Rash with allergic urticaria description. Types of urticaria, localization and treatment features of the problem

When a person goes to the doctor with obvious allergy symptoms, not every disease can be identified immediately.

This also applies to hives. The term urticaria refers to several diseases that have only their own mechanism of development and causes of appearance, but at the same time clinical manifestations common to all such ailments.

Therefore, it is important to know what urticaria looks like in order to promptly seek the help of a doctor and prevent the transformation of the pathology into a chronic form.

Urticaria is an immediate allergic skin reaction. The occurrence of the disease is due to various factors. This disease is one of the most common.

Every third person has encountered it at least once. Urticaria ranks second among all allergic ailments, right after asthma. Pathology can develop both in a child and an adult. To accurately determine the cause of skin rashes, you need to know the main signs of urticaria in adults.

Often, the disease is characterized by:

the appearance of spots;
the occurrence of blisters;
edema and hyperemia of the dermis;
intense itching;
skin rashes without pain;
Quincke's edema (sometimes).

A characteristic feature of the pathology is the disappearance of the elements of the rash during the day. After a rash on the dermis of the body or face, there are no residual effects in the form of scars or scars. Outwardly, the rash looks like an insect bite or a nettle burn.

The size of the rash on average reaches several centimeters. It rises above the surface of the dermis and has clear boundaries. This disease has been known since the time of Hippocrates. Already at that time, people knew what hives looked like.

For the first time, the term "urtica", which translates as "blister", was proposed by the scientist Kuplen. Today, according to statistics, more than 15% of the world's population suffers from pathology, of which 50% is an acute form of urticaria. Children are more susceptible to the development of the acute form. Chronic urticaria is often diagnosed in adults. The disease occurs in 20% of cases and more often in representatives of the weaker half of society after 30 years.

There are several types of pathology: cholinergic, dermographic, solar. They differ in the course, manifestations, duration and nature of the rashes. The acute form of the disease is characterized by a rapid onset. Rashes in this pathology occur suddenly.

They can cover any part of the skin. First, intense itching of the dermis appears, then swelling and hyperemia of the dermis, then the formation of bright pink blisters is noted. Exudate due to the release of blood cells from the vascular bed can acquire a hemorrhagic character.

Rashes in acute form can be localized both on the body (stomach, back, legs, arms) and on the face. If a person knows what urticaria looks like, he will be able to go to the hospital in time (in the initial stages), be cured and prevent the transition of the pathology into a chronic form.

Signs of urticaria: the main manifestations of acute and chronic forms of the disease

Depending on the duration of the pathology, acute, chronic and episodic urticaria are distinguished. The disease in acute form is characterized by a rapid course. From the appearance of the first blister to the disappearance of the last one, as a rule, a month and a half passes.

The main signs of acute urticaria are intense itching of the skin, malaise, headache, fever. Often there is a fusion of the elements of the rash with each other and the formation of large foci. As for the localization of the rash, the disease often affects the arms, torso and buttocks.

Often, the tongue, lips, nasopharynx and larynx are affected by the rash. Because of this, there are complaints of difficulty breathing and swallowing. The clinical symptoms of acute urticaria do not last long. The rash disappears after a few hours. The diagnosis of chronic urticaria is established in the case of a prolonged course, more than six weeks. The main signs of urticaria: undulating prolonged course, mild rash, joint pain, fever, headache, intense itching.

If the ailment has affected the gastrointestinal mucosa, the appearance of diarrhea, nausea and vomiting is noted. Often, in the chronic form of the disease, urticarial elements are transformed into papular ones.

Due to scratching, the appearance of pustules and other elements is observed. If urticaria occurs, you should immediately seek the help of a qualified specialist.

After a thorough examination, he will prescribe treatment. There is also episodic urticaria, characterized by an acute onset and a short course. The main sign of urticaria and a distinctive feature is the disappearance of all its manifestations. After stopping the disease, the dermis becomes normal, without spots and scars.

Urticaria disease: symptoms and how the rash is treated

There are cholinergic, dermographic, papular and solar urticaria. Urticaria disease has pronounced symptoms. However, depending on the type of pathology, the manifestations are somewhat different.

Dermographic urticaria is one of the most common varieties. Pathology occurs due to mechanical irritation of the dermis and is accompanied by the appearance of bands protruding above the dermis. Rash urticaria and blisters in this type of ailment are localized in the course of scratching.

Rashes often appear on the body. There are primary and secondary dermographic urticaria. The occurrence of the primary is due to the effect on the skin of the allergen: wool, chemical, and the secondary - the existing disease (serum sickness or mastocytosis).

There are several types of this type of pathology:

immediate type. It is characterized by the onset of symptoms after a few minutes after exposure to an irritant. The duration of the course is half an hour;
medium type. Develops in about half an hour and lasts up to nine hours;
late type. The urticaria rash occurs five hours after exposure to the irritant and resolves in two days.

No less common is cholinergic urticaria. What allergic urticaria looks like can be seen in the photo. People 15-30 years old are more susceptible to the occurrence of pathology. The development of the disease is provoked by emotional stress, intense physical activity, increased sweating, hot showers. The main symptom of cholinergic urticaria is the appearance of small, pinpoint blisters of a pale pink color.

Symptoms of the disease urticaria, after half an hour after the end of the action of the stimulus disappear. Rash elements occur either on large areas of the body, or not on the whole body. Sometimes the disease is accompanied by bronchospasm, pain in the head, pre-syncope and fainting. The occurrence of solar urticaria is due to the action of ultraviolet radiation on the dermis. Representatives of the weaker half of society are more susceptible to pathology.

Localization of the elements of the urticaria rash - open areas of the dermis - face, shoulders, arms. This disease is characterized by seasonality. It often appears in spring and summer. The disease is accompanied by the occurrence of swelling, itching and rash. The development of papular urticaria is provoked by the transformation of a long-lasting urticarial rash into a papular one.

The ailment is characterized by the addition to the manifestations of persistent edema with cellular infiltration of hyperpigmentation of the dermis, as well as thickening and keratinization of the skin. Localization of the rash - bends of the limbs. Papules are bright red in color. In children, the pathology is more severe than in adults. It is characterized by the appearance of a rash on the limbs and trunk, intense itching, and fever. The child becomes irritable, whiny.

The duration of the course of the disease can be as much as half an hour, or several hours and even days. There are acute and chronic childhood urticaria. With urticaria in children, the disease has more pronounced symptoms. The most dangerous variant of the course is Quincke's edema, accompanied by a rash on the lips, cheeks, tongue, and larynx. Swelling of the mucous membrane of the upper respiratory tract is fraught with difficulty breathing, coughing, and suffocation.

When such symptoms appear, you need to call an ambulance. When the gastrointestinal tract is affected, the appearance of rapidly passing diarrhea, nausea, vomiting, malaise, pre-syncope conditions is noted.

With proper and timely treatment, the disease disappears without a trace by the age of five to seven years. But it happens that it transforms into diffuse neurodermatitis or pruritus. Symptoms of hives in a child are similar to scabies.

This point must be taken into account when making a diagnosis. For the treatment of pathology, along with the elimination of the impact of the irritating factor and diet, antihistamines are prescribed: Loratadine, Ebastine, Cetirizine. If such antiallergic drugs do not bring the desired result, hormonal medications are prescribed - Dexamethasone, Prednisolone.

People with autoimmune urticaria, with low effectiveness of antihistamine medications, are prescribed immunosuppressants: Cyclosporine. Also, for the treatment of pathology, the use of antiallergic ointments is prescribed: Fenistil, Psilo-balm, Soventol, Flucinar, Fluorocort, Advantan, Clovate. The diet of a person suffering from urticaria should consist of hypoallergenic foods.

It is strictly forbidden to use products with preservatives, emulsifiers and dyes. It is not recommended to consume tomatoes, strawberries, coffee, spirits, spices, milk, poultry meat, nuts, oranges, tangerines, grapes, mushrooms, honey. It is recommended to use cereals on the water, vegetable soups, baked apples, fermented milk products, olive oil, apple compote. In addition, it is important to observe the drinking regimen.

It is necessary to drink at least two liters of purified non-carbonated water per day. In order to prevent the development of urticaria or exacerbation of the pathology, it is recommended: avoid contact with irritants, keep a food diary. People suffering from a chronic form of pathology are advised to keep antiallergic medicines on hand (Cetirizine, Loratadine). They will help to quickly eliminate symptoms and relieve itching.

