Sunday, October 16th, 2011 VN:F [1.9.3_1094]
You were taking a bath when you first saw the reddish patches that were all over your chest. At first, you thought it was merely an allergic reaction to something you ate or the new soap you bought because it smelled lovely. But even after six months passed by, it seemed to multiply. From a small patch on your chest, it seemed to reach your arms and your legs. What’s worse, it’s also starting to become increasingly itchy that you can’t focus your mind on anything else. after deciding to stop delaying asking a doctor’s advice, you visit your health provider to ask for treatment. you underwent a series of physical exams and diagnostic tests before your physician recognized that you have been suffering chronic urticaria (CIU).
The disease may not be life threatening but it can seriously affect how a person lives his life among others. in the United States alone, fifteen (15%) to twenty three (23%) percent of the population are diagnosed with this medical condition. The most common type of urticaria is one that is chronic and recurs often.
Signs and symptoms
The hallmark sign of urticaria, no matter the type, is usually the appearance of typically temporary eruption of inflammatory cutaneous wheals with pruritus (itching) and redness. The wheals may vary in size, ranging from a few millimeters up to several centimeters when measured in terms of diameter. nevertheless, when wheals are so close to each other that they look like they’re the same wheal, plaques can be larger than the average size. The wheals can last for less than 24 hours although there are instances where it can last for more than 48 hours, especially in people who are suffering from urticarial vasculitis (UV). normally, the wheals may be irregular with a pseudopdal shape or round. The wheals have a bright red center with a slightly paler surrounding skin, creating a halo-like impression on the skin. This is known as the “steal effect”, wherein the flow of blood towards the area increases, thereby decreasing the blood flow of the skin outside the lesion. Typically, these types of wheals are more common in people suffering from cholinergic and acute allergic urticaria in lieu of chronic urticaria. nevertheless, it can also occur in people diagnosed with the latter as well. The wheals may manifest in almost any part of the skin such as the palms, the soles and the scalp.
Itchiness varies in intensity from one patient to another. The quality may be different too. there are patients who complain that the itchiness seems to burn while there are also those who feel a pricking sensation alongside the itchiness. The itchiness also tends to increase in the evening although it can easily be relieved by rubbing the itchy skin.
Angiodema, which are usually red or skin-colored, temporary submucosal or subcutaneous dermal edema, is also a common manifestation of people who are suffering from chronic urticaria. Fifty percent of people diagnosed with CIU also manifest angiodema in their skin. It lasts for less than 24 hours although larger angiodemas may last for more than the average. It can cause severe disfigurement on the skin although it is considered to be more dangerous in the oropharynx as it blocks the pathway of air.
Although chronic urticaria is known to be an autoimmune disease, the cause of it is still largely unknown in the medical field. there are a lot of hypothesis surrounding the possible cause of this medical condition, alongside numerous triggers that exacerbate the signs and symptoms. Experts believe that the manifestations of CIU are due to the extensive and recurring activation o the dermal mast cell, thereby triggering the release of histamines and other mediators in the body. other theories also believe that basophils, several viruses and even the bacteria Helicobacter pylori are believed to cause CIU. People who are allergic to certain foods are also believed to be more prone to CIU due to the IgE-mediated type I allergy, which causes subsequent acute urticaria.
The diagnosis used to determine the presence of chronic urticaria is called the autologous serum skin testing. It is very specific and sensitive, especially when plasma or blood is used during the peak of disease activity. The exact volume of 0.05 plasma or blood will then be injected intradermally into the skin that is not affected by wheals or angiodema. A wheal that is more than 1.5 millimeters in diameter is considered to be a positive for CIU.
Medical intervention for CIU is usually through H1 antihistamine treatment, particularly to patients who suffer from wheals and itching outbreaks on a regular basis. It is essential to stress to the patient about taking the medication daily in order to optimize the effect of the medicine. Statistics have shown that combining H1 and H2 antihistamine medications have a significant advantage to reduce the inflammatory signs and symptoms in people suffering from CIU. Corticosteroids and leukotriene antagonists have also been used at some point in order to lessen the inflammation that manifest.
For patients who are tested to be autoantibody positive wherein the medications above can’t be given, cyclosporine treatment is often recommended. although clinical studies have shown that cyclosporine is highly effective in treating severe autoantibody-negative diseases, it still values to be effective for autoantibody positive patients. during treatment, it is important to monitor the kidney function and the blood pressure, which is usually affected by cyclosporine treatments.
Lifestyle modification is also an important part of living a life that is not debilitated by CIU. Doctors recommend that you take alcohol only in moderation. Being excessively tired should be avoided too as well as been exceedingly stressed. It is also important to prevent being in an area with extreme heat as it may only exacerbate the symptoms of CIU. Dietary restrictions are not recommended and taking regular tepid baths can also help reduce the signs and symptoms of CIU.
Living with chronic urticaria can be debilitating not only to the person’s self-esteem and self-confidence but to daily activities as well. However, sticking to the treatment religiously can help reduce the symptoms, allowing the patient to live a prolific life.
1. Greaves, M. (1995) “Chronic Urticaria”, new England Journal of Medicine.
2. Popov, T. (2011) “Challenges in the Management of Chronic Urticaria”, World Allergy Organization Journal.
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