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Urticaria
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- This is a reaction in the skin involving small, red swellings called wheals.
- Hives occur when the body's immune system reacts to an outside stimulus, such as an allergen, in an inappropriate manner, releasing IgE antibodies that trigger a "complement cascade" of histamine. The histamine results in the red lesions of hives that we see.
- It usually resolves within 48 hours. However, chronic Urticaria persists for longer than 6 weeks; its mechanisms are unknown.
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- Red, sometimes circular, hives/wheals -- red, raised welts. Sometimes the welts will "melt into each other," giving the appearance of areas with large raised red swelling.
- Itching is usually severe, but occasionally absent.
- Swelling of tongue, lips, eyelids, palms, soles, and genitals in more severe attacks. Breathing problems may also occur.
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- Food, e.g., shellfish, nuts,
strawberries
- Environmental, e.g., feathers,
animal hairs, and cosmetics
- Medications, e.g., penicillin,
aspirin
- Medications -- nonallergic form, e.g., atropine, pilocarpine, morphine
- Insect/bug bites and stings
- Heat
- Cold
- Skin pressure
- Infections such as Hepatitis B
- Rarely hereditary
- Chronic Urticaria can be associated with lymphoma, collagen disease, or psychogenic disease.
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- Classic rash that blanches with pressure
- Scratching skin can produce lines of swelling.
- Check for low blood pressure and for coughing or wheezing.
- Blood tests are only necessary if symptoms are chronic or severe.
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- Epinephrine 1:1000 injection for severe reactions (especially if associated breathing problems or more severe reactions such as swollen lips and tongue occur)
- Antihistamines, e.g., hydroxyzine, Zyrtec
- Oral prednisone is sometimes helpful.
- Doxepin (an older antidepressant) helps in chronic cases
- Oral ranitidine or cimetidine may be helpful for recurrent symptoms.
- Chronic Urticaria:
- Avoid allergens
- Non-sedating antihistamine
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- Severe cases may involve breathing problems
- Scratching can cause infections or scarring.
- Antihistamines can be sedating.
- Steroids can have many side effects if used for long periods.
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- Seek immediate medical attention for your child. This condition can be life-threatening if it is not treated immediately.
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- Avoid known irritants
- May require life-long use of non-sedating antihistamines
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- Angioedema
- Flea bites
- Poison ivy, oak or sumac
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