Urticaria is an itchy plaques or skin rash that occurs on the skin surface, varying in size from a few millimeters to several centimeters, often pale in the middle. This picture, which we define as urticaria, usually fades within 24-48 hours and does not leave any traces on the skin.
Urticaria can be seen alone, or it can be accompanied by swelling, which we call approximately 50% angioedema, without collapse when stepped on. When it is associated with angioedema, the subcutaneous layers are also affected besides the skin surface. It is important that angioedema generally affects the lips, tongue, eye area, hands, feet and genital areas. In addition, there is a feeling of pressure, burning, pain rather than itching. Patients may have itchy, red skin blistering lesions that can be all over the body, along with swelling on the eyelids and lips.
Urticarial lesions are defined as acute if they last less than six weeks. Lesions are defined as chronic if they persist for more than 6 weeks.
Urticaria/angioedema is a very common skin reaction. The risk of developing it at any time in a lifetime ranges from 15-25% in humans. There is a possibility that we will have an attack of urticaria throughout our lives. Especially acute urticaria is more common in young adults and children. Chronic urticaria is less common (1%) and is more common in adults and women.
HOW IS A URTICARIC RAP IN ADULTS
Urticaria is a red itchy plaques or skin rash that occurs on the surface of the skin, varying in size from a few millimeters to several centimeters, often pale in the centre.
Urticaria rash usually occurs suddenly in any part of our body. Small blisters may form on the skin. These blisters and rashes can be as large as a pinhead or larger and are itchy. The bumps appear in white or red.
Sometimes it occurs in very few numbers, but sometimes it can be in various parts of the body or in enough to cover the whole body. When the blisters start to fade, the redness around it may remain, then these reddened spots disappear and the skin returns to normal. Generally, the lesions disappear without a trace between 24 hours and 48 hours. If the redness and swelling remain without disappearing for more than 24 hours and leave a light brown trace when disappearing, if it is accompanied by other complaints such as joint pain, fatigue, fever, it is necessary to consider that urticaria is not due to allergic reasons, but to a more serious cause such as vasculitis affecting the vessels.
WHAT ARE URTICARE SYMPTOMS IN ADULTS?
While everything is progressing normally, most of the patients say that they start to complain of itching and redness in the body in a way they can’t understand, sometimes they say that they have itchy red skin rashes all over their body when they wake up. Skin rashes, which we define as acute urticaria, appear spontaneously and may disappear on their own.
They say that some of the patients have itching that they cannot pinpoint, and then typical urticaria lesions appear.
Urticaria is sometimes especially noticed by the patient how it occurs. It can happen when you exercise, sweat, go out in the sun, in heat or cold. Urticaria can be affected by psychological factors and may occur in intense stress situations.
In an adult patient; Urticaria should be considered if there is a raised, itchy red skin rash with a pale middle that lasts for more than 24-48 hours, if it occurs spontaneously in one part of the body and then disappears, if it is accompanied by generalized body itching or swelling on the eyelids and lips.
WHAT ARE THE CAUSES OF URTICARIA IN ADULTS?
Many factors have been blamed for urticaria. The most important causes of acute urticaria are drugs, foods and infections. In most cases (80%-90%) of chronic spontaneous urticaria, the cause is not clear. In fact, while investigating the causes of urticaria, the most important thing is to take the patient’s history in detail. With a detailed story alone, we are more likely to find the reasons. It is very important to get an appropriate and detailed history from the patients, and the causes that may be responsible for chronic urticaria should be investigated.
Patients are generally bothered by itching that they cannot locate in the whole body. Typical urticaria lesions appear after patients complain of itching. The typical lesions we see on the skin in urticaria appear in a short time and then disappear. Urticaria plaques do not stay in the same place for more than 24 hours, lesions may recur during the day. Urticaria plaques can be commonly seen in the form of skin redness or raised lesions on the arms, legs, and the whole body, or they can be a few millimeters in size like a pinhead, sometimes pale and very similar to each other.
Many reasons in the formation of urticaria mainly cause the secretion of chemical substances such as histamine from the allergy cells in the skin. These substances cause the veins to expand in that area, and the fluid (serum) to leak out of the vein, causing them to leak into the intradermal area and cause itching. In addition; the same allergy cells secrete other chemical substances in a later time, such as 5-6 hours. These newly secreted substances cause the lesions to last longer. As a result, skin redness, itching and swelling occur. These chemicals are eliminated in the body in a short time. Urticaria plaques disappear in one part of the body and appear in another, usually they do not stay in the same place for more than 24 hours.
Since drugs and foods are among the most common causes of urticaria, tests related to these can be done. Apart from this, many reasons such as allergens (inhalation, contact), Transfusion reactions, Infections (bacterial fungal viral helmitic), Insect stings, rheumatic collagen tissue diseases, Malignant diseases (tumors), autoimmune diseases (Hashimoto’s thyroiditis) can be listed.