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CLASSIFICATION

By type of effect on the skin:

Cold and thermal (respectively, low or high ambient temperature).
Vibrating (mechanical "shaking").
Dermographic (mechanical effect, reminiscent of drawing individual strokes).
Urticaria caused by pressure (squeezing of the skin, sometimes even slight).
Aquagenic (water on the skin).
Contact (occurring after direct contact of the skin with the allergen).
Solar (short exposure to the sun).

By type of mediator:

Cholinergic (hypersensitivity to acetylcholine); and adrenergic (hypersensitivity to adrenaline).

By clinical course:

acute;
giant urticaria (acute angioedema);
chronic relapsing;
persistent papular.

CLINICAL FORMS

A variety of clinical forms of urticaria often makes it difficult to quickly diagnose and timely treat this pathology.

Acute urticaria

This form of the disease is characterized by a sudden abrupt onset and is accompanied by a deterioration in the condition of patients. Rashes on the skin do not have clearly defined sizes and outlines. Blisters tend to merge, may contain hemorrhagic exudate. Their appearance is always accompanied by severe itching.

Giant urticaria (acute angioedema)

It is a limited swelling of the skin or mucous membranes with the obligatory involvement of deep layers, including subcutaneous fat. In most cases, it is located in the groin or on the face. May be accompanied by a burning or tingling sensation. If it occurs in the region of the respiratory throat, a fatal outcome due to asphyxia is possible.

Chronic recurrent urticaria

This form of the disease is due to the prolonged presence of foci of infection in the body. It can be seasonal and involve not only the skin, but also the mucous membranes of the internal organs. Characteristic is the alternation of periods of exacerbation and remission of indefinite duration. The appearance of rashes can be accompanied by excruciating itching, leading to neurological disorders.

Persistent papular urticaria

It is distinguished by the appearance of single itchy nodules of a dark red or brown color, mainly in the places where the limbs are bent. This form affects exclusively the skin, without involving the mucous membranes and deeper layers in the process. Often, a small blister forms at the top of the nodule, which disappears after a few days, and a bloody “crust” appears in its place. Itching characteristic of urticaria is not observed in this form, however, often the appearance of a “crust” is accompanied by stabbing pains and localized edema with a slight impairment of mobility.

THE REASONS

Urticaria is a polyetiological disease with a variable onset of the course, and it is sometimes not possible to say which allergen caused its occurrence in each specific case. They can become:

various physical factors (temperature, humidity, pressure);
direct contact with the allergen or its entry into the body;
various endogenous factors (pathological processes in the gastrointestinal tract, bacterial infection, diseases of internal organs, disorders of the endocrine system, metabolic processes or neurohumoral regulation).

Allergens can be: products of incomplete breakdown of protein molecules, various organic or inorganic substances (food, drugs, house dust, animal hair, plant pollen, etc.), as well as strong emotional experiences.

SYMPTOMS

The main signs of urticaria are: the sudden onset of a specific rash and the itching that accompanies it.

Rashes are small areas of redness of the skin (erythema), which quickly transform into blisters.

Blister- This is a characteristic element of the uritary rash, which is formed by a limited swelling of the dermis. The location of blisters on the body is usually asymmetric, their size can vary from a few millimeters to several centimeters. The color of the elements of such a rash is pale pink with areas of hyperemia along the periphery.

Sometimes the blisters merge, forming a rather extensive area of skin edema. Rashes are painless, not accompanied by fever. In most cases, such symptoms, with proper treatment, disappear in the first few days without a trace.

Especially dangerous spreading rash on the face. Due to the intensive blood supply to this area, the urticaria quickly merges. This is fraught with the spread of edema to the tongue and larynx with the formation of angioedema and symptoms of acute respiratory failure.

In childhood, the acute course of the disease is usually diagnosed. Chronic urticaria is extremely rare.

In children, manifestations of urticaria are accompanied by more pronounced exudative signs. The elements of the rash are edematous, rise above the surface of the skin. The intensity of itching is more pronounced than in adults. The course of the disease is often accompanied by a noticeable deterioration in the general condition, an increase in body temperature. Also in children, there is a high probability of rapid development of angioedema due to age-related features of the structure of the skin.

Symptoms characteristic of all clinical forms:

Variable worsening of the condition, swelling of the skin of the mucous membranes at the site of the localization of the process and itching or pain at the site of localization.

Symptoms of acute urticaria:

sudden appearance of rashes without clear boundaries;
fever, malaise, chills;
painful itching;

Symptoms of giant urticaria:

the sudden appearance of deep edema with localization in the groin, face or throat, accompanied by impaired activity of the organs located in these areas (difficulty breathing and urinating, decreased visual acuity, displacement of the eyeballs);
burning and itching at the site of the process;
sudden cessation after a few hours or days (with a favorable course).

Symptoms of chronic recurrent urticaria:

long course with alternating periods of complete remission and relapses;
possible pronounced seasonality of the appearance of symptoms;
headaches, general weakness, fever;
nausea, vomiting, diarrhea;
pain in the joints and muscles;
constant painful itching;
insomnia;
neurological disorders.

Symptoms of persistent papular urticaria:

pronounced seasonality of the occurrence of symptoms;
spot rashes, localized in places of natural skin folds (in the place of folds of the joints), accompanied by itching;
the appearance of dry bloody "crusts" on the tops of the rashes;
local swelling and soreness;
slight stiffness of movement in the joint.

DIAGNOSTICS

It is possible to diagnose urticaria already by identifying the characteristic elements of the rash. When conducting a clinical examination, it is important to correctly collect an anamnesis: the time of onset of the disease, the relationship with a possible provoking agent, the frequency and form of rashes, etc.

Considering that the symptoms and treatment of urticaria directly depend on the type and place of penetration of the provoking allergen into the human body, the main diagnostic methods are aimed precisely at identifying the cause of the disease.

The necessary volume of examination is prescribed by the allergist. In most cases, it is necessary to do a complete blood count, determine the level of IgE in the blood, conduct allergic skin tests, etc.

Urticaria is treated already at the first signs of the disease. With a known cause of this disease and its uncomplicated course, the necessary therapy can be prescribed by a therapist (in adults) or a pediatrician. Consultation with an allergist is mandatory in any case.

Treatment of the disease, as in all other cases, is mainly aimed at the complete elimination of contact with the allergen.

Principles of therapy for urticaria:

Elimination (elimination) or limitation of known factors provoking the development of the disease.
Medical treatment.
Careful examination of patients with subsequent treatment of pathologies that may be the cause of sensitization of the body.

In the case of an established cause of acute or chronic urticaria, it is necessary to completely eliminate or significantly limit the impact of the provoking factor on the body of a sick person.

So, with solar urticaria, direct exposure to the sun's rays on the skin should be avoided. To this end, you should use sunscreens with a high protection index (SPF 50 or more) and, unless absolutely necessary, do not go outside during periods of intense solar activity. To reduce sensitivity to sunlight, phototherapy or PUVA therapy is used. With aquagenic urticaria, a greasy cream or petroleum jelly is applied to the skin before contact with water.

For food allergies, follow a hypoallergenic diet with the exception of food allergens. However, one must remember the so-called cross-allergy, when an allergic reaction can occur not only when using a known allergen product, but also similar in chemical composition to it. For example, if you are allergic to strawberries, you may experience a reaction when you eat raspberries or currants. More accurate information about cross-allergy and the list of excluded products can be obtained from the allergist after the necessary examination.

Medical treatment

The use of drugs for urticaria is aimed at the pathogenetic mechanism of the development of this pathology and reducing the severity of symptoms of the disease.

Of the drugs used:

systemic and local antihistamines;
desensitizing drugs (in case of hypersensitivity to sunlight);
sedatives (with severe neurological disorders).

For the main treatment of urticaria, various antihistamines are prescribed for systemic and local use (H1-histamine receptor blockers). Currently, there are four generations of such drugs, differing mainly in their effect on the central nervous system. The selection of the necessary medication, its dose and method of administration is carried out by the doctor.

In severe cases of the course of this disease or with the ineffectiveness of antihistamines, it is advisable to prescribe drugs of steroid hormones of the adrenal glands (corticosteroids).

To reduce the intensity of itching, local anti-inflammatory and antipruritic agents (in the form of gels, ointments, solutions or aerosols) can be used.

