Urticaria and angioedema are skin allergic reactions. The role of the Dermatologist is crucial both in the correct diagnosis and in their treatment. Although in acute urticaria we more easily recognize the cause, with diet and insect bites being the most common factors, in chronic urticaria we do not always find what causes the allergic reaction. However, we increasingly recognize anxiety as a triggering factor. In fact, sometimes chronic urticaria can be classified as psychodermatological disorders and to some extent we can talk about anxious urticaria. Moreover, urticaria is one of the most common skin conditions during pregnancy.
What is urticaria?
Urticaria is characterized by a rash that comes and 'goes' within 24 hours. Specifically, often within a few hours some lesions that had appeared disappear and new ones take their place in another location. Pathologically, it is characterized by the release of histamine leading to swelling of the skin and the swellings we often see ('wheels', 'candles'). Characteristic is the rash that most people have in the spring when they come into contact with caterpillars in pine trees.
In angioedema, swelling occurs in deeper layers of the skin and therefore no swellings are formed on the skin but the whole area swells (swelling of the eyes, lips, etc.).
Acute Urticaria and Chronic Urticaria
In the acute form of urticaria, especially in allergic individuals who are predisposed to 'bad' reactions to allergic stimuli such as bee stings, etc. the serious risk is anaphylactic shock with a drop in blood pressure and edema of the larynx that can lead to difficulty in breathing or even asphyxia. Fortunately, these reactions are rare, but in any case, someone who believes they have such symptoms, it is good to go as soon as possible to the nearest emergency hospital. These bad reactions take place in the first hours after the allergenic stimulus. Urticaria that lasts up to 6 weeks is characterized as acute.
In our clinic, we treat cases of acute urticaria usually after the first 24 hours and more frequently cases of chronic urticaria, where more than 6 weeks have elapsed since the onset of symptoms and the problem persists.
What are the causes of urticaria?
Special importance in the management of these reactions is to find, if possible, the triggering factor that causes the allergy e.g. bite, medication, pressure, friction, cold, type of food. Most of the time this is not possible and chronic urticaria is characterized as idiopathic. What we believe happens is that an allergen triggers the allergic reaction of the organism causing histamine release and the organism enters a vicious cycle and continues the functioning of the mechanism even after the allergen has ceased to bother it. Important factors affecting this process are stress and thyroid function. Basically, the allergen is a substance that does not pose a real danger to the organism, so this reaction, classified as a type I inflammatory reaction of our organism, starting with histamine secretion, is an exaggerated reaction that simply troubles the organism and does not protect it. For this reason, it is desirable and effective to suppress this reaction with the use of drugs while avoiding the factors that caused it.
Urticaria and anxiety
As we said, most of the time chronic urticaria is characterized as idiopathic as we cannot essentially find the triggering factor. In these cases, however, the importance of anxiety is increasingly recognized as a cause. Some scientists classify chronic urticaria into a group of psychodermatological disorders. Since the secretion of the hormone cortisol is very affected by stress and cortisol has a significant regulatory role in the inflammations of the organism, this has a chemical background that we still cannot fully recognize. At this level, managing anxiety is important with changes in daily life and exercise.
Urticaria - Treatment
Obviously, avoiding the factors that lead to allergic reactions is the first and most important step. Also, avoiding certain foods that promote histamine secretion such as chocolate, cheese, and fruits with seeds or are more often allergens such as nuts and seafood helps a lot.
Regarding drug therapy, crucial in treating this mechanism is the use of antihistamines, targeting more than one receptor, for a sufficient period of time to 'tame' the organism that has deviated from its normal function and to restore it to its previous balance gradually stopping treatment. Older generation antihistamines may be more effective but may make us drowsy and require caution in driving and especially in people using machinery. For this reason, good communication and contact with the patient are required. Sometimes the use of cortisone may be necessary for stubborn cases while there is also a new generation injectable factor that is useful in some forms of chronic urticaria.