Seven most frequently asked questions on Urticaria

Urticaria is one of the most common diagnoses made in my everyday clinical dermatology practice at Bangalore. Most of the patients are distressed and overwhelmed by the very enigmatic nature of this disease. I will be addressing frequently asked questions about this annoying mysterious entity.

Q 1 What is urticaria?

Ans – Spontaneous appearance of  pale red to pink skin swellings known as ‘hives’ is called as urticaria. It may last for less than six weeks (acute form) and chronic if lasting for more than six weeks. It may resolve in few minutes to hours only to reappear at a different site.

Q 2– What are the symptoms and signs of this disease?

Ans – Usually these hives itch or have a stinging sensation.  It may impart pain if the same swellings occur at a deeper level. Some patients may report dizziness, headache, nausea or diarrhea or even shortness of breath although the numbers are low.

Hives

Q3-What is the cause of Urticaria?

Ans- The’ Mast cell’ is central to the cause of this condition. It is a resident cell near the nerves and small blood vessels of the skin and releases a chemical known as ‘Histamine’ upon activation. In urticaria the number of these cells is believed to be more due to unknown cause or in some patients, It releases more amount of histamine. Histamine dilates the blood vessels in affected areas causing hives.

Q4- What triggers these cells to release histamine –Can I avoid that?

Ans – Mast cells normally get activated in response to foreign stimuli to the body like bacterial, viral or hepatitis infections, certain drugs , food items or in few chronic cases ‘auto-antibodies’. The latter are the immune cells which very weirdly start acting against own body’s cells. The patients who have increased auto-antibodies tend to have a longer course and sometimes it takes long to tailor their drug treatment.

Q5- How do I know whether I have autoimmune chronic urticaria?

Ans- Although this can only be confirmed by few tests like ASST which is available only in higher research centres , certain clues can be elicited in patient’s history . They may also have a personal or family history of other autoimmune diseases like thyroid, Diabetes mellitus type I or Rheumatoid arthritis. Premenstrual flare in women and exacerbation during menses can be commonly seen. A long course with no response to the conventional treatment therapies is another diagnostic clue.

Q6- What are the things I can avoid to prevent an attack?

Ans- Each patient should maintain a diary of events preceding an attack and it should be discussed at each visit to the doctor. It is difficult to generalize trigger food items but few of them are notorious like non vegetarian , seafood, mushrooms , yam  , jackfruit , avocadoes , cheese and peanuts. Certain infections like sore throat, diarrhea can also trigger along with long standing but yet undiagnosed conditions like thyroid disorders can also be incriminated. Even stress and intense physical exertion are known to be the triggers. But for most of the patients, despite a detailed investigation, we are not able to find the triggering cause.

Q7- In how much time will I get rid of this disease?

Ans – Urticaria is more of an annoying condition rather than a disease. It is difficult to predict the course of disease in all patients although acute urticaria generally resolves in 3 to 4 weeks in 99% of cases. Chronic cases take some time to resolve sometimes few months to years but adequate control can be achieved hence improving the quality of life. It is very important to keep a diary