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Urticaria - Medical Malpractice
Most people call urticaria "hives" and it is a common skin disorder seen in the emergency room and at doctors' offices. It looks like a bunch of raised, well-circumscribed bumps that can be of differing sizes. The bumps are almost always red and very itchy. It can last less than six weeks and can be considered acute. It can last longer than 6 week and be termed chronic. There are several types of urticaria including IgE mediated urticaria, autoimmune urticaria, urticarial vasculitis, cold urticaria and other forms of the disease.
Urticaria in its acute form affects about 15-20 percent of the general population at some time in their lifetime. Itching is the most common symptom and while people are uncomfortable, there is very little mortality associated with the condition. It occurs more commonly in women at 60 percent but all races are affected equally. It can occur in any age group; however chronic urticaria is more common in a person's 30s and 40s.
Urticaria can resemble a number of other rashes but is distinguished by its intensely itching nature. It can look like insect bites, pityriasis rosea and other rashes but these others do not itch nearly as much as urticaria does.
The symptoms of urticaria are the classic rash, which can involve the entire body or just a portion of the body. There can be hundreds of lesions or just a few. The rash is, as mentioned, intensely itchy and red. The lesions blanch when pushed on them, which is not true of some lookalike rashes.
Doctors need to diagnose urticaria through an intense history and physical examination. The doctor needs to ask about previous episodes of urticaria, as these are commonly something a person gets over and over again. Precipitants like cold, heat, pressure, exercise, emotional stress or chronic autoimmune disorders, lymphoma, polycythemia vera and amyloidosis can contribute to the disease. There may be a family history of angioedema which is a variant of urticaria that can be life threatening. There is both hereditary and acquired angioedema. There aren't really any blood tests necessary for the diagnosis of urticaria because the clinical presentation and history usually give the diagnosis away. In chronic or recurrent cases of urticaria, the doctor will go ahead and do a CBC, sed rate, ANA and TSH, which are blood tests that can look at the possibility that other diseases are causing the urticaria.
Causes of urticaria are many, including recent illness, certain medication allergies, allergy to IV contrast dye, and certain tropical diseases like malaria and amoebiasis. There can be allergies to shellfish, eggs, fish, cheese, nuts, chocolate, berries and tomatoes. Certain perfumes in beauty products can contribute to urticaria and exposure to pet dander can trigger the rash. Pregnancy can cause a great deal of itching due to urticaria. Nickel allergies can cause hives as can latex and rubber. Cold exposure or sun exposure can lead to urticaria. Exercise can cause urticaria in some people.
Chronic urticaria, lasting six weeks or more, can be caused by autoimmune diseases, connective tissue diseases, hyperthyroidism, chronic stressors, mastocytosis, cold and idiopathic causes. In fact, the cause of urticaria is unknown in 80 to 90 percent of cases.
Recurrent urticaria-urticaria that comes and goes-is due to exercise (cholinergic urticaria), sun exposure, emotional distress, physical stressors or water exposure.
Urticaria comes from the release of histamine into the skin and in the bloodstream. Bradykinin, leukotriene C4, prostaglandin D2 and other chemicals in the body are also contributing factors to urticaria. The itching is caused strictly by the histamine release. It is released from mast cells and basophils within the skin.
The main treatment for urticaria is removing the cause of the condition and giving Benadryl or diphenhydramine. This blocks the histamine response and controls the itching. If you scratch these lesions, you tend to release even more histamine and you'll get more lesions. Epinephrine can be used if there is laryngeal angioedema and trouble breathing. Corticosteroids can have some benefit in this condition as well.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here