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Urticaria & Angio-oedema

Urticaria & Angio-oedema

Description

Urticaria : also called nettle rash, with hives, superficial pruritic lesions

Angio-œdema : swelling induced by cutaneous vasodilatation

These 2 lesions can either appear alone or together. They are caused by the degranulation of mast cells (histamin liberation) and are due to the skin immune system’s instability and hyperreactivity.

They occur suddenly and disappear without a trace.

Reactions are either acute or chronic:

  • Acute urticaria &/or angio-oedema: appearing and disappearing quickly, without leaving any scars, with numerous triggers.
  • Chronic urticaria &/or angio-oedema: when lesions appear a few times a week, at least for 6 weeks, chronicity is established. Considering the large number of possible triggers, a general health check-up is always necessary to narrow possible causes down.

Etiology (causes)

  • Acute urticaria &/or angio-oedema:
    • food, wasp/bee sting, contact with specific substances, medicine.
    • In these cases, allergic response may be immediate, sometimes general and severe (anaphylaxy).
    • Lesions may be triggered by a virus, although it is not always possible to demonstrate the link.
  • Chronic urticaria &/or angio-oedema:
    • Nearly 90 % of chronic angio-oedema and urticaria are considered “idiopatic” (i.e. no underlying pathology).
    • 8 % have a physical cause: dermographism (stratching), cold, warmth, pression, cholinergic, vibrations. Patients develop these lesions when in contact with physical stimuli.
    • 2 % are statistically associated to various etiologies (mostly immune diseases, immune thyroïd lesions, immune deficit, chronic infections, parasites, Helicobacter pylori, neoplasm, and a whole list of rare illnesses). When urticaria lesions are fixed and do not spred nor move, an immune disease or a vasculitis must be considered.
    • some histamin-liberating medicine or food (fish, cheese, etc.) may trigger lesions in predisposed patients.

Treatment

  • In case of anaphylactic reaction, emergency treatment will be aimed at the anaphylaxy (adrenalin). When respiratory or cardiac symtoms are present,  patient should be admitted to hospital immediately.
  • Other less severe reactions respond well to antihistaminics (intraveinous or tablets), and in ase of giant angio-œdema, coticoïds (intraveinous or tablets) may be used.
  • Naturally,the allergen responsible for the lesions must be avoided (medicine, food, insect) at all cost.

giant urticaria

angio-oedema of the eyes

   

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