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VOL: 99, ISSUE: 40, PAGE NO: 23


- The word urticaria comes from the Latin for ‘nettle’ and refers to a group of disorders in which swellings (weals) occur on the skin. It is also known as hives.



- These can be a few millimetres or several centimetres in diameter. They can be white or red, are often surrounded by a red flare and are frequently itchy.



- They can last a few minutes or several hours, and may change shape. In chronic urticaria recurrent rashes can last in excess of six weeks.



- Angioedema is a deeper form of urticaria frequently occurring in the eyelids, lips and sometimes in the mouth. The swellings may not be itchy and usually settle in a few days.



- Urticaria is common, affecting 20 per cent of people at some stage of their lives.



- Acute urticaria can be caused by foods, colourings, preservatives or by medicines, especially aspirin, antibiotics, and codeine. Other possible causes are plant, animal and chemical contacts, for example latex.



- The cause of chronic urticaria, which can last in excess of six weeks, is rarely established.



- Cholinergic urticaria - occurs under conditions that cause sweating such as heat, exertion and stress.



- Dermographism - itching weals occur when skin is rubbed. Weals often appear as lines.



- Cold urticaria - cold, including rain and wind, causes itching weals.



- Solar urticaria - itching weals occur immediately after exposure to sunlight (very rare).



- Aquagenic urticaria - small weals occur on the skin at sites of contact with water of any temperature (extremely rare).



- Delayed pressure urticaria - swellings occur at skin sites where pressure has been applied (tight clothes, gripping tools, and so on).



- Angioedema urticaria - deep-seated subcutaneous swellings occur with or without mucous membrane and are not itchy.



- Urticarial vasculitis - a small percentage of people experience tender weals that last longer than two days and can bruise. These symptoms can be accompanied by Joint and stomach pains as a result of inflamed blood vessels (vasculitis).



The release of histamine and other chemotactic agents causes small blood vessels to leak, which results in tissue swelling. This can be triggered by:



- Foods;



- Colourings and preservatives;



- Perfumes;



- Flowers and plants;



- Parasites;



- Blood transfusions;



- Dyes;



- Heat and cold;



- Water;



- Sunlight;



- Exercise;



- Pressure on the skin;



- Drugs: antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs).



- It is important to avoid anything that may worsen urticaria.



- Antihistamines block the effects of histamine and can help reduce itching and rash in most people, but may not relieve urticaria completely.



- Doxepin.



- Prednisolone - useful for severe angioedema. Should never be used routinely.



- Cyclosporin - for chronic idiopathic urticaria under specialist supervision.



- Leucotriene antagonists.



- Exclusion diets - selected patients only. Strict monitoring required by specialist and dietitian.



Johnson, G., et al (2000) The Minor Illness Manual. Abingdon: Radcliffe Medical Press.



NHS Direct



Medic Alert Foundation 1 Bridge Wharf, 156 Caledonian Road, London N1 9UU. Tel: 020 7833 3034.



British Allergy Foundation St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE. Tel: 020 7600 6127.
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