With the food genesis of urticaria, enterosorbents are prescribed, laxatives are taken, sufficient fluid intake is recommended.

In the treatment of the chronic form of the course of urticaria, the main emphasis is on the long-term routine use of antihistamines with the obligatory correction of frequent concomitant symptoms. So, in the event of psychoneurological disorders, sedatives, antidepressants, tranquilizers, etc. are prescribed.

Also, for a cure, it is necessary to completely remove the foci of chronic infection, correct the disturbed hormonal status, and treat autoimmune diseases. You should follow a hypoallergenic diet with an emphasis on products of dairy and vegetable origin.

Traditional medicine in this disease should not be used. This is mainly due to the fact that herbal medicines, most commonly used in traditional medicine, can cause additional sensitization of the body and worsen the course of urticaria up to the development of acute conditions that threaten the life of the patient.

COMPLICATIONS

The acute course of the disease can be complicated by a life-threatening condition - anaphylactic shock. Acute swelling of the larynx and the development of respiratory failure are also possible. Such conditions require emergency resuscitation. Therefore, already at the first symptoms of urticaria, you should immediately consult a doctor for adequate treatment of this disease.

The chronic course of urticaria is often accompanied by a noticeable decrease in the quality of the patient and the occurrence of various neuropsychiatric disorders. They are mainly associated with a debilitating constant feeling of itching of urticaria elements on the body, as well as the aesthetic side of the problem.

PROGNOSIS FOR RECOVERY

With timely diagnosis, exclusion of the provoking factor and proper treatment, the prognosis, in general, favorable. With the development of complications, the prognosis is determined by the severity of the course of the underlying condition.

In the case of a chronic course of urticaria, the prognosis for recovery is less favorable and depends mainly on the completeness of the elimination of the provoking factor.

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Localization and nature of the rash with urticaria

With urticaria, the rash appears suddenly, it covers any area of \u200b\u200bthe skin. There are numerous blisters that have a bright pink color and cause severe itching. Bubbles have a dense texture. Their sizes vary from small pimples to huge blisters the size of a palm or more. The duration of the rash is 1-2 hours. Then the symptoms suddenly disappear, but new lesions often appear instead of old blisters. The total duration of an attack can be several hours or days. In rare cases, chronic urticaria is observed, it lasts for several months or even years. Sometimes the rash is accompanied by fever, headache, general malaise.

In medicine, it is customary to classify urticaria depending on etiological factors. There are light (allergy to infrared radiation, ultraviolet and other visible rays), toxic (occurs upon contact with an irritant), heat (typical for pregnant women, the elderly, premenstrual period), cold (the reaction to cold is not always noticeable immediately, it can occur after 1-2 days), mechanical, nutritional, medicinal form of the disease.

Chronic urticaria is often caused by dysfunctions of the gastrointestinal tract, kidneys, liver, helminthic invasions, toxicosis during pregnancy, foci of chronic infection, decay products secreted by malignant tumors.

Rash in a child urticaria

Pediatric urticaria is food sensitized. As a rule, it occurs with exudative diathesis, the most common in overfed or artificially fed children. It is also important to take into account other factors: local foci of infection (otitis, sinusitis, tonsillitis), allergic and toxic effects in infectious or gastrointestinal diseases, insect bites, various household and food allergens.

Localization and nature of the rash in pediatric urticaria

The sudden appearance of blisters quickly turn into pink-brown nodules. Their sizes usually do not exceed the head of a pin, at the top of the hearth there is a small bubble. When scratching, bloody crusts and erosion occur. Most often, the rash is localized on the upper limbs, in the area of large folds, in some cases all parts of the body are affected.

Prolonged rashes make children restless, capricious, irritable, their sleep and appetite worsen. In addition, various dyspeptic disorders often develop: constipation, diarrhea, vomiting.

The disease disappears without a trace by 3-7 years, but in some cases the urticaria transforms into pruritus, diffuse neurodermatitis. Children's urticaria is similar to scabies in terms of symptoms, this point is important to consider when making a diagnosis.

Quincke's edema

Quincke's edema is an acute process characterized by the sudden development of edema of the subcutaneous tissue, muscles, fascia. Typically, the edema is the size of a chicken egg or more. It occurs in the scrotum, oral mucosa, cheeks, eyelids, lips and other parts of the body with loose fiber. Symptoms persist for several hours, sometimes the swelling does not go away for 2-3 days.

The most dangerous phenomenon is angioedema in the larynx. In this case, there is a risk of death of the patient from asphyxia. First, hoarseness of voice appears, sometimes there is a "barking cough". Further, the symptoms gradually increase, shortness of breath and difficulty breathing increase. The face becomes first bluish and then pale. The victim needs urgent medical attention. Rational therapy is vital, within its framework, a subcutaneous injection of adrenaline 1 ml is used.

Treatment consists in prescribing desensitizing and antihistamine drugs after the allergen has been eliminated.

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Classification and etiopathogenesis

The mechanisms of development of various forms are very complex and still not well understood.

How long does the illness last? In most clinical classifications, in accordance with the duration of the pathological process, the following types of urticaria are distinguished:

Acute, which can last from a few minutes to 6 weeks. It occurs much more frequently and is diagnosed on average in 75% of all cases of urticaria.
Chronic. Its duration is more than 6 weeks. The chronic form with relapses occurs in 25%. This form of the disease in the natural course can last, basically, up to 10 years (in 20% of patients).

Among children under 2 years of age, as a rule, only its acute form develops, after 2 years and up to 12 years - acute and chronic forms, but with a predominance of the first, after 12 years, urticaria with a chronic course is more common. Chronic urticaria is most typical for people 20 - 40 years of age.

A regularity was noted - if the chronic process lasts for 3 months, then half of these people then get sick for at least 3 years, and with a preliminary duration of more than six months, 40% of patients suffer from its symptoms for another 10 years.

Remission in chronic urticaria can occur spontaneously, regardless of how this pathology is treated. In half of the patients, it occurs within the first half of the year from the onset of the disease, in 20% - within 3 years, in another 20% - 5 years, and in 2% - 25 years. In addition, at least 1 relapse develops in every 2nd patient suffering from a chronic course with spontaneous remission.

In addition, depending on the prevalence in the body, the disease is divided into options:

localized - on a certain limited area of \u200b\u200bthe body;
generalized (spread of rash elements throughout the body), which is a life-threatening condition, especially when localized in the area of organs of vital importance.

According to the cause and mechanism of formation of the reaction, the following forms of urticaria are distinguished:

allergic, caused by various immunological (cytotoxic, reaginic, immunocomplex) mechanisms of hypersensitivity (hypersensitivity);
non-allergic.

The reasons

The causes of hives are numerous. The most frequent of them are:

Inhalation allergens, for example, household and industrial aerosols, epidermal antigens, plant pollen.
Foods that promote the release of histamine contained in the body, or contain histamine themselves. These are eggs, cow's milk, pineapple, citrus fruits, honey, confectionery products with food additives in the form of salicylates and dyes, smoked products, many spices and mustard, fish products and seafood, tomatoes, legumes, eggplant, cheeses, extractives, alcoholic beverages. and others. In addition, the acute form of urticaria in persons suffering from hay fever can develop as a result of the use of those foods that contain antigens that cross with plant pollen. So, if there is a tendency to allergic reactions to pollen produced during tree flowering, urticaria may develop after eating nuts, berries and / or stone fruits, etc., sensitization to birch pollen can cause urticaria after eating carrots or apples, especially red ones. .
Viruses, bacteria and fungi.
External, internal and injectable drugs. Urticaria is very common after antibiotics, sulfonamides, antibacterial and anti-inflammatory drugs (salicylates, non-steroidal anti-inflammatory drugs), after taking anticonvulsants, vitamins, especially B vitamins and ascorbic acid, the use of antiseptics, iodine-containing drugs, including radiopaque agents , drugs used for arterial hypertension, coronary heart disease and heart failure (captopril, enalapril, hinapril, prestarium, enam, etc.), insulin, blood and its protein substitutes, dental implants, etc. Very rarely, but all- there is a reaction even to antihistamines and glucocorticosteroids.
Physical impact factors - pressure, friction, cold or elevated ambient temperature, vibration, sunlight, heavy physical exertion, bathing.
Poison wasps, bees, hornets, mosquitoes, bug bites, fleas and even grasshoppers.
Neuro-psychic load under the influence of psychogenic factors.
Tumor processes, thyroiditis, dysfunction of the thyroid gland and other endocrine organs, autoimmune diseases of the connective tissue, diseases of the digestive tract, etc.

