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Hives and Angioedema

Definition


Disease: Hives and Angioedema Hives and Angioedema
Category: Dermatological diseases
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Disease Definition:

Also known as urticaria, hives are raised, red and itchy welts (swellings or wheals) of various sizes, which seem to appear and disappear on the skin. Angioedema, which is a type of swelling, causes large welts deeper in the skin, particularly near the lips and eyes.

Hives and angioedema are harmless in most cases, and even without treatment, they don't leave any lasting marks.
Antihistamine medications are the most common treatment for hives and angioedema. In case the swelling of an angioedema causes the throat or tongue to block the airway and leads to loss of consciousness, it could be life-threatening.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

HIVES:
Some of the signs and symptoms of hives may be:

 

  • A single welt or group of welts that can cover large areas of the skin.
  • Burning or stinging in the affected area
  • Raised, red or white welts (swellings or wheals) of different sizes.
  • Itching, which may be severe
  • Welts that resolve while new welts erupt, making it seem as if the condition "moves"


Hives could be acute or chronic. Acute hives usually last from less than a day to up to six weeks, while chronic hives usually last more than six weeks and could sometimes occur for months or years at a time.


ANGIOEDEMA:
Similar to hives, angioedema occurs deeper in the skin. Some of the signs and symptoms of angioedema may be:

 

  • Large, thick and firm welts
  • Pain or warmth in the affected areas
  • In severe cases, difficulty swallowing or breathing
  • Swelling of the skin
  • Blisters (bullae) in areas of severe swelling


Although angioedema could occur on the hands, feet, genitalia or inside the throat, it usually develops near the eyes or lips.
Hives and angioedema could either occur at the same time or separately.

Even though uncommon, hereditary angioedema is more serious. This condition could cause a sudden, severe and rapid swelling of the face, arms, legs, hands, feet, genitalia, digestive tract and airway.
Some of the signs and symptoms of hereditary angioedema may include:

 

  • Difficulty or obstructed breathing due to the swelling of the airway
  • Sudden and severe swelling of the face, arms, feet, digestive tract, hands, genitalia, legs and airway
  • Abdominal cramping, as a result of digestive tract swelling.


Usually, mild hives and angioedema are not life threatening and could be treated at home.

In case someone's symptoms continue to appear for more than a couple of days, or if the hives or angioedema doesn't respond to treatment, a doctor should be consulted. Someone should seek emergency care in case they:

 

  • Have difficulty breathing
  • Feel their throat is swelling
  • Feel lightheaded

Causes:

Inflammation in the skin could result in hives and angioedema. Hives and angioedema could sometimes be triggered when certain cells called mast cells release histamine and other chemicals into the bloodstream and skin.

Hives and angioedema could be caused by allergic reactions to medications or foods. Many allergens have been identified, such as:

Medications:
Although almost any medication could cause hives or angioedema, however, some of the common culprits are blood pressure medications, ibuprofen, penicillin and aspirin.

Foods:
In sensitive people, many foods could cause problems. However, some of the frequent offenders are fish, eggs, shellfish, milk, nuts and chocolate. Some other potential allergens include food additives such as salicylates and sulfites.

Other allergens:
Direct contact with animal dander, latex, pollen and insect stings are some of the other substances that could cause hives and angioedema.

Some of the additional triggers that could produce hives or angioedema may include:

Dermatographia:
The name of this condition literally means "write on the skin." Raised lines appear on the areas where the skin is scratched, or where pressure is applied to the skin due to histamine-based angioedema, which causes swelling beneath the skin.

Physical factors:
In some people, environmental factors could result in the release of histamine with subsequent hives or angioedema. Water, heat, cold, exercise, pressure on the skin, sunlight and emotional stress are some examples of environmental factors.

In addition to the triggers mentioned above, hives and angioedema could also occur in response to the body's production of antibodies. Immune system disorders, such as cancer or lupus; infections, such as hepatitis; blood transfusions; certain thyroid disorders; or even a cold could cause this.

The inherited form of angioedema is called hereditary angioedema, which is related to low levels or abnormal functioning of certain blood proteins (C1 inhibitors). These inhibitors play a role in regulating how the immune system functions.

Complications

Complications:

Discomfort and itching may be caused by hives and angioedema.

Some complications that could occur in more serious cases such as when swelling occurs inside the mouth or throat may include:

 

  • Loss of consciousness
  • Difficulty breathing
  • Anaphylactic shock


Anaphylaxis or anaphylactic shock is a serious allergic reaction that involves the heart or lungs. It becomes difficult to breathe when someone's bronchial tubes narrow, and their pressure drops causing dizziness and in some cases loss of consciousness or even death. Anaphylactic shock requires immediate medical care and occurs rapidly.

Treatments:

Patients may not need treatment in case their symptoms are mild. As mentioned before, antihistamines, which block the symptoms-producing release of histamine, is the standard treatment for hives and angioedema. Those medications may include:

Nonprescription medications:

 

  • Cetirizine
  • Chlorpheniramine
  • Diphenhydramine
  • Loratadine


Chlorpheniramine, diphenhydramine or other antihistamines could cause drowsiness. However, loratadine doesn't.

Prescription medications:

 

  • Hydroxyzine
  • Desloratiadine
  • Levocetrirzine
  • Fexofenadine


Oral corticosteroids, such as prednisone, which could help lessen swelling, redness and itching, could sometimes be prescribed for severe cases of hives or angioedema.

TREATMENT FOR HEREDITARY ANGIOEDEMA:
The medications mentioned above are not effective in treating hereditary angioedema.
Certain androgens such as danazol, that help regulate levels of blood proteins, are some of the medications that are used specifically to treat hereditary angioedema on a long-term basis. There are also ongoing clinical trials, which are testing new medications to treat hereditary angioedema.

EMERGENCY SITUATIONS:
A person may need an emergency injection of adrenaline (epinephrine) and a trip to the emergency room for a severe attack of hives or angioedema. Patients may be prescribed and instructed how to use adrenaline, to carry with them for use in emergency situations in case they have repeated attacks in spite of treatment.

Prognosis:

Not Available

Expert's opinion

Expert's Name:
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Expert's opinion:

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Clinical Trials:

Not Available

 

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