited to a single cast but, despite treatment, there are other possible throw and therefore there is no need to worry if your child still in the days following the first eruption, after apparently everything had disappeared, one or more new itchy rash: This is a normal occurrence that does not express an inadequacy of therapy or a particular hazard or a particular meaning morbid event.
In the chronic form of urticaria can be used also two antihistamines simultaneously and must be used for each, at high doses. The treatment also has to be very protracted, up to one to two months after the disappearance of all symptoms. In fact because the hives disappear definitively is necessary to keep it under control for a period of time as long as possible. To suppress the hives must prevent the recurrence for as long as you can because, as they say "the hives is urticaria" that there is a mechanism of self-renewal (lability mast cells acquired) for which the poussèes facilitate poussèes other in a vicious circle .
nell'orticaria diets are useful for at least doubtful, all in chronic elimination diets of various foods and food groups do not appear to be practically useful as ever not seem useful diets without additives. Nell'orticaria acute, as the utility is not certain, can you recommend for some time without a power supply so-called food rich in histamine and histamine that may contribute to the maintenance of the disease.
Obviously in cases of urticaria food allergy or drug or physical factor etc. is essential to the avoidance of the causative factors.

Common Mistakes

1. Consider always and in every case the hives allergy. Urticaria is more often due to reasons not allergic.
Nell'orticaria the most frequent cause is acute viral infections and in cases where the cause is an allergy relationship with the drug or the food is so obvious that in is generally the same mother and told.
in chronic allergy has nothing to do ever: it is therefore completely useless stubborn allergy investigations in more or less complessi.2. Administer steroids, also intramuscularly or intravenously, nell'orticaria acute. Urticaria is an isolated event that benefits all benign perfectly antihistamines. The use of cortisone is allowed, but in a single dose, when there is angioedema, which is the swelling of eyelids, ears, lips, etc..
3. Not inform the parents that the rash is a disease poussées to throw next. Parents often resort to the emergency room when they see reappear on baby's skin these spots and swelling after these had disappeared, and while your child is taking prescribed medications. You have to tell them that, despite therapy for a few days there may be other eruptive thrown but they are not dangerous and that this is the normal pattern of the disease.