When we look at the causes of urticaria, urticarial complaints may occur in the course of many diseases. Among these, conditions such as foods, drugs, common allergens, hormone treatments, environmental factors such as heat, cold, sunlight, water, pressure on the skin, emotional stresses and exercise are more likely to cause hives.
WHEN TO SEE A DOCTOR FOR ADULT URTICARE
Urticaria is a red, itchy plaques or skin rash that occurs on the skin surface, varying from a few millimeters to several centimeters in size, often pale in the middle, and is often pale in the middle. This picture, which we define as urticaria, usually fades within 24-48 hours and does not leave any traces on the skin. Urticaria disappears without leaving a permanent trace, but it causes serious problems such as depression because it affects the quality of life of patients and their comfort of life. Urticarial plaques may sometimes herald a pre-existing disease or may appear during the course of the disease. Therefore, urticaria should be considered and its causes should be investigated.
If urticarial eruptions persist for more than 6 weeks, it is considered as chronic urticaria and underlying diseases should be investigated.
If urticarial complaints with a sudden onset exceed 6 weeks
If persistent and persists in the same place for a long time
If it affects the respiratory tract
Weakness other than urticaria, fatigue, joint pain, skin If there are other complaints such as dryness, it should be investigated in diseases that may be related to internal diseases. It should be examined in detail by specialists trained in allergy diseases on internal medicine. Especially infectious diseases such as autoimmune diseases, rheumatic diseases, hepatitis should be investigated.
WHAT TO DO WHEN GOING TO THE DOCTOR FOR URTICARE IN ADULTS
While everything is normal, most of the patients usually say that they don’t understand, that they start to complain of itching and redness in the body, sometimes they say that they have itchy red skin rashes all over their body when they wake up. It is necessary to investigate the cause of these complaints, especially in patients with urticaria complaints that persist for more than 6 weeks. While investigating the causes of urticaria, patients’ own observations and history can be extremely important.
There are some preparations you need to make before the examination in order to make the examination better for you and your doctor. Here’s what you need to do to be ready before the examination;
-When the symptoms occur and how long they last can be noted down by the patient. In urticaria complaints, sometimes foods and medicines can cause complaints even though they have been used many times before.
-We should not forget that urticaria, which has many causes, can occur for many reasons, including vitamins, herbal medicines or supplements that we use in our lives but think are not important. That’s why we should write down all kinds of products we use
– Write down the questions you will ask your doctor before the examination so that they are not forgotten during the examination.
-Urticaria can sometimes occur at the first sign of the disease or during the course of the disease. That’s why we should definitely tell you about our previous diseases and treatments. Sometimes a hypertension drug that we have been using for a long time can cause severe throat swelling, angioedema.
-Since urticaria may be an underlying allergy, your allergist may perform a skin allergy test for diagnosis. For this reason, stop the allergy, pain reliever and depression medications that he is using 1 week before the examination.
-Bring your previous test or x-ray results with you.
HOW IS URTICARIA DIAGNOSED IN ADULTS
Urticaria is a red, itchy plaques or skin rash that occurs on the surface of the skin, varying from a few millimeters to a few centimeters in size, often pale in the middle. This picture, which we define as urticaria, usually fades within 24-48 hours and does not leave any traces on the skin. That’s why it’s sometimes overlooked. In particular, the underlying causes of urticaria lasting more than 6 weeks should be investigated.
The diagnosis of urticaria is made by anamnesis and physical examination. Before laboratory findings, a careful history of the patient should be taken and then an examination is performed.
It should be kept in mind that drug and food allergies may be the underlying causes of urticaria. If patients have complaints about food, food skin tests should definitely be done. If foods increase their symptoms, it may be important whether they increase when removed from the diet and reintroduced.
It should be explained that drugs, especially drugs in the NSAID group, increase urticaria attacks and that precautions should be taken.
In patients with urticaria, blood tests are requested, which can be helpful in diagnosing according to the patient’s history. These may have anomalies in the complete blood count and erythrocyte sedimentation rate. In cases with urticaria, eosinophilia may be a guide for the detection of parasitic infection or atopic condition.
Since there may be many diseases other than allergies among the causes of urticaria, these causes should be revealed. In urticaria of unknown cause other than allergy, ANA, thyroid peroxidase antibodies, complement profiles, hepatitis markers and serum protein electrophoresis should be studied.
Some special diseases may only occur with angioedema. The C4 level is low in the disease we call hereditary angioedema. If it is necessary to look at the C4 level of the patient, it will be useful to measure the C1 inhibitor level and function.
SHOULD ALLERGY SKIN TEST BE DONE IN THE DIAGNOSIS OF ADULTS URTICARIA?