The causes of acute and chronic forms of the disease are different:

Also in: Cold urticaria

Among all chronic forms of urticaria, idiopathic (with an unknown cause) occurs on average in 75-80%, in 15% - caused by a physical factor, in 5% - due to other factors, including allergic ones.

Development mechanisms

Under the influence of one or more causative factors, both immunological and non-immunological in nature, skin mast cells are activated with the destruction of their granules (degranulation), as a result of which mediators (biologically active substances) are released from them. They cause in the skin symptoms characteristic of acute local inflammatory processes.

In this case, the main biologically active substances are histamine and prostaglandins. Under the influence of histamine, local expansion of small vessels of the skin occurs with an increase in their permeability. As a result, there is a limited redness of the skin (erythematous spot) and swelling of the hypodermal or submucosal layer with the formation of a blister or papule. In addition to hyperemia and edema, these mediators cause itching, sometimes significant.

Prostaglandin D 2 and histamine are also activators of C-fibers secreting neuropeptides. The latter cause additional vasodilation and degranulation processes in mast cells, which determines the duration (more than 12 hours) of rashes.

Most often, acute urticaria is associated with allergic, that is, with immunological activation reactions of mast cells, on the membrane surface of which there are highly specific receptors for antibodies of immunoglobulin “E” (IgE), as well as receptors for cytokines, receptors C3A, C5A, etc.

Allergic reactions are mediated mainly by the participation of immunoglobulin "E". Characteristic of urticaria, regardless of the cause, are increased permeability of microcirculatory vessels and the development of acute edema in the tissues located around these vessels, with various manifestations of an allergic reaction.

In cases of the chronic form of the disease, immunological mechanisms are not excluded, for example, in the presence of autoimmune pathology (systemic lupus erythematosus, rheumatism, scleroderma, etc.). At the same time, in the chronic process, mast cells are more often activated by non-specific (non-immunological) stimuli (emotional stress, the influence of alcoholic beverages, the premenstrual period, physical factors, etc.).

In the last 10 years, the concept of the autoimmune nature of the chronic course of the pathological process has prevailed, according to which autoimmune urticaria is caused by the presence of autoantibodies to IgE receptors with high affinity and antibodies directed against IgE. This mechanism occurs in 30-50% of patients suffering from chronic urticaria.

Autoantibodies bind to the IgE receptor, resulting in the activation of basophils or mast cells, which leads to histamine-like reactions with corresponding symptoms. This principle formed the basis of a relatively new theory, according to which in some patients the chronic form is an autoimmune disease.

Other mediators, such as bradykinin, prostaglandins, neuropeptides, leukotrienes, and platelet activating factor, may also be involved in maintaining the chronic course. Mast cells in remission are restored to normal.

Is hives contagious and can you get rid of it?

Based on the description of the causes and mechanisms of the development of pathology, it becomes clear that it has nothing to do with infectious diseases.

What does urticaria look like and is it dangerous?

Clinical picture

The acute form is characterized by fairly typical manifestations. The onset of the disease is sudden. The main symptoms of urticaria are rashes, accompanied by severe itching and a burning sensation, sometimes a feeling of "bursting". In the chronic course of the disease, itching can occur at certain times of the day without the appearance of morphological elements.

As a rule, the morphological element is a rounded blister (less often a papule), protruding above the skin surface and having clearly demarcated contours. It resembles an insect bite or a stinging nettle and is a limited swelling of the dermal papillary layer, which is a few millimeters in diameter, but elements with a diameter of several centimeters can often be. With the dermographic variant of the pathology, the blister takes the form of a traumatic physical object (tourniquet, spatula).

The elements have a pale pink or red color, in the peripheral sections hyperemia is more pronounced. When pressed, they become pale in color, no pressure marks remain.

A rash with urticaria can be localized on any part of the skin - on the scalp, on the body, on the arms and legs, including the areas of the palms and soles of the feet. On the face and neck, the density of mast cells is very high, so usually the number of elements here is greater than in other parts of the body. Often they also occur on the mucous membranes, especially on the lips, soft palate and in the larynx.

The duration of the episode is determined from the moment the first element appears and the last element disappears. In most cases, the duration of the existence of blisters does not exceed 24 hours, during which they quickly appear, increase in size, and can merge with each other, acquiring a bizarre shape.

A small blister can thus turn into a giant element with an area of up to several tens of centimeters. Their merging with each other is accompanied by a deterioration in the general condition - general weakness, joint pain, headache, chills (“nettle fever”) appear, body temperature rises to 38 ° and above.

Then, also, for 1 day, the color intensity and clarity of the boundaries of the rashes decreases, after which they disappear without a trace - without the formation of secondary elements (pigmentation and peeling).

Against the background of the above symptoms, acute urticaria may be accompanied by cramping abdominal pain, intermittent pain in small joints, as well as in the elbow and knee joints (arthralgia), petechial hemorrhages and nosebleeds. Very rarely, and mostly in children, symptoms of meningism may develop.

Histologically, a classic wheal is an edema of the middle and upper dermis, as well as dilated venules and lymphatic vessels located in the upper dermis. In addition, an infiltrate around small vessels is determined in the skin, which consists of mast cells, blood cells (neutrophils and eosinophils) and T-lymphocytes.

In the case of edema spreading to the deep dermal layers, subcutaneous tissue and mucous membranes with similar histological changes (described above), the disease can occur in the form of a "giant urticaria", or acute limited angioedema angioedema.

angioedema angioedema

It accompanies 50% of cases of chronic urticaria, may occur alone or be combined with localized manifestations of the acute form.

Quincke's edema is characterized by an asymmetric location of pronounced painless edema on the face (in the area of the cheeks, lips, eyelids, auricle), which leads to its disfigurement, or on the external genital organs. The skin in the affected area becomes white or (rarely) pinkish in color. Angioedema disappears after a few hours or, at most, after three days.

In clinical practice, hereditary angioedema is especially distinguished due to a quantitative or functional deficiency of the C 1 inhibitor, which is a serum protein synthesized in the liver. With its deficiency, plasmin is activated, which is the starting factor for the development of edema. Pathology is hereditary. Edema is localized, as a rule, in the mucous membrane of the larynx and is provoked by psycho-emotional stress or microtrauma. Men are most often affected. The principles of treatment for this condition differ from those of other forms of therapy.

Why is urticaria dangerous?

The consequences of urticaria, as a rule, do not pose a danger to health and life. If a slight limited swelling of the mucous membranes develops, swelling of the tongue, conjunctivitis and rhinitis, cough, swallowing disorder, nausea and vomiting, diarrhea, and abdominal pain are possible. Edema of the mucous membrane of the larynx, especially in children under 1.5 - 2 years old, is dangerous for the development of stenosis of the larynx and respiratory failure in the form of suffocation.

At the same time, emergency care for urticaria and its nature are not determined by the causes that caused the reaction of the body, although they must be taken into account, but by the localization, severity and prevalence of edema and urticarial (blistering) rashes.

25% of cases of Quincke's edema develop on the neck in the larynx, resulting in a sudden swelling of the subcutaneous fat, muscles and fascia of the neck. This is manifested by hoarseness of voice, difficulty in breathing and shortness of breath, rapid intermittent breathing, barking cough, cyanosis of the face against the background of its pallor, anxious and excited state of the patient.

If the degree of damage is mild to moderate, this condition (without medical assistance) can last from 1 hour to a day. But, at the same time, after a decrease in the severity of symptoms, soreness in the throat, hoarseness of voice and coughing, difficulty breathing, especially during physical exertion (even minor ones), persist for some time, and scattered dry rales are auscultated over the lungs. If the edema spreads to the trachea and bronchial tree, a bronchospastic syndrome may develop with a fatal outcome.

With the localization of edema in the area of the mucous membranes of the digestive tract, nausea, vomiting appear, abdominal pain is possible, which at first is local and then diffuse. Against this background, false symptoms of intestinal obstruction or peritonitis may develop, while elements of rashes are present in only 30% of patients. This is the reason for the significant difficulty in diagnosis and in some cases - the reason for useless surgical intervention.

