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Urticaria

Updated : January 24, 2024





Background

Urticaria, also known as hives, is a type of skin rash characterized by the development of itchy, raised red lesions on the skin. The lesions, called wheals, can range in size from a few millimeters to several centimeters in diameter and may appear on any part of the body.

Urticaria can be caused by a variety of factors, including allergic reactions to foods, medications, or other substances; exposure to physical triggers such as cold, heat, or pressure; and infections or underlying medical conditions such as autoimmune diseases or thyroid problems.

In some cases, the cause of urticaria is unknown and is also referred to as idiopathic urticaria. Urticaria can range from mild to severe, and it may resolve on its own or persist for an extended period.

Epidemiology

Urticaria is a common skin condition that can affect people of all ages. It is estimated to occur in up to 20% of the general population at some point in their lives. The prevalence of urticaria varies depending on the specific type of urticaria and the population being studied. Chronic urticaria, defined as urticaria that lasts for more than six weeks, is less common than acute urticaria.

It is estimated to occur in 0.1-0.5% of the general population. Chronic urticaria is more common in women than men and is more likely to occur in people between the ages of 20 and 40. Acute urticaria, defined as urticaria that lasts for less than six weeks, is more common than chronic urticaria.

It is estimated to occur in up to 10% of the general population at some point in their lives. Acute urticaria can affect people of all ages, but it is more common in children and young adults.

Anatomy

Pathophysiology

The pathophysiology of urticaria involves the release of histamine and other inflammatory mediators from mast cells in the skin. Mast cells are a type of immune cell that is found in the skin and other tissues throughout the body. They contain granules filled with histamine and other substances released when the mast cell is activated.

In the case of urticaria, the mast cells are activated by various stimuli, such as allergens, physical triggers, or underlying medical conditions. When the mast cells are activated, they release histamine and other substances into the surrounding tissues, leading to the symptoms of urticaria, such as swelling, redness, and itching.

The precise mechanisms by which the mast cells are activated in urticaria vary depending on the specific type of urticaria and the underlying cause. In some cases, the activation of the mast cells may be triggered by an immune response to an allergen or other substance.

Etiology

The etiology of urticaria is often challenging to determine and can be caused by various factors.

Common causes include allergic reactions to certain foods, medications, or substances in the environment, insect stings or bites, physical triggers such as cold, heat, pressure, or sunlight, infections, especially viral infections, autoimmune disorders such as lupus or thyroid disease, and idiopathic, which means the cause is unknown.

In many cases, the underlying cause of urticaria is not found. Some people develop chronic urticaria, which is defined as hives lasting longer than six weeks, and the cause of this condition is often difficult to determine.

Genetics

Prognostic Factors

The prognosis for urticaria, also known as hives, depends on the underlying cause of the condition and the severity of symptoms. In most cases, urticaria is a self-limiting condition that will resolve within a few days to weeks.

In some cases, the cause of urticaria may be difficult to determine, and the condition may become chronic, lasting for months or even years. Acute urticaria usually goes away in 6-8 weeks, and most people recover fully. However, in some cases, the symptoms may be recurrent or chronic.

Clinical History

Clinical History

Urticaria is characterized by the appearance of itchy, red, swollen patches on the skin, called papules and plaques, that typically have a pale center. These patches can vary in size and shape and may join together as they appear. The condition is usually temporary, and the affected areas usually disappear within 24 hours without leaving any discoloration or pigmentation behind.

The patches are often found on areas of the body under pressure, such as the waist, underarms, and groin, but can appear anywhere on the body. Scratching the affected areas can lead to further skin damage, such as scratches, erosions, and crusts.

Some people with urticaria may also experience swelling of deeper layers of the skin, called angioedema, which occurs in up to 40% of people with hives. This can affect areas such as the lips, eyelids, genitals, and extremities and causes discomfort and pain instead of itching.

Physical Examination

Physical Examination

Urticaria is characterized by raised, palpable wheals on the skin. These wheals can be linear, annular, or arcuate in shape and can appear on any area of the skin. They are often transient and migratory and may be separated by normal skin or rapidly coalesce to form larger areas of erythematous, raised lesions.

The physical examination of a person with urticaria focuses on identifying conditions that could potentially be life-threatening, such as angioedema of the lips, tongue, or larynx. Urticarial lesions that are painful, long-lasting, or ecchymotic, as well as those that leave residual hyperpigmentation or ecchymosis upon resolution, are present. Systemic signs or symptoms, such as fever, arthralgias, arthritis, weight changes, bone pain, or lymphadenopathy, are noted.

In addition, the examination should check for scleral icterus, hepatic enlargement, or tenderness that may indicate liver disease and thyromegaly, which may indicate autoimmune thyroid disease. The examination should also include a joint examination for any evidence of connective tissue disease, rheumatoid arthritis, systemic lupus erythematosus, and any signs of lung infections.

