Urticaria: The Puzzling Case of the Itchy Red Hives

 

Urticaria is a common condition, but it can significantly impact a person's quality of life. It is characterized by wheals, superficial dermal bumps that are typically itchy, pink or pale in the center, and sudden and temporary swelling of lips, eyelids and face (known as angioedema), a thick and temporary, shifting swelling of the skin and mucosa that is less often painful appearing like a map in the atlas. 

According to Institute of Applied Dermatology (IAD) founder-director and senior dermatologist Dr S R Narahari, though the symptoms of Urticaria may seem straightforward, the underlying causes can be varied and sometimes elusive.

Environmental allergies, autoimmune disorders like thyroid problems, medications like pain relievers, dietary  allergens, or even infections anywhere in the body, such as a tooth cavity, can all potentially trigger urticaria. Surprisingly, many cases of spontaneous urticaria remain unexplained, even after extensive evaluation, earning the label "idiopathic or unknown cause."

Some of the potential causes can be classified as follows:

Allergic reactions

Urticaria can be triggered by an allergic response to certain foods, medications, insect stings or bites, latex, or environmental allergens.

Infections

Bacterial, viral, or fungal infections, particularly those that affect the respiratory system, can sometimes lead to the development of urticaria.

Physical factors

Urticaria can also be triggered by physical stimuli, such as pressure, cold temperatures, heat, exercise, friction, or vibration.

Autoimmune disorders

In some cases, urticaria can be caused by an autoimmune reaction where the body's immune system mistakenly attacks its own tissues.

Stress

Emotional stress and anxiety can exacerbate or trigger urticaria in some individuals.

Hormonal changes

Fluctuations in hormone levels, such as those associated with menstrual cycles, pregnancy, or thyroid disorders, can sometimes contribute to the development of urticaria.

Heredity

There may be a genetic predisposition to urticaria in some cases, as it tends to run in families.

Idiopathic (unknown cause)

In some instances, the cause of urticaria remains unknown, even after thorough investigation.

Diagnosing urticaria primarily relies on a thorough medical history and clinical examination. However, determining the cause or triggering factor, as well as ruling out other potential diagnoses, may require detailed investigations, which can be expensive but necessary.

Despite its common occurrence, urticaria can cause considerable distress and significantly impact a patient's quality of life. The unpredictable nature of the condition, with symptoms appearing and disappearing within hours, can be particularly challenging for patients and their families.

"Effective management of urticaria often involves long-term medication management with antihistamines. These medications come in different groups, and doctors may need to adjust or switch between them to find the most effective option for each patient. It's a process that requires patience, persistence, and close collaboration between the patient and their healthcare provider," Dr Narahari said.

“At IAD, we use specific protocols to find the cause of urticaria. It includes a detailed diet history to know if the patient is taking foods that release histamines that trigger urticaria, patch testing, an ayurvedic evaluation to determine additional underlying causes not described”

One of the key lessons in managing urticaria is the importance of not dismissing or minimizing a patient's concerns, even when the symptoms seem to come and go. Actively listening to patients' experiences and taking their concerns seriously is crucial in obtaining an accurate diagnosis and developing an appropriate treatment plan.

"As healthcare providers, it's our responsibility to listen attentively, investigate thoroughly, and provide compassionate care and effective management strategies tailored to each individual's needs," he added.