The development of Quincke's edema in the head area may be the reason for the involvement of the meninges in the process, especially in children, with the development of convulsive syndrome and meningeal symptoms.

Rarely, morphological elements can be papules or urticarial rash (papular urticaria) is transformed into them. Papules are usually found in women and children with a persistent chronic course and can persist for months. They are localized mainly on the limbs at the bend, have sizes up to 6 mm and are rich red in color with a brownish tint.

Papular elements rise above the skin surface and have a domed or flat shape. They are characterized by greater density and resistance than blisters, as well as the absence of a tendency to group and merge. The rash is accompanied by severe, sometimes unbearable itching. After the resolution of the elements, pigmentation and peeling often remain, and sometimes scars formed as a result of a purulent infection during scratching.

Diagnosis of the disease

Diagnostics consists of several conditionally sequential stages.

I stage

It consists in a careful collection of an anamnesis of the disease and finding out if the patient has concomitant somatic pathology. Maximum attention is paid to questions about the presence of a tendency to allergic reactions.

At the same time, the duration of the disease itself, the nature of the elements, their localization and prevalence, the frequency of occurrence and the duration of evolution, the dependence of the appearance on the season and time of day, the appearance of angioedema and subjective sensations in the area of rashes are necessarily specified. It is very important to establish the presence of predisposition to allergies of family members and a possible connection with a certain causative factor.

II stage

Includes an external examination of the patient, which determines the nature of the rash and / or angioedema, localization, the presence of pigmentation or peeling in the area of the rash. It is necessary to assess the general condition of the patient and conduct a preliminary diagnosis of possible somatic diseases (in the absence of anamnesis data on their presence), which may be the cause of urticaria or its provoking factors. In addition, at this stage, the nature of skin dermographism is also determined, but after a 2-day break in taking antihistamines or a week (at least) - immunosuppressants.

Stage III

Evaluation of the clinical activity of the disease in accordance with a specially designed 3-level point scale, which takes into account the number of blisters and the degree of itching intensity.

IV stage

Conducting a scream test with non-infectious allergens (skin pricking at the sites of application of various pollen, food, epidermal, household and contact allergens) and intra-skin tests with infectious (mycotic and bacterial) allergens. Tests are also carried out to diagnose other forms of the disease:

Duncan test (cold using ice cubes);
skin thermal - by means of a water compress with a temperature of 25 °;
tourniquet test;
mechanical, or stroke test with a spatula;
testing with suspension or application of the load;
bicycle ergometric test - to determine the reaction to the general physical activity;
phototesting.

Stage V

Includes laboratory diagnostic and instrumental studies. A detailed examination is determined by the need to identify diseases that provoke urticaria, especially chronic, or pathologies in which it is a symptom, for example, diseases of the digestive system, helminthiases, hepatitis, malignant neoplasms, lymphoma, systemic autoimmune connective tissue pathology, etc.

Therefore, the main laboratory and instrumental studies are clinical and biochemical (glucose, total protein, cholesterol, creatinine, urea, liver tests) blood tests, clinical urinalysis, RW, examination for hepatitis B, C and HIV infection, determination of total IgE in blood serum by enzyme immunoassay, ultrasound of the abdominal organs, ECG, esophagogastroduodenoscopy, chest fluorography and, if indicated, radiography of the paranasal sinuses.

Further examination is carried out depending on the results of the preliminary examination. For example, consultations of specialists of a narrow profile (otolaryngologist, gastroenterologist, etc.) are prescribed, if it is assumed that there is an autoimmune form of urticaria - intradermal tests using autologous serum, if thyroiditis is suspected - determining the content of antibodies to thyroid tissue in the blood, etc. d.

Treatment of urticaria and prevention of recurrence

Treatment of patients with an acute course or relapse of the disease is aimed at the fastest complete relief of all clinical manifestations, especially in cases of development of symptoms that threaten the patient's life. In addition, the goal of treatment is to achieve a state of the longest possible clinical remission in the chronic form.

Urticaria treatment at home and diet

Perhaps in cases of mild disease. In the absence of the effect of outpatient treatment, with moderate and severe course, as well as with angioedema in the vital areas (tongue, larynx), intestines, with abdominal syndrome, dehydration, in combination with anaphylactic reactions and in any conditions that pose a threat to life the patient is treated in a hospital, preferably an allergological one, and sometimes even in the intensive care unit. The duration of treatment in the allergology department is on average about 20 days.

Non-drug therapy provides for frequent wet cleaning and ventilation of the living space, exclusion of contact (if possible) with known or suspected causal and provoking factors, which are often detergents and other household chemicals, epidermis and pet hair, food.

What can you eat?

Nutrition should exclude foods containing histamine or contributing to its release in the body (citrus fruits, nuts, alcoholic beverages, extractives, etc.). In some cases, 2 - 3-day fasting is necessary, followed by a gradual transition to a hypoallergenic diet. A diet for hives is, as a rule, table number 7.

At the same time, it is recommended to use the so-called elimination therapy (to remove allergens from the body, etc.), which, in addition to nutrition, includes the use of diuretics, laxatives, and enterosorbents (Polysorb). On an outpatient basis, dysbacteriosis is also treated, chronic sources of infection in the body are sanitized, and, if indicated, specific immunotherapy.

Medical therapy

The choice of the volume of specific drug therapy is determined by the severity of the patient's condition. In all cases, the basic drugs for urticaria are first and second generation antihistamines. The first generation (classic) drugs mainly include Clemastine, or Tavegil, and Chloropyramine, or Suprastin in tablets for oral administration or in solution for intramuscular and intravenous, more often drip, administration.

However, the classic first generation antihistamines have a number of side effects in the form of drowsiness, slowing down of the reflex reaction, general depression of the central nervous system, dizziness, impaired coordination, blurred vision and double vision, dry mucous membranes and many others.

In this regard, the drugs of choice are second-generation antihistamines. Most of them are devoid of many side effects and can be used in high dosages. These include Loratadine, Fexofenadine, Cetirizine and Levocetirizine, Desloratadine, Ebastin.

Urticaria is a skin disease that manifests itself in blisters, similar to blisters from a nettle burn. Most often, blisters appear on the trunk, arms and buttocks, as well as on the mucous membranes of the nasopharynx, larynx and soft palate, on the tongue.

The main cause of hives is an allergic reaction. Urticaria can also be a manifestation of some other diseases: helminthic invasions, disturbances in the functioning of internal organs, or occur during blood transfusion. In addition to blisters, the patient may be disturbed by fever, headaches, and weakness.

Forms of urticaria

Urticaria is divided into acute and non-acute: acute urticaria lasts from several days to several weeks. Acute urticaria appears suddenly and is manifested by intensely itchy blisters of various sizes. Blisters with hives can merge, forming extensive areas on the skin. In such cases, fever develops: body temperature rises, chills and headache appear.

Chronic urticaria lasts for years, with periods of exacerbations and remissions alternating. Urticaria should be considered chronic if symptoms persist for more than 6 weeks. The cause of chronic urticaria is usually a chronic infection (caries, adnexitis, tonsillitis), dysfunction of the gastrointestinal tract, etc. In chronic urticaria, blistering may be accompanied by fever, joint pain, vomiting, and diarrhea. The excruciating itching of the blisters can lead to insomnia and neurotic disorders.

Depending on the cause that causes the manifestations of the disease, urticaria is divided into the following types:

dermographic - blisters with this type of urticaria have a linear shape and do not itch;
cholinergic - may appear during exercise;
cold - occurs as an abnormal reaction of the body to cold;
aquagenic - with an allergic reaction to water (or rather, to the substances contained in it);
light - caused by rays of sunlight, occurs in some people with liver disease;
thermal - occurs during the transition from cold to heat;
contact - develops after contact with the allergen;
medicinal - appears after taking medicines;
food - appears after eating an allergen;
mechanical - blisters may appear at the site of pressure on the skin (for example, after wearing heavy bags or backpacks) or after vibration exposure;
toxic - caused by house dust, pollen;
stressful;
idiopathic.

According to the type of localization of blisters, urticaria is divided into localized and generalized. Generalized urticaria is characterized by the presence of rashes all over the body, while the blisters often merge and itch severely. In severe generalized urticaria, angioedema may develop in the stomach, brain, or mucous membranes of the throat. In this case, you should immediately give the patient antihistamines and call an ambulance, since there is a serious danger to the life of the patient.

