Urticaria & Angioedema

h-nutsUrticaria (hives) and angioedema (swelling) are very common conditions affecting up to 10% of the population at some point during their life. Urticaria is characterized by raised red lesions (welts) with a pale center that are usually hot and itchy. They can occur at any location on the body. These lesions tend to change position/migrate on the body over time. Angioedema is a soft tissue swelling under the skin which is usually not as itchy and may be mildly painful. In rare cases it may become life-threatening with swelling of the throat. The most common sites are the lip, tongue, under the eye, neck, hands and feet. In about 50% of people, hives and angioedema occur together, while hives occur alone in 40% and 10% have only angioedema.

If episodes have lasted six weeks or less it is considered acute; and more than six weeks is chronic. The most common causes of urticaria and angioedema are:

  • Idiopathic – Studies have shown that over 80% of hives and angioedema have no known demonstrable cause. This is called idiopathic urticaria and angioedema. The good news is that in about 50% of such patients, the hives and swelling will resolve by itself in a year or less, and there is nothing seriously wrong with the patient’s health.

  • Drugs – Any prescription, over-the-counter, or supplement ingested may cause urticaria and/or angioedema. The most common offenders are blood pressure medications and antibiotics.

  • Allergies/Food – Inhalant allergies are a rare cause of symptoms. Food allergens are a common cause in sensitized patients. Complete avoidance of the allergic food will usually cause a complete resolution of symptoms. Food additives such as seasonings, preservatives, taratazine (FD&C Yellow Dye #5), aspartame (NutraSweet) and benzoates along with natural salicylates found in certain foods have been known to provoke symptoms.

  • Contacts/Inhalants – Contacts at the home or office such as detergents, cosmetics, cleaners and sun tan lotions to name only a few have been reported to produce symptoms. It is important to recall any new contacts at the time the hives developed. Inhalants refer to any new exposure, indoor or outdoor, such as paint, insulation, lining, or vapor. Any new fans or new ventilation systems can increase the level of an existing exposure to cause symptoms.

  • Physical Factors – Physical factors such as scratching/rubbing the skin, pressure, heat, cold, exercise or sunlight have been known to provoke hives.

  • Infections – Hives have been reported prior to or shortly after a parasitic, fungal, bacterial or viral infection. Most often the hives will resolve when the infection is resolved or shortly thereafter (within 2-3 months).

  • Hereditary – Hereditary may play a role in certain causes of chronic urticaria and angioedema. One condition called Hereditary Angioeurotic Edema is characterized with intermittent episodes of painful swelling due to an enzyme deficiency. Usually there is a family history of this problem.

  • Systemic Diseases – Numerous systemic diseases have been associated with chronic hives. Autoimmune disorders such as systemic lupus erythematosis, rheumatoid arthritis, and endocrine disorders, especially hyperthyroidism, can cause symptoms. In rare cases, malignancies of the lung and colon have been reported with hives and swelling.

Evaluation and Treatment

Few cases of urticaria and angioedema are curable, but most are treatable. Your allergist will attempt to help you find a cause and a cure, treat your symptoms aggressively and help guide you through a medical regimen to help you manage your own symptoms.

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