Acute urticaria
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Acute Urticaria: Clinical Aspects, Etiology, and Treatment
Introduction to Acute Urticaria
Acute urticaria is a common skin condition characterized by the sudden appearance of wheals, angioedema, or both, typically lasting less than six weeks. It affects individuals across all age groups and can be triggered by various factors, including infections, medications, and food allergies 123.
Clinical Features and Epidemiology
Symptoms and Presentation
Acute urticaria presents with transient, erythematous, and pruritic wheals. In infants, it often manifests as large, annular, or geographic plaques that are slightly raised 2. The condition can also be associated with systemic symptoms such as fever, dyspnea, and, in severe cases, anaphylaxis 45.
Prevalence
The prevalence of acute urticaria in the general population ranges from 1% to 5%, with a lifetime incidence of up to 20% 79. In children, the frequency can reach up to 6.7% 7.
Etiology and Triggers
Common Triggers
The etiology of acute urticaria is often idiopathic, with identifiable triggers found in less than half of the cases. Common triggers include upper respiratory tract infections (36.7% to 39.5%), medications (9.2% to 20.7%), and food allergies (0.9% to 7.4%) 145. In some cases, insect bites and contact urticaria are also noted as triggers 4.
Special Cases
Acute urticaria can also be a prodromic symptom of viral hepatitis, particularly hepatitis A and B, and occasionally hepatitis C 8. In pediatric patients, it is crucial to differentiate acute urticaria from other conditions with similar presentations, such as urticaria multiforme and Henoch-Schönlein purpura 6.
Diagnosis and Differential Diagnosis
Diagnostic Approach
A thorough history and physical examination are essential for diagnosing acute urticaria. Identifying potential triggers and ruling out other conditions with overlapping features are critical steps 36. In children, careful morphological examination of lesions helps in differentiating acute urticaria from its mimickers 26.
Treatment and Management
First-Line Treatment
The first-line treatment for acute urticaria involves second-generation H1-antihistamines, which are preferred due to their efficacy and safety profile 27. In severe cases, corticosteroids may be added to the treatment regimen 12.
Comparative Efficacy
Studies have shown that both loratadine and prednisolone are effective in controlling whealing. However, corticosteroid-treated patients experience faster symptom resolution, with complete remission occurring within three days in 93.8% of cases, compared to 65.9% for loratadine-treated patients 1.
Emergency Room Management
Acute urticaria frequently leads to emergency room visits, with significant predictors of longer stays being anaphylaxis, food, and drug hypersensitivity 4. Prompt identification and management of these triggers are crucial for effective treatment.
Prognosis and Quality of Life
Disease Course
Acute urticaria is generally self-limited, with most cases resolving within three weeks 15. However, the condition can significantly impact the quality of life, particularly due to pruritus 5.
Long-Term Outlook
While acute urticaria typically resolves without long-term issues, a small percentage of patients may develop chronic urticaria, with symptoms persisting for up to six months in some children 7.
Conclusion
Acute urticaria is a prevalent and often idiopathic condition that can significantly impact patients' quality of life. Effective management involves identifying and eliminating triggers, using second-generation antihistamines as first-line treatment, and considering corticosteroids in severe cases. Prompt and accurate diagnosis, especially in pediatric patients, is essential for appropriate treatment and improved outcomes.
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