Urticaria localized on the skin gives the patient mainly psychological discomfort: large blisters formed on the body in a conspicuous place attract unwanted attention from strangers. Localized urticaria is usually accompanied by severe itching.

Localized urticaria indicates a mild allergic reaction of the body. Generalized urticaria indicates a severe, prognostically unfavorable development of the disease.

Mechanism of urticaria

Most often, urticaria occurs when the body is exposed to a substance that causes an acute allergic reaction in it. It can be food, antibiotics and other drugs, insect bites.

Blisters on the skin with urticaria appear as a result of increased vascular permeability and the development of edema around them. Vascular permeability can be increased by substances such as prostaglandins, interleukins, histamine, or serotonin. Accumulating in the body, such a chemical provokes the expansion of capillaries, which increases the permeability of the walls of blood vessels and the development of edema of the papillary dermis.

Diagnostics

Also, when determining the type of urticaria, the following tests can be carried out with the patient: the doctor will offer to pedal the exercise bike (if blisters appear after that, then the urticaria is cholinergic), the doctor may scratch the skin of the forearm (dermographic urticaria appears after scratches) or apply an ice cube to the skin ( so cold urticaria is detected). If all the results of the examination indicate exceptional health, then the patient is diagnosed with an idiopathic form of urticaria.

Urticaria treatment

A feature of such a disease as urticaria is the rapid disappearance of symptoms and external manifestations with adequate treatment. Great importance in the treatment of urticaria should be given not only to taking medications, but also to diet, the state of the gastrointestinal tract and the state of the nervous system.

When the first case of urticaria appears, to prevent the transition of the disease to the chronic stage, it is necessary to be examined for the presence of any chronic infections and treat them. You also need to be examined for the presence of helminths and consult an otolaryngologist and a neuropathologist. With the allergic nature of urticaria, it is necessary to identify the allergen as soon as possible to eliminate, as far as possible, any contact of the patient with it.

In the treatment of an acute form of urticaria with a severe course, glucocorticosteroids, laxatives and diuretics, antihistamines, hyposensitizing agents are used. If allergic urticaria develops after eating any product, the patient is prescribed cleansing enemas (for three days) and a special diet that excludes the food that caused the allergy, and foods that most often provoke the development of an allergic reaction (citrus fruits, chocolate, chicken, chicken eggs, canned food, carbonated drinks).

In order to alleviate the patient's condition in the acute form of urticaria, systematic treatment should be carried out for 1-2 days. In order to remove the symptoms of the disease in chronic urticaria, complex treatment is required for 2-3 weeks.

Urticaria is a disease that manifests itself as erythematous itchy elements that rise above the surface of the skin and, as a rule, increase with rashes. Urticaria or urticaria, from the Latin word urtica - nettle, is a disease of the skin in the form of small erythematous rashes. The rash is accompanied by itching and is most often provoked by allergies. The name "urticaria" rashes received because of the visual similarity with the blisters that remain after contact with the nettle. As a symptom, urticaria is not a specific sign, since it can be a manifestation of both an allergic reaction and another disease.

Approximately 10-20% of people have had hives at least once in their lives. Urticaria and angioedema are more common in girls.

Approximately 15-20% of children suffer from urticaria at least once. In most cases, urticaria has a mild course, but it can turn into a more severe generalized form, which in exceptional cases leads to anaphylactic shock or laryngeal edema. Urticaria can cause obstruction of the upper respiratory tract, threatening the life of the patient. The leading mechanism for the development of urticaria is the reaginic mechanism of damage. In blood transfusions, type II injury mechanism may be involved; with the introduction of a number of drugs, antitoxic serums, gamma globulins - the immunocomplex mechanism of damage.

ICD-10 code

L50.0 Allergic urticaria

Causes of hives

Acute urticaria in 90% of cases is the result of one or another type of allergy. The mechanism of formation of acute urticaria is based on the synthesis of specific immunoglobulins - IgE antibodies. More often urticaria is provoked by the following factors:

Medications - a group of penicillins, sulfonamides, non-steroidal anti-inflammatory drugs, glucocorticosteroids, diuretics and many others.
Food ingredients - products containing protein, tyramine, salicylates, pollen.
Insect bites.
Other causes that provoke hives by contact are latex, gasoline, rubber, metal.
Acute viral infections.
Hormonal dysfunctions.

It should be noted that the above causes most often provoke an acute form of urticaria, chronic urticaria is considered idiopathic, that is, a disease of unclear etiology. Allergists put forward the version that idiopathic urticaria can be caused by autoimmune, endocrine diseases, but this theory still needs to be statistically confirmed.

Urticaria symptoms

The main symptoms of hives are the following signs:

Small rashes that look like blisters. The rash may appear as small patches of reddened skin (erythema) or localized, coalesced blisters.
Characteristic itching, which can start without an obvious rash.
Lack of pain (blisters are painless).
The characteristic short duration of rashes, which usually disappear in a day, leaving no trace. Blisters that begin to peel or ulcerate after a day are indicative of another disease.
The rash can develop intensively, up to Quincke's edema.

Description of the rash with urticaria is fundamental information for the diagnosis of the disease. The rash can be located symmetrically in cholinergic urticaria, but most often the rashes are located asymmetrically, can be in the form of single chaotic blisters, but sometimes merge into a continuous angioedema, which is defined as Quincke's edema. The blisters are pale pink to slightly reddish in color and appear anywhere on the body. Quincke's edema is characterized by localization on the face, when the rash spreads over the eyelids, lips, swelling affects the tongue and larynx, and only then spreads to the hands and feet. Urticaria is rarely accompanied by hyperthermia, if the body temperature rises, this indicates the presence of a concomitant inflammatory infection. Statistics claim that in half of patients with urticaria is diagnosed as an isolated symptom that does not flow into angioedema, however, in the second half Quincke's edema often develops very quickly.

Urticaria of allergic origin is not in itself contagious and is not transmitted by contact or airborne droplets. However, urticaria can be a symptom of an infectious rather than an allergic disease, then the patient is a source of possible infection for others.

It should be noted that the symptoms of urticaria are similar to those of other diseases. Among them, the following are the most common:

Systemic or cutaneous mastocytosis (urticaria pigmentosa) is a diffuse infiltration of the skin that begins with the appearance of small blisters.
Urticarial vasculitis, which, unlike classic urticaria, lasts from 3 to 7 days.
Drug rash - an allergy to contact with external medicines.
Atopic dermatitis (allergic dermatitis).
Scabies is an acarodermatitis caused by a mite.
Anaphylactoid purpura - capillary toxicosis, hemorrhagic disease.
Contact dermatitis is an allergic skin reaction of a delayed type.
Erythema multiforme - exudative rashes.

Types of urticaria

Urticaria is divided into two main categories according to the type of course of the disease:

Chronic urticaria. It is believed that if the urticaria lasts more than six weeks, it has a chronic form.
Acute urticaria lasts several hours or days. The total duration does not exceed six weeks.

Chronic urticaria in clinical practice is most often found in women, the acute form - in children and adolescents in puberty. Allergists say that the acute form of urticaria does not need serious treatment, since it goes away on its own, provided that it is clearly diagnosed. However, in 10% of all allergy sufferers, there is a transition from an acute form to a chronic one, when therapy can be quite long, however, after 6-8 months, one hundred percent complete recovery occurs.

In addition to forms, urticaria is divided into various types, among which physical urticaria (mechanical) is most often diagnosed. This type of rash is associated with exposure to the skin of various irritants:

The domestic cause of a mechanical nature is squeezing and rubbing with uncomfortable clothing, an object (pressure urticaria, dermographic urticaria);
Exposure to solar radiation - solar urticaria;
Water exposure - aquatic urticaria;
Psycho-emotional impact, stress, aggravated by stuffiness; dry air in the room - cholinergic urticaria;
Exposure to heat - heat urticaria;
Exposure to cold - cold urticaria.
Insect bites, skin contact with external medicines - papular or contact urticaria.

The rarest subspecies are vibrational (when exposed to constant vibration, for example, from a production, industrial device).