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Differential Diagnosis

Urticarial Vasculitis

Mastocytosis

Bullous Pemphigoid

Scabies

Allergic Contact Dermatitis

Atopic Dermatitis

Pityriasis Rossea

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Urticaria is typically managed with medications and lifestyle changes. The most common medications used to treat urticaria include antihistamines, which block the effects of histamine and can reduce itching, swelling, and other symptoms. Corticosteroids may also be used to reduce inflammation.

In severe cases, other medications, such as leukotriene antagonists or immunosuppressants, may be used. Managing urticaria may involve making certain lifestyle changes. One of the most important steps is identifying and avoiding triggers that cause hives, such as certain foods, medications, or environmental factors.

Wearing loose, cotton clothing can also help reduce irritation on the skin. It is also important to use non-irritating skin products and keep the skin cool and dry. These changes can help alleviate symptoms and prevent further outbreaks.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

desloratadine 

Indicated for Allergic Rhinitis & Urticaria and Chronic Idiopathic Urticaria:

5

mg

Orally 

every day



clemastine 

Take dose of 2.68 mg orally daily every 8 hours and a maximum daily dose up to 8.04 mg



bilastine 

20 mg once daily
If the symptoms are not controlled after 2 weeks, increase the dose to 40 mg once daily
If, after additional 2 weeks, still, the symptoms are not controlled, increase the dose to 80 mg once daily



bentoquatam 


Indicated for Allergic Urticaria
Apply an adequate quantity of lotion to form a noticeable coating 15 min prior to contact with plants



alimemazine 

(pruritis):

10 mg orally given as alimemazine tartrate twice or thrice a day. In Refractory cases: 100 mg is given daily



azatadine 

Take 1-2 mg by oral route two times daily



pheniramine 

Administer 20mg tablet daily once



brompheniramine 

4 - 8

mg

Orally 



Dose Adjustments

The dose may vary depending on the patient's response.
In most patients, the dose may be two times a day
6mg- 12mg orally two times a day (extended-release)
The dose may vary depending on the patient's response.
In most patients, the dose is maybe once a day at bedtime
Maximum dose: 24mg/day

chlorcyclizine 

Take a dose of 10 ml orally every 4 to 6 hours
Maximum dose should not be more than 6 doses in a day



 

desloratadine 

For Perennial Allergic Rhinitis and Chronic Idiopathic Urticaria
Age 6-12 months:

1

mg

Orally 

every day


Age 1-5 years: 1.25 mg orally daily
Age 6-12 years: 2.5 mg orally daily
Age > 12 years: 5 mg orally daily

For Allergic Rhinitis and Urticaria
Age 2-5 years: 1.25 mg orally daily
Age 6-12 years: 2.5 mg orally daily



clemastine 

<6 years old: take 0.05 mg/kg daily as clemastine base divided every 8 to 12 hours and dose not more than 1.34 mg
6 to 12 years old: take 0.67 to 1.34 mg clemastine fumarate every 12 hours and a daily dose not more than 4.02 mg
>12 years old: follow dose as per adults



bilastine 

For children 4-11 years, 10 mg once daily
For children more than 12 years, 20 mg once daily



bentoquatam 


Indicated for Allergic Urticaria
Age >6 years
Apply an adequate quantity of lotion to form a noticeable coating 15 min prior to contact with plants



alimemazine 

pruritis:

above 2 years: orally given as alimemazine tartrate three to four times a day



azatadine 

Age more than or equal to 12 years
Take 1-2 mg by oral route two times daily



pheniramine 

6 to 11 years (Weighing at least 20 kgs): Administer 10mg tablet daily once ≥12 years: Administer 20mg tablet daily once



brompheniramine 

For children less than six years old:
0.125mg/kg four times a day (immediate release)
Maximum dose: 6mg- 8mg/day
2mg suspension (extended-release) orally two times a day
Note: do not administer more than two doses per day
For children of 6- 12 years of age:
2mg- 4mg orally 3-4 times a day (immediate release)
Maximum dose: 12-16mg/day
4mg suspension orally (extended-release), two times a day
Note: Do not exceed two doses per day
For children more than 12 years of age:
4mg- 8mg orally four times a day (immediate release)
The dose may vary depending on the patient's response.
In most patients, the dose may be two times a day 6mg- 12mg orally two times a day (extended-release)
The dose may vary depending on the patient's response.
In most patients, the dose is maybe once a day at bedtime
Maximum dose: 24mg/day



chlorcyclizine 

For >12 years old:
Take a dose of 10 ml orally every 4 to 6 hours
For 6 to 12 years old:
Take a dose of 5 ml orally every 4 to 6 hours



 

alimemazine 

10 mg orally given as alimemazine tartrate once or twice a day



Media Gallary

References

Urticaria

Updated : January 24, 2024




Urticaria, also known as hives, is a type of skin rash characterized by the development of itchy, raised red lesions on the skin. The lesions, called wheals, can range in size from a few millimeters to several centimeters in diameter and may appear on any part of the body.

