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Urticaria


Hives



  • 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.

  • Red 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.

  • Allergies:
    1. Food, e.g., shellfish, nuts, strawberries
    2. Environmental, e.g., feathers, animal hairs, and cosmetics
    3. 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.

  • 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.

  • 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:
    1. Avoid allergens
    2. Non-sedating antihistamine

  • 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.

  • Seek immediate medical attention for your child.  This condition can be life-threatening if it is not treated immediately.

  • Avoid known irritants
  • May require life-long use of non-sedating antihistamines

  • Angioedema
  • Flea bites
  • Poison ivy, oak or sumac



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