Description of the types of urticaria

Dermographic subspecies of urticaria, which is called urticarial dermographism. Such urticaria is a form of mechanical rash and is provoked by friction or irritation of the skin. The reason may be uncomfortable clothing, an item that a person, by virtue of his profession, is forced to use constantly.
Solar urticaria, which manifests itself as a reaction to excessive tanning or simply due to intolerance to ultraviolet radiation.
A very rare type of urticaria is aquagenic, which is provoked by contact with any water, manifested by severe itching and erythematous rashes. four.
Cholinergic appearance, which is the result of excessive sweating. The activation of sweat secretion, in turn, is provoked by a psycho-emotional factor that causes a typical vegetative reaction. A person's body temperature can rise several degrees without apparent inflammatory causes. Less commonly, cholinergic urticaria appears after being in a very stuffy, hot room or due to physical overexertion. This type of urticaria is manifested by diffuse multiple rashes throughout the body and quite often ends with Quincke's edema.
Cold urticaria, which was also considered until recently a rare allergic species. Today, every tenth allergic person suffers from cold urticaria, apparently due to the general allergic orientation of the body. A cold reaction can be provoked not only by external exposure to cold air, but also by the use of cold drinks, foods, and even touching a cold object.
Heat urticaria is similar to cold urticaria but is triggered by exposure to warm air or hot foods and drinks. This type of rash is extremely rare.
Mastocytosis or urticaria pigmentosa is an autoimmune disease in which an excessive amount of mast cells (mastocytes) accumulate in the tissues.
Papular urticaria is a contact form, provoked by small insects that bite human skin. The rash is very characteristic and manifests itself in the form of tiny nodules - papules.

Also, urticaria has obscure, little-studied types, which include neuropsychic, more similar to the cholinergic type, there is recurrent urticaria, idiopathic urticaria - these are types of the disease with an unexplained etiology.

How dangerous is hives?

The most dangerous consequence of urticaria is angioedema, that is, Quincke's edema, which can develop under the condition of an acute form of the course of an allergic disease. However, in allergological practice, such cases are very rare. All other types of urticaria are completely harmless and do not pose a threat to the life of the patient. The only unpleasant symptom is severe, incessant itching. Most often, urticaria occurs in an acute form and disappears within a day, a maximum of a week. Rarely, acute urticaria lasts more than a month, this happens when the rash is provoked by an infectious disease. As soon as the root cause is eliminated, both itching and blisters go away. The chronic form of urticaria is more uncomfortable, but also does not threaten with serious complications.

Immunomodulatory drugs are most often indicated for the chronic form of urticaria.

If urticaria is accompanied by bronchospasm, antileukotriene drugs may be prescribed to relieve asthmatic attacks.

Quincke's edema suggests emergency medical care. As a rule, it is neutralized by the immediate administration of epinephrine (adrenaline).

Urticaria in any form and of any kind requires a hypoallergenic diet, even if it is not caused by a food provocateur. All foods containing tyramine are excluded from the diet - hard cheeses, red wine, liver, dry sausage, legumes, beer. It is also necessary to abandon all types of citrus fruits, cocoa, chocolate, nuts and honey, and limit the consumption of chicken eggs. The diet should be followed for at least three weeks, the further menu depends on the dynamics of the disease and improvement in the condition.

It's important to know!

Mastocytosis (synonym: urticaria pigmentosa) is a disease based on the accumulation of mast cells in various tissue organs, including the skin. The clinical manifestations of mastocytosis are due to the release of biologically active substances during mast cell degranulation.

Urticaria is a heterogeneous disease in terms of causal factors, the main clinical manifestation of which is a skin rash in the form of widespread or limited blisters that disappear spontaneously or under the influence of appropriate treatment.

Pathology occurs on average in 20% of the population, in 25% of which it is chronic. Among children, the disease is less common than in adults, and in women more often than men. The maximum frequency of cases falls on 20 - 40 years of age. What are the causes of hives?

Classification and etiopathogenesis

The mechanisms of development of various forms are very complex and still not well understood.

How long does the illness last? In most clinical classifications, in accordance with the duration of the pathological process, the following types of urticaria are distinguished:

Acute, which can last from a few minutes to 6 weeks. It occurs much more frequently and is diagnosed on average in 75% of all cases of urticaria.
Chronic. Its duration is more than 6 weeks. The chronic form with relapses occurs in 25%. This form of the disease in the natural course can last, basically, up to 10 years (in 20% of patients).

In addition, depending on the prevalence in the body, the disease is divided into options:

localized - on a certain limited area of \u200b\u200bthe body;
(spread of elements of the rash throughout the body), which is a life-threatening condition, especially when localized in the area of organs of vital importance.

According to the cause and mechanism of formation of the reaction, the following forms of urticaria are distinguished:

allergic, caused by various immunological (cytotoxic, reaginic, immunocomplex) mechanisms of hypersensitivity (hypersensitivity);
non-allergic.

The reasons

The causes of hives are numerous. The most frequent of them are:

Inhalation allergens, for example, household and industrial aerosols, epidermal antigens, plant pollen.
Foods that promote the release of histamine contained in the body, or contain histamine themselves. These are eggs, cow's milk, pineapple, citrus fruits, honey, confectionery products with food additives in the form of salicylates and dyes, smoked products, many spices and mustard, fish products and seafood, tomatoes, legumes, eggplant, cheeses, extractives, alcoholic beverages. and others. In addition, the acute form of urticaria in persons suffering from hay fever can develop as a result of the use of those foods that contain antigens that cross with plant pollen. So, if there is a tendency to allergic reactions to pollen produced during tree flowering, urticaria may develop after eating nuts, berries and / or stone fruits, etc., sensitization to birch pollen can cause urticaria after eating carrots or apples, especially red ones. .
Viruses, bacteria and fungi.
External, internal and injectable drugs. Urticaria is very common after antibiotics, sulfonamides, antibacterial and anti-inflammatory drugs (salicylates, non-steroidal anti-inflammatory drugs), after taking anticonvulsants, vitamins, especially B vitamins and ascorbic acid, the use of antiseptics, iodine-containing drugs, including radiopaque agents , drugs used for arterial hypertension, coronary heart disease and heart failure (captopril, enalapril, hinapril, prestarium, enam, etc.), insulin, blood and its protein substitutes, dental implants, etc. Very rarely, but all- there is a reaction even to antihistamines and glucocorticosteroids.
Physical impact factors - pressure, friction, cold or elevated ambient temperature, vibration, sunlight, heavy physical exertion, bathing.
Poison wasps, bees, hornets, mosquitoes, bug bites, fleas and even grasshoppers.
Neuro-psychic load under the influence of psychogenic factors.
Tumor processes, thyroiditis, dysfunction of the thyroid gland and other endocrine organs, autoimmune diseases of the connective tissue, diseases of the digestive tract, etc.

The causes of acute and chronic forms of the disease are different:

Among all chronic forms of urticaria (with an unknown cause), it occurs on average in 75-80%, in 15% - caused by a physical factor, in 5% - due to other factors, including allergic ones.

Development mechanisms

In cases of the chronic form of the disease, immunological mechanisms are not excluded, for example, in the presence of an autoimmune pathology (systemic lupus erythematosus, rheumatism, etc.). At the same time, in the chronic process, mast cells are more often activated by non-specific (non-immunological) stimuli (emotional stress, the influence of alcoholic beverages, the premenstrual period, physical factors, etc.).

Rash with hives

Is hives contagious and can you get rid of it?

Based on the description of the causes and mechanisms of the development of pathology, it becomes clear that it has nothing to do with infectious diseases.

What does urticaria look like and is it dangerous?

Clinical picture

The elements have a pale pink or red color, in the peripheral sections hyperemia is more pronounced. When pressed, they become pale in color, no pressure marks remain.

Urticaria symptoms

angioedema angioedema

It accompanies 50% of cases of chronic urticaria, may occur alone or be combined with localized manifestations of the acute form.

Quincke's edema

Why is urticaria dangerous?

Diagnosis of the disease

Diagnostics consists of several conditionally sequential stages.

I stage

II stage

Stage III

Evaluation of the clinical activity of the disease in accordance with a specially designed 3-level point scale, which takes into account the number of blisters and the degree of itching intensity.

IV stage

Duncan test (cold using ice cubes);
skin thermal - by means of a water compress with a temperature of 25 °;
tourniquet test;
mechanical, or stroke test with a spatula;
testing with suspension or application of the load;
bicycle ergometric test - to determine the reaction to the general physical activity;
phototesting.

Stage V

Treatment of urticaria and prevention of recurrence

Urticaria treatment at home and diet

What can you eat?