Urticaria can be caused by a variety of factors, including allergic reactions to foods, medications, or other substances; exposure to physical triggers such as cold, heat, or pressure; and infections or underlying medical conditions such as autoimmune diseases or thyroid problems.

In some cases, the cause of urticaria is unknown and is also referred to as idiopathic urticaria. Urticaria can range from mild to severe, and it may resolve on its own or persist for an extended period.

Urticaria is a common skin condition that can affect people of all ages. It is estimated to occur in up to 20% of the general population at some point in their lives. The prevalence of urticaria varies depending on the specific type of urticaria and the population being studied. Chronic urticaria, defined as urticaria that lasts for more than six weeks, is less common than acute urticaria.

It is estimated to occur in 0.1-0.5% of the general population. Chronic urticaria is more common in women than men and is more likely to occur in people between the ages of 20 and 40. Acute urticaria, defined as urticaria that lasts for less than six weeks, is more common than chronic urticaria.

It is estimated to occur in up to 10% of the general population at some point in their lives. Acute urticaria can affect people of all ages, but it is more common in children and young adults.

The pathophysiology of urticaria involves the release of histamine and other inflammatory mediators from mast cells in the skin. Mast cells are a type of immune cell that is found in the skin and other tissues throughout the body. They contain granules filled with histamine and other substances released when the mast cell is activated.

In the case of urticaria, the mast cells are activated by various stimuli, such as allergens, physical triggers, or underlying medical conditions. When the mast cells are activated, they release histamine and other substances into the surrounding tissues, leading to the symptoms of urticaria, such as swelling, redness, and itching.

The precise mechanisms by which the mast cells are activated in urticaria vary depending on the specific type of urticaria and the underlying cause. In some cases, the activation of the mast cells may be triggered by an immune response to an allergen or other substance.

The etiology of urticaria is often challenging to determine and can be caused by various factors.

Common causes include allergic reactions to certain foods, medications, or substances in the environment, insect stings or bites, physical triggers such as cold, heat, pressure, or sunlight, infections, especially viral infections, autoimmune disorders such as lupus or thyroid disease, and idiopathic, which means the cause is unknown.

In many cases, the underlying cause of urticaria is not found. Some people develop chronic urticaria, which is defined as hives lasting longer than six weeks, and the cause of this condition is often difficult to determine.

The prognosis for urticaria, also known as hives, depends on the underlying cause of the condition and the severity of symptoms. In most cases, urticaria is a self-limiting condition that will resolve within a few days to weeks.

In some cases, the cause of urticaria may be difficult to determine, and the condition may become chronic, lasting for months or even years. Acute urticaria usually goes away in 6-8 weeks, and most people recover fully. However, in some cases, the symptoms may be recurrent or chronic.

Clinical History

Urticaria is characterized by the appearance of itchy, red, swollen patches on the skin, called papules and plaques, that typically have a pale center. These patches can vary in size and shape and may join together as they appear. The condition is usually temporary, and the affected areas usually disappear within 24 hours without leaving any discoloration or pigmentation behind.

The patches are often found on areas of the body under pressure, such as the waist, underarms, and groin, but can appear anywhere on the body. Scratching the affected areas can lead to further skin damage, such as scratches, erosions, and crusts.

Some people with urticaria may also experience swelling of deeper layers of the skin, called angioedema, which occurs in up to 40% of people with hives. This can affect areas such as the lips, eyelids, genitals, and extremities and causes discomfort and pain instead of itching.

Physical Examination

Urticaria is characterized by raised, palpable wheals on the skin. These wheals can be linear, annular, or arcuate in shape and can appear on any area of the skin. They are often transient and migratory and may be separated by normal skin or rapidly coalesce to form larger areas of erythematous, raised lesions.

The physical examination of a person with urticaria focuses on identifying conditions that could potentially be life-threatening, such as angioedema of the lips, tongue, or larynx. Urticarial lesions that are painful, long-lasting, or ecchymotic, as well as those that leave residual hyperpigmentation or ecchymosis upon resolution, are present. Systemic signs or symptoms, such as fever, arthralgias, arthritis, weight changes, bone pain, or lymphadenopathy, are noted.

In addition, the examination should check for scleral icterus, hepatic enlargement, or tenderness that may indicate liver disease and thyromegaly, which may indicate autoimmune thyroid disease. The examination should also include a joint examination for any evidence of connective tissue disease, rheumatoid arthritis, systemic lupus erythematosus, and any signs of lung infections.

