Urticaria and Angioedema - Internet

1 What you shouldknowaboutGuidelinesforpatientsUrti caria andAngioedema Symptoms Diagnosis TreatmentPublished by the Department of ImmunologySt James s Hospital, Dublin 8, IrelandFirst publication: July 2015 This booklet may be downloaded in .pdf format fromthe St James s Hospital website: please visit you should know aboutGuidelines for patientsUrticaria andAngioedema Symptoms Diagnosis TreatmentAuthors: Conleth Feighery MD, FRCPathProfessor of Immunology (Emeritus)and Fellow, Trinity College DublinConsultant Immunologist, St James s Hospital, Dublin 8 Niall Conlon MB, PhD, FRCPathConsultant Immunologist, St James s Hospital, Dublin 8 Department of ImmunologySt James s HospitalDublin 8 IrelandContents1 Urticariapage 4 Acute and chronic Urticaria , the skin rash, angioedema2 Frequently-asked questionspage 7 Causes, physical events and factors,the role of mast cells3 More about angioedemapage 13 The frequency of Angioedema ; is it dangerous?

2 4 Making a diagnosispage 14 Patient history, tests that may be performed5 Treatment for urticariapage 15 Antihistamines, stress management, steroids,newer therapies, the outlook for patients6 Summary / Information on the Internetpage 19 Glossarypage 2023 Urticariais a medical condition commonly known as hives; it isfrequently associated with skin swelling, termed patient booklet is to help you develop an understanding ofchronic or recurring Urticaria and Angioedema . The booklet aims: to describe the symptoms associated with Urticaria and Angioedema to discuss reasons why you develop Urticaria and Angioedema to describe treatments that may be used to controlthese conditions successfully to answer frequently-asked : red, itchy blotches on the skin,sometimes said to look like nettle rash 51 UrticariaUrticariais the medical term for hives, a common skin people will have an outbreak of hives at some point in their livesand the rash consists of red, itchy blotches, sometimes described asbeing like a nettle rash.

3 Urticaria is often accompanied by swellingof the skin and the medical term to describe this is Urticaria experienced by most people is short-lived, lasting for afew days. The rash then clears up completely. This is termed acuteurticaria. However, in some people, the Urticaria will persist for a longtime and become urticariais also quite common and about one in 100 peoplewill have a prolonged bout of Urticaria at some point in their of chronic Urticaria is normally very successful, with theuse of anti-histamine skin rash in urticariaUrticaria can occur anywhere on the body. It can appear very may be widespread or occur in just one area.

4 The appearance canvary considerably. Individual hives can be as small as a pencil tip, orhives can join together and involve a very large in the appearanceof urticariaMost often, hives are about the size of a one-euro coin and consist ofa central, slightly raised white area known as a wheal, surrounded by alarger red area. They are characteristically intensely hive lasts only for a short time if you draw a circle around asingle rash spot it will be gone within a few hours. However, in somepatients, new hives can appear, resulting in the rash persisting overdays, weeks or of the skin angioedemaSwelling of the skin, or Angioedema , often develops with Angioedema occurs on the face and is severe, it can be quitedisfiguring and cause alarm.

5 If the lips are swollen they may becomevery prominent. The loose skin around the eyes may swell and evenimpair the tongue swells it may make speech and even swallowing a patient develops Angioedema like this anyway frequently, it canseriously disrupt daily , angioedemaappears alone and there isno associated booklet focuses on thecondition chronic urticariaand Angioedema . People withthis condition can becomefrustrated because the rash andswelling keeps coming backand often become preoccupiedwith finding a questionsWhat causes chronic Urticaria ?It is quite understandable that someone with chronic Urticaria willwant to find a cause for their condition.

6 The expectation is that someevent perhaps a food or a chemical is responsible. In an attemptto find a cause patients will often modify their diet or avoidcertain detergents or : swollen andprominent lipsHowever,thissearchforatriggerisrarel ysuccessfuland mostlynocauseis reality is that no single triggering event is type of Urticaria is the most common form found in found!Is chronic Urticaria caused by an allergy?No. chronic Urticaria is not caused by to chronic Urticaria and, as we will see, allergy-type mechanismsare involved in both contrast,a single episode of urticariaor Angioedema may be caused by an allergic reaction to a drug or foodand it is usually fairly obvious that these acted as triggers of the drugs cause chronic Urticaria ?

7 No. Drugs are very unlikely to be the cause of chronic , it is very important to obtain information on any drugs that apatient may be taking. This is particularly the case when Angioedema isdeveloping alone, in the absence of Urticaria in this situation, certaindrugs used to treat high blood pressure, called ACE inhibitors, may is well known that certain drugs can trigger the development of acuteurticaria and Angioedema . Classic examples include the commonly-usedanti-inflammatory drugs, such as Brufenor Difene, taken for pain reliefor involvement of these drugs is normally obvious, since the reactionusually takes place within an hour of taking the foods cause chronic Urticaria ?

8 No. Food allergy is not an important cause of chronic patients report that frequently they wake in the morning with arash or swelling and, because there has been a long time lapse sincethey last ate, this is good evidence that food is not involved. Clearly,food allergy can result in acuteurticaria and again the link with thefood is usually obvious, since the reaction may develop within minutes,or at most two hours, of eating the practitioners may advise patients that a wide rangeof foods are responsible for their chronic may base their opinionon various tests that lacksound scientific dietaryrestriction, as oftenadvised by thesepractitioners, isrejected by allmajor medicaland governmentalorganisations thathave examined this there any pointers to the cause of chronic Urticaria ?

9 Single triggers are rarely responsible for chronic Urticaria . Instead severalfactors may combine and contribute to the development of the combination can include factors such as genetic inheritance,variation in hormone levels and stress: either from physical events oremotional is the cause of the skin rash?The rash in Urticaria is caused by an increase in blood flow to that areaof skin: this is why the rash is red in colour. The increased blood flowis caused by widening of the small blood vessels in the skin. The bloodvessels can leak fluid into the skin and this causes a weal to develop,the white elevated area in the some instances more marked leaking of fluid occurs with greateramounts of skin swelling and this is the cause of causes blood vessels to behave like this?

10 A cell in the skin, called a mast cell, plays a key role in the cells are abundantnot only in the skinbut also in tissuessuch as thetongue and are locatedclose to blood vesselsand contain highamounts ofhistamine andof variousother mast cellsrelease histaminethe local blood vessels widenand increase the blood flow to the area. Histamine also stimulates localnerves in the skin, causing the symptoms of itch and sometimes physical events or factors can cause Urticaria ?It is now evident that a range of physical factors can cause of these relate to changes in temperature. So, for example,patients may react to hot water when taking a shower or to very coldwater after swimming in the may develop Urticaria and Angioedema during strenuous physicalexercise, such as long-distance running.