Medical therapy

Almost everyone has experienced various skin rashes and diseases. Many rashes are very similar and share common characteristics, but usually skin changes are just a symptom of a more complex disease. One of the manifestations of allergic dermatitis on the skin is urticaria.

What is urticaria

A rash with urticaria is commonly called urticaria, it can affect large areas of the skin in a few minutes, has a reddish color, and in appearance resembles nettle burns. As a rule, urticaria becomes a consequence of allergic dermatitis and manifests itself by direct contact with an irritant; in some cases, urticaria can become a symptom of a more serious disease. According to its external signs, the rash can be confused with erythema. It is also worth noting that the appearance of skin changes is accompanied by itching and burning.

There are several forms of rash:

Acute - urticarial rash quickly affects the skin and disappears after a few days, sometimes after a couple of weeks.
Chronic - such a rash can periodically pass, and then reappear in another place. This form is characterized by constant relapses, treatment can take several months, and sometimes years.
Investigative or artificial - this form of the disease is typical for people who constantly suffer from allergic dermatitis. In this case, the rash manifests itself from a mechanical effect on the skin, for example, urticaria appears at the site of strong compression, which soon disappears.
Atypical - chronic persistent papular rash.

Urticaria can affect both a child and an adult; according to statistics, it is clear that every third person at least once in his life has encountered such changes in the skin. The disease mainly occurs in women.

As an allergen, which provoked the manifestation of a rash, may be:

Medicinal product.
Nutritional supplements.
Food.
Polysaccharides of bacterial origin.
Serum.

Characteristics of the rash depending on the causes of manifestation

Physical urticaria- this type of urticaria can be primary, which develops as an independent disease, or secondary as a result of a more serious illness, such as serum sickness or mastocytosis. With any physical irritation of the skin, an internal chemical reaction occurs, which leads to the release of substances into the cells, in particular histamine. Such a reaction provokes skin changes that can appear immediately, after a few minutes or hours.

stress urticaria- such a reaction of the body is caused by nervous shocks or constant stress. A rash appears as a result of stressful situations, physical exertion, taking a contrast shower, and profuse sweating.

Cold urticaria- this type is considered to be causeless. Such an allergic reaction can manifest itself in children from 6 months and in adults. Symptoms can be manifested only by external indicators, and sometimes disrupt the functioning of internal systems: the central nervous system - headaches occur, the respiratory system - difficulty breathing, coughing, the circulatory system - arthremia, low pressure, the gastrointestinal tract - nausea, vomiting. Blisters appear at the moment of warming and disappear after half an hour.

Sun rash - upon contact with direct sunlight on the skin in the first minutes, a rash occurs that itches and burns. In a complex degree, difficulty in breathing, loss of coordination is manifested.

drug rash- the use of pharmacological drugs can provoke acute or chronic urticaria. The reaction may follow immediately or appear a few days after the start of the course of treatment.

contact urticaria- rashes appear at the site of direct contact with the allergen. In this case, anything can act as an allergen, from tissue to plant pollen.

It is also worth noting that the cause of hives can be a blood transfusion or exposure to physical factors. Very often, urticaria is the result of contact with poisonous plants, insect bites, jellyfish or shellfish.

"Artificial urticaria" manifests itself, without any contact with the allergen, from strong squeezing with an elastic band

Rash treatment

First you need to accurately determine the allergen that provoked the urticaria rash. There is a group of highly allergenic foods that are excluded from the diet in the first place, especially in case of a violation of the digestive tract. It is worth noting that for most people, various allergens can cause hives, which is dangerous for one, safe for another. To achieve a positive result, most of the products are excluded, after which new ones are periodically introduced into the menu. Such actions help to analyze and establish the exact cause of allergic dermatitis. During treatment, it is recommended to follow a strict diet.

Treatment may include topical preparations to relieve itching and reduce the external manifestations of the disease. Doctors say that such remedies do not provide much relief.

The rash is treated with antihistamines. In complex forms, long-term drug treatment, blood transfusion, and histoglobulin injections are prescribed.

Important: Self-medication for urticarial rash is not recommended, since the elimination of external symptoms does not eliminate the causes of skin changes. Continued contact with the allergen can lead to skin hypersensitivity and swelling.

Diagnosis of rashes in children

Urticaria in a child manifests itself in the place of contact with clothing, in skin folds. The rash has a light pink color, a different shape. Rashes on the skin cause discomfort and itching, children very often comb the blisters, which increase in volume, and it becomes very difficult to visualize a separate spot. When you click on the blister in the center, you can see small white dots.

The manifestation of acute urticaria in a child requires the diagnosis of a pediatrician

A pediatrician or dermatologist can diagnose the disease in a child; for a more accurate diagnosis, skin sampling and a general blood test may be prescribed. Also often performed analysis of feces, studies of the thyroid gland. Sometimes a doctor may order liver function tests.

Causes of hives in children

The main task of diagnosis is to determine the cause of the manifestation of skin changes in a child, the most common of them:

The main forms of the course of the disease

Mild form - the disease manifests itself in a separate area of \u200b\u200bthe body of a child or adult. As a rule, the rash disappears after one day, while it is accompanied by mild symptoms: almost imperceptible itching, no swelling of blisters on the skin, mild intoxication.

The average form - the disease acquires more pronounced symptoms, intoxication of the body, chills (fever) are possible, an extensive swelling appears in certain areas of the skin, which very quickly affects the entire body, sometimes the throat, which can cause difficulty breathing.

Severe form - accompanied by pronounced symptoms, there may be a problem with the gastrointestinal tract.

Complex treatment of urticarial rash in children

Doctors distinguish four main stages of treatment in a child:

Elimination of contact with the allergen - first of all, all products that can cause hives are removed. It is necessary to review all medications that have been taken recently.
Dieting - food can include the safest foods, vegetables and fruits, except for red and orange, you should also not eat tropical fruits, including bananas. Dairy products and cereals are allowed. A strict diet is observed for 2-4 weeks, after which one product is added to the menu once a week, if there is no reaction, then it can be left.
Drug therapy - depending on the form of the course of the disease, the doctor prescribes pharmacological treatment at his discretion.
Cleansing the body - sometimes a gastric lavage or a blood transfusion is required.

Important: During treatment, it is worth completely eliminating the use of all cosmetics and detergents.

First aid

If the first signs of a urticaria rash in a child are noticed, the following measures should be taken:

If urticaria occurs due to anaphylactic shock, then immediate hospitalization is necessary.
Hospitalization will be needed if the child has Quincke's edema.
Immediately stop taking any pharmacological drugs that can provoke an allergic reaction.
With a strong food allergy, do a gastric lavage and douching with an enema, take enterosorbent preparations (smecta, polysorb, enterosgel).
If the allergy is provoked by an insect bite, you need to make sure that there is no sting left and remove the remnants of the poison.
For contact rubella, the allergen should be removed.
Start complex treatment with first-generation antihistamines and local ointments.
If the drugs are ineffective, they are changed to second-generation antihistamines.
In case of ineffectiveness of antihistamines, it is necessary to seek medical advice and continue treatment with hormonal drugs.
In severe autoimmune urticaria, a specialist prescribes treatment with immunosuppressants.

A particularly complex form of urticaria causes swelling of the entire body

Vaccination during hives

Manifestations of any allergic reactions, including urticaria, require precautionary measures:

Vaccination should be carried out when skin rashes are completely absent, and the child feels well.
It is necessary to consult with an allergist who will help determine the causes of an allergic reaction.
The child must follow the diet prescribed by the doctor.
Before the manipulation, the baby is examined by a pediatrician.
The interval between vaccinations should be longer than in a healthy child.
Only one vaccination can be given at a time.
Before carrying out the manipulation, it is worth drinking anti-allergic drugs; children are often prescribed L-cevit or loratadine.
It is worth refraining from vaccination in case of a rash, if there is an allergic reaction to previous vaccinations.

It is worth remembering that urticaria can be the cause of more serious diseases associated with disruption of the body's systems, therefore, without a doctor's examination, treatment is extremely inappropriate. Allergic urticaria requires treatment: very often a neglected rash can cause Quincke's edema, which provokes difficulty in breathing. Urticaria rash passes quickly, after eliminating the causes of the manifestation, very rarely the disease becomes chronic, in which there is a difficulty in treatment.