What is urticaria?

Urticaria, also known as hives, wheals or welts, is a skin condition that causes a red, swollen, itchy and sometimes painful rash to appear on the skin. Alongside the rash, some people will also experience skin swelling known as angioedema, which most commonly affects the eyelids, lips, hands and feet1.

Urticaria is fairly common, affecting around 20% of people at some point in their lifetime. Most cases are the result of an allergic reaction and usually settle within a few days. If the rash clears completely within 6 weeks, it is known as acute urticaria.1

Chronic urticaria (CU)

Chronic urticaria is the name given to urticaria when the symptoms don’t settle and reoccur for at least 6 weeks.1

Around two-thirds of people living with CU have a type called chronic spontaneous urticaria (CSU) CSU), also known as chronic idiopathic urticaria (CIU). The spontaneous or idiopathic in the name means that there is no known cause for the reaction. In contrast, one-third of people with CU have chronic inducible urticaria (CIndU), a form of the condition where the trigger is identifiable. There are many possible triggers, and may include cold and heat, pressure, sunlight and vibrations.2,3

Who is affected by urticaria?

Around 20% of people will experience urticaria at some point in their lives, although for most, it is short lasting and does not come back.1 Chronic urticaria can affect up to 1% of the population, with women twice as likely to be affected by chronic urticaria compared to men. While it can affect all ages, the incidence peaks between 20-40 years of age.4

Symptoms of CU

The main symptoms of CU (and urticaria in general) include patches of welts or wheals, which can be red in appearance and occur anywhere on the body. They can vary in size and shape and may be itchy. Another symptom experienced by many is swelling (known as angioedema), especially of the eyelids, lips, hands and feet.

Disease impact

For many people, living with CU can affect a lot more than just the skin, although the visible aspect of the disease can already be very disruptive to their lives. CU symptoms can also have a significant impact on other aspects of physical and psychological health, with people often experiencing sleep deprivation, anxiety, depression and stress because of their CU.4

What causes chronic urticaria?

During a flare, the body releases a chemical called histamine in response to something that it has identified as a threat. Specifically in the case of CSU/CIU, a trigger for this response cannot be identified. Histamine triggers further reactions within the body that result in the rash and swelling symptoms of CU.5

Diagnosis

Your general practitioner can confirm a diagnosis of CU in some cases, but you may also require a referral to a specialist, usually an allergist or dermatologist. To help determine whether there is a noticeable trigger of your urticaria, the doctor may ask you to keep a diary of your activities, medications, diet and symptoms.1 

 

Mental Health

Treatment

Antihistamines tend to be the first treatment option offered to people living with CU.  You may have heard of this type of drug in relation to treating allergies such as hay fever. They work by stopping a substance called histamine, which can cause inflammation and swelling, affecting the cells in your body.6 Unfortunately, antihistamines only relieve symptoms in less than 50% of patients with CU, so other treatment options are needed for many people.4 

Steroid drugs are another anti-inflammatory drug that can benefit people with CU, but as they can cause potential side effects, their use is normally limited to short-term.1

Biologic drugs are designed to mimic substances produced by the human body, and because of this can have a more targeted effect. In many cases they are aimed at steps in the immune system that can play a role in the disease process. Biologic therapies are a treatment option for people with CU who have not responded to treatment with antihistamines.7 In most cases they can only be prescribed by a specialist, and you will need to meet certain criteria to be eligible for these more advanced treatments.

 

 

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References

[1] NHS inform. Urticaria (hives). 2019. Available at: https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/urticaria-hives. Last accessed June 2019

[2] Maurer M., Fluhr JW., Khan DA. How to Approach Chronic Inducible Urticaria. J Allergy Clin Immunol Pract. 2018. 6(4):119-1130

[3] Maurer M., et al. Differences in chronic spontaneous urticaria between Europe and Central/ South America: results of the multi-center real world AWARE study. World Allergy Organization Journal. 2018. 16(11):32

[4] Maurer M., et al. Unmet clinical needs in chronic spontaneous urticaria. A GALEN task force report. Allergy. 2010. 66(3):317-330

[5] Web MD. Hives and Your Skin. 2019. Available at: https://www.webmd.com/skin-problems-and-treatments/guide/hives-urticaria-angioedema#1. Last accessed June 2019

[6] NHS. Antihistamines. 2017. Available at: https://www.nhs.uk/conditions/antihistamines/. Last accessed June 2019

[7] Web MD. Hives and Your Skin Continued. 2019. Available as: https://www.webmd.com/skin-problems-and-treatments/guide/hives-urticaria-angioedema#2. Last accessed June 2019