In patients who are thought to have urticaria by allergy specialists, skin allergy test and blood allergy test may be required to determine the cause. If food allergy is considered among the causes of urticaria, allergic food can be detected by skin prick test, and a treatment path is followed accordingly.
After the nutrient has been identified, it is recommended to remove the nutrient and all foods containing that nutrient from the diet list.
Urticaria can sometimes reproduce during pollen seasons. Especially in those with pollen allergy, urticarial rashes occur when patients eat fruit or vegetables, as sometimes there is a cross-reaction between pollen in fruit and vegetables. Although the main cause of this picture, which we call oral allergy syndrome, is pollen allergy, there are complaints with cross-reactive fruit. Therefore, it is necessary to do skin tests to understand whether there is a pollen allergy in patients with urticaria.
If patients cannot have skin tests, sometimes food or other allergens they are allergic to can be found with blood tests, but blood tests are less sensitive than skin tests.
HOW TO TREAT URTICARE IN ADULTS?
While everything is progressing normally, most of the patients say that they start to complain of itching and redness in the body in a way they can’t understand, sometimes they say that they have itchy red skin rashes all over their body when they wake up. Skin rashes, which we define as acute urticaria, appear spontaneously and may disappear on their own.
In acute urticaria, sometimes the symptoms are severe once and may not recur afterwards. Patients may not need medication. Especially in chronic urticaria lasting more than 6 weeks, drug treatment is required depending on the intensity of the complaints.
Urticaria treatment; If there is an underlying disease in the treatment, it is treated. Allergic urticaria angioedema will resolve completely in a short time if contact with the allergen can be cut off. If we can find the cause as a result of the tests performed for the diagnosis of urticaria, it is very important to avoid the allergic food or allergen. If we cannot detect the cause of urticaria, that is, idiopathic urticaria, drug treatment is required.
The first drugs used in the treatment of urticaria are antihistamine drugs. Normal doses of antihistamine drugs may not be sufficient. For this reason, higher doses of antihistamine drugs that can suppress the patient’s complaints or combinations can be used. Unfortunately, the most important problem with antihistamine drugs is that they cause side effects such as drowsiness, distraction and concentration disorder, and increased appetite. In another problem, after a while, its sufficient effectiveness is lost and becomes ineffective. Therefore, patients cannot see the same effect even if they use the drugs for a long time.
Corticosteroids are other drugs that are effective in urticaria. However, long-term use causes serious side effects. Corticosteroids are sufficient to control complaints, especially in acute urticaria. In patients with intense urticaria complaints, short-term cortisone treatment can be applied. It is not recommended to use long-term cortisone treatment as it will bring side effects.
Patients with life-threatening angioedema or anaphylaxis attack respond to adrenaline (epinephrine)
Many drugs have been used for the treatment of chronic urticaria, some of which have immunosuppressive properties. Immunosuppressive drugs such as cyclosproin have had effective treatment results, but they should be used very carefully because of the problems that will occur when we suppress the immune system.
They are H2 receptor antagonists used as stomach drugs that suppress histamine receptors in other auxiliary drugs in patients with urticaria. The patient’s use of drugs such as ranitidine and famotidine together with antihistamines can also reduce urticaria complaints.
ARE THERE NEW DRUGS FOR THE TREATMENT OF ADULT URTICARIA?
Chronic urticaria poses very serious problems for patients. In some of the patients, it can cause distressing problems that lead to serious depression. Newly developed drugs in the treatment of urticaria have been extremely effective in eliminating these problems
Omalizumab is a new drug treatment that has been used recently. Anti-IgE treatment completely improves the symptoms of the disease in more than 90% of chronic urticaria patients. Omalizumab is a drug that inhibits the effect of IgE antibody, which plays a role in the formation of allergic diseases. Omalizumab has been started to be used in the treatment of chronic idiopathic urticaria, whose symptoms cannot be adequately controlled with these drugs despite still taking antihistamines or corticosteroids. It is used as a subcutaneous injection every 4 weeks. It is applied under the control of allergy specialists. Although the duration of treatment is variable, the duration is 3 months, especially in chronic urticaria. In case of need, it can be used safely for longer periods depending on the patient’s complaints being under control.
With omalizumab, urticaria is now treated more easily. With the treatment that patients receive as an injection once a month, their quality of life increases immensely. Many restrictions in their lives disappear over time.
In the near future, patients will be treated more rapidly with anti-inflammatory and immune modulatory agents. 5-Lipooxygenase inhibitors, PG-D receptor antagonists produced for the treatment of allergic diseases are expected to be effective in chronic urticaria.
There are more and more effective treatments available to allergists to treat urticaria. After the causes of urticaria are investigated, treatment can be done.