Differential Diagnosis

Urticarial Vasculitis

Mastocytosis

Bullous Pemphigoid

Scabies

Allergic Contact Dermatitis

Atopic Dermatitis

Pityriasis Rossea

Urticaria is typically managed with medications and lifestyle changes. The most common medications used to treat urticaria include antihistamines, which block the effects of histamine and can reduce itching, swelling, and other symptoms. Corticosteroids may also be used to reduce inflammation.

In severe cases, other medications, such as leukotriene antagonists or immunosuppressants, may be used. Managing urticaria may involve making certain lifestyle changes. One of the most important steps is identifying and avoiding triggers that cause hives, such as certain foods, medications, or environmental factors.

Wearing loose, cotton clothing can also help reduce irritation on the skin. It is also important to use non-irritating skin products and keep the skin cool and dry. These changes can help alleviate symptoms and prevent further outbreaks.

desloratadine 

Indicated for Allergic Rhinitis & Urticaria and Chronic Idiopathic Urticaria:

5

mg

Orally 

every day



clemastine 

Take dose of 2.68 mg orally daily every 8 hours and a maximum daily dose up to 8.04 mg



bilastine 

20 mg once daily
If the symptoms are not controlled after 2 weeks, increase the dose to 40 mg once daily
If, after additional 2 weeks, still, the symptoms are not controlled, increase the dose to 80 mg once daily



bentoquatam 


Indicated for Allergic Urticaria
Apply an adequate quantity of lotion to form a noticeable coating 15 min prior to contact with plants



alimemazine 

(pruritis):

10 mg orally given as alimemazine tartrate twice or thrice a day. In Refractory cases: 100 mg is given daily



azatadine 

Take 1-2 mg by oral route two times daily



pheniramine 

Administer 20mg tablet daily once



brompheniramine 

4 - 8

mg

Orally 



Dose Adjustments

The dose may vary depending on the patient's response.
In most patients, the dose may be two times a day
6mg- 12mg orally two times a day (extended-release)
The dose may vary depending on the patient's response.
In most patients, the dose is maybe once a day at bedtime
Maximum dose: 24mg/day

chlorcyclizine 

Take a dose of 10 ml orally every 4 to 6 hours
Maximum dose should not be more than 6 doses in a day



desloratadine 

For Perennial Allergic Rhinitis and Chronic Idiopathic Urticaria
Age 6-12 months:

1

mg

Orally 

every day


Age 1-5 years: 1.25 mg orally daily
Age 6-12 years: 2.5 mg orally daily
Age > 12 years: 5 mg orally daily

For Allergic Rhinitis and Urticaria
Age 2-5 years: 1.25 mg orally daily
Age 6-12 years: 2.5 mg orally daily



clemastine 

<6 years old: take 0.05 mg/kg daily as clemastine base divided every 8 to 12 hours and dose not more than 1.34 mg
6 to 12 years old: take 0.67 to 1.34 mg clemastine fumarate every 12 hours and a daily dose not more than 4.02 mg
>12 years old: follow dose as per adults



bilastine 

For children 4-11 years, 10 mg once daily
For children more than 12 years, 20 mg once daily



bentoquatam 


Indicated for Allergic Urticaria
Age >6 years
Apply an adequate quantity of lotion to form a noticeable coating 15 min prior to contact with plants



alimemazine 

pruritis:

above 2 years: orally given as alimemazine tartrate three to four times a day



azatadine 

Age more than or equal to 12 years
Take 1-2 mg by oral route two times daily



pheniramine 

6 to 11 years (Weighing at least 20 kgs): Administer 10mg tablet daily once ≥12 years: Administer 20mg tablet daily once



brompheniramine 

For children less than six years old:
0.125mg/kg four times a day (immediate release)
Maximum dose: 6mg- 8mg/day
2mg suspension (extended-release) orally two times a day
Note: do not administer more than two doses per day
For children of 6- 12 years of age:
2mg- 4mg orally 3-4 times a day (immediate release)
Maximum dose: 12-16mg/day
4mg suspension orally (extended-release), two times a day
Note: Do not exceed two doses per day
For children more than 12 years of age:
4mg- 8mg orally four times a day (immediate release)
The dose may vary depending on the patient's response.
In most patients, the dose may be two times a day 6mg- 12mg orally two times a day (extended-release)
The dose may vary depending on the patient's response.
In most patients, the dose is maybe once a day at bedtime
Maximum dose: 24mg/day



chlorcyclizine 

For >12 years old:
Take a dose of 10 ml orally every 4 to 6 hours
For 6 to 12 years old:
Take a dose of 5 ml orally every 4 to 6 hours



alimemazine 

10 mg orally given as alimemazine tartrate once or twice a day