Summary about Disease
Chronic urticaria, also known as chronic hives, is a skin condition characterized by the recurrent appearance of itchy, raised wheals (hives) or angioedema (swelling) or both, lasting for more than six weeks. Unlike acute urticaria, which is often triggered by a specific allergen, chronic urticaria's cause is frequently unknown (idiopathic). It can significantly impact a person's quality of life due to persistent itching, discomfort, and potential disfigurement.
Symptoms
Wheals (Hives): These are raised, itchy welts on the skin that can vary in size and shape. They may appear and disappear quickly, often within 24 hours in one location, only to reappear elsewhere.
Itching (Pruritus): Intense itching is a primary symptom.
Angioedema: This involves swelling in deeper layers of the skin, commonly affecting the face (lips, eyelids), hands, feet, or genitals. Angioedema can be painful and may last longer than individual hives.
Redness: The affected skin areas often appear red or inflamed.
Burning or Stinging: Some people may experience a burning or stinging sensation in addition to itching.
Causes
The exact cause of chronic urticaria is often unknown (idiopathic). However, several factors are believed to contribute:
Autoimmunity: In many cases, chronic urticaria is thought to be an autoimmune condition, where the body's immune system mistakenly attacks its own tissues, leading to the release of histamine and other chemicals that cause hives.
Physical Stimuli: Some individuals experience hives triggered by physical factors like pressure, cold, heat, sunlight, exercise, or vibration. This is called inducible urticaria.
Infections: In rare cases, chronic infections (bacterial, viral, or fungal) may be associated with chronic urticaria.
Underlying Medical Conditions: Thyroid disorders, celiac disease, and some types of cancer have been linked to chronic urticaria in some individuals.
Medications: Although less common in chronic cases, certain medications can sometimes trigger or worsen urticaria.
Food: Unlike acute urticaria, food allergies are rarely the cause of chronic urticaria. However, certain food additives or preservatives may play a role in some cases.
Stress: Emotional stress can exacerbate symptoms in some individuals.
Medicine Used
Antihistamines: These are the first-line treatment. Non-sedating (second-generation) antihistamines like cetirizine, loratadine, or fexofenadine are typically preferred. Higher doses than those used for allergies may be required.
H2 Antagonists: These medications, such as ranitidine or famotidine, block histamine receptors and may be used in conjunction with antihistamines.
Leukotriene Receptor Antagonists: Montelukast is sometimes used, particularly if antihistamines are not fully effective.
Omalizumab: This is a monoclonal antibody that targets IgE, a key player in allergic reactions. It's often effective for chronic idiopathic urticaria that doesn't respond well to antihistamines.
Corticosteroids: Oral corticosteroids like prednisone may be prescribed for short-term relief during severe flare-ups, but long-term use is generally avoided due to potential side effects.
Immunosuppressants: In severe cases, immunosuppressant medications like cyclosporine or methotrexate may be considered.
Is Communicable
No, chronic urticaria is not contagious or communicable. It cannot be spread from person to person.
Precautions
Identify and Avoid Triggers: If possible, identify and avoid any triggers that seem to worsen your symptoms. This may involve keeping a diary to track potential triggers.
Avoid Irritants: Wear loose-fitting clothing, use mild soaps and detergents, and avoid hot showers or baths that can irritate the skin.
Manage Stress: Practice stress-reduction techniques such as yoga, meditation, or deep breathing exercises.
Avoid Alcohol and Caffeine: These substances can sometimes worsen urticaria symptoms.
Cool Compresses: Applying cool compresses to affected areas can help relieve itching.
Sun Protection: Protect your skin from the sun, as sunlight can trigger hives in some people.
Follow Doctor's Instructions: Adhere to your doctor's prescribed medication regimen and follow their advice regarding lifestyle modifications.
How long does an outbreak last?
By definition, chronic urticaria lasts for more than six weeks. Individual hives typically resolve within 24 hours, but new hives can continue to appear over weeks, months, or even years. Some individuals experience chronic urticaria for months or years, while others may have intermittent flare-ups over a longer period.
How is it diagnosed?
Medical History: The doctor will ask about your symptoms, medical history, and any potential triggers.
Physical Examination: The doctor will examine your skin to assess the appearance of the hives or angioedema.
Allergy Testing: Allergy testing (skin prick tests or blood tests) is usually not helpful in chronic urticaria, as it's rarely caused by allergies. However, it may be done to rule out other conditions.
Blood Tests: Blood tests may be performed to look for underlying medical conditions, such as thyroid disorders, autoimmune diseases, or infections.
Skin Biopsy: In rare cases, a skin biopsy may be necessary to rule out other skin conditions.
Physical Challenge Tests: If inducible urticaria is suspected, the doctor may perform physical challenge tests (e.g., applying ice to the skin to test for cold urticaria).
Timeline of Symptoms
The timeline of chronic urticaria symptoms is highly variable.
Initial Onset: Hives or angioedema appear, often without a clear trigger.
Recurrence: Hives or angioedema recur frequently (daily or almost daily) for more than six weeks. Individual hives usually disappear within 24 hours, but new ones continue to appear.
Fluctuations: The severity of symptoms can fluctuate over time, with periods of more intense outbreaks followed by periods of relative calm.
Long-Term Course: Chronic urticaria can persist for months or years. In some cases, it may eventually resolve on its own, while in others, it may require ongoing management.
Important Considerations
Quality of Life: Chronic urticaria can significantly impact quality of life due to persistent itching, sleep disturbances, anxiety, and social embarrassment.
Psychological Impact: The chronic nature of the condition can lead to frustration, anxiety, and depression. Seeking psychological support may be beneficial.
Angioedema: Angioedema can be life-threatening if it affects the throat and causes difficulty breathing. Seek immediate medical attention if you experience swelling in the throat or difficulty breathing.
Medication Side Effects: Be aware of the potential side effects of medications used to treat chronic urticaria, particularly corticosteroids and immunosuppressants.
Individualized Treatment: Treatment should be tailored to the individual's specific symptoms, triggers, and medical history.
Specialist Referral: If your symptoms are severe or difficult to manage, consider seeing a dermatologist or allergist with expertise in urticaria.