What is urticaria
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Understanding Urticaria: Definition, Classification, and Management
Definition and Clinical Presentation of Urticaria
Urticaria, commonly known as hives, is an inflammatory skin disorder characterized by the sudden appearance of smooth, erythematous, or blanching itchy swellings called wheals or hives. These wheals can vary greatly in size and shape and typically last less than 24 hours before fading, leaving normal skin behind 12. Urticaria can occur in isolation or be associated with angioedema and, in some cases, anaphylaxis 16.
Pathogenesis and Mechanisms
The underlying cause of urticaria is the degranulation of mast cells, which can be triggered by both immunological and non-immunological mechanisms 15. This process releases histamine and other inflammatory mediators, leading to the characteristic symptoms of urticaria. Recent research has highlighted the role of autoantibodies to mast cell receptors in chronic idiopathic urticaria, suggesting an autoimmune component in some cases .
Classification of Urticaria
Urticaria is broadly classified based on the duration and triggers of the symptoms:
- Acute Urticaria: Lasts less than six weeks and is often triggered by infections, medications, or foods 27.
- Chronic Urticaria: Persists for more than six weeks and can be further divided into chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), which includes physical urticarias triggered by factors like pressure, temperature, or exercise 57.
- Physical Urticarias: Include conditions like delayed pressure urticaria and urticarial vasculitis, which require distinct management approaches .
Epidemiology and Impact
Urticaria is a common condition, with a lifetime prevalence of approximately 20% for acute urticaria 26. Chronic urticaria, although less common, significantly impacts the quality of life, affecting daily activities and work performance 23.
Diagnosis and Differential Diagnosis
Diagnosing urticaria primarily involves a thorough clinical history and physical examination. It is crucial to differentiate urticaria from other skin conditions that can mimic its presentation, such as autoinflammatory or autoimmune disorders, drug-induced reactions, and hyperproliferative diseases 16. Extensive laboratory evaluations are often unrevealing, especially in chronic cases .
Management and Treatment
The primary goal in managing urticaria is symptom relief. First-line treatment typically involves non-sedating H1-antihistamines, such as cetirizine, loratadine, and fexofenadine 48. For patients who do not respond to standard antihistamines, second-line treatments may include H2-antagonists, leukotriene receptor antagonists, corticosteroids, and immunomodulatory agents like omalizumab, an anti-IgE antibody 458.
In severe or refractory cases, more aggressive treatments, including immunosuppressive therapies, may be considered . For angioedema associated with urticaria, especially hereditary or acquired forms, specific treatments like C1 inhibitor replacement therapy and other targeted therapies are recommended .
Conclusion
Urticaria is a multifaceted skin disorder with a significant impact on patients' lives. Understanding its pathogenesis, classification, and management options is essential for effective treatment. While antihistamines remain the cornerstone of therapy, ongoing research into the underlying mechanisms of urticaria continues to inform and improve therapeutic strategies.
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