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Initial treatment of acute urticaria should focus on the short-term alleviation of pruritus and reduction of wheals. The literature on the management of acute urticaria is rare, probably because the condition is too often self-limited. Current guidelines recommend modern second-generation H1-antihistaminess...
In patients with poor response to antihistamines, a brief course of oral corticosteroids might also be required while attempting to eliminate suspected triggers and develop an effective treatment plan
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Similar to “it’s just constipation,” or “it’s just a virus,” we need to be mindful of the phrases we use when dealing with kids who present with urticaria. Not all urticaria is due to allergic reactions.
Skin mast cells have a central role in urticaria pathogenesis and are found in the upper papillary dermis as well as the deep dermis and subcutis, mostly around cutaneous blood vessels and sensory nerves. Their activation with subsequent degranulation drives the development of itchy wheals and/or angioedema.
Symptoms of alpha-gal are typical of IgE-mediated allergic reactions and include pruritis, urticaria, angioedema, or anaphylaxis. Some individuals may experience gastrointestinal symptoms alone, making it particularly difficult to diagnosis as an allergic reaction.
“Despite the evidence that second-generation H1-antihistamines treat acute urticaria without disturbing side effects, many physicians believe that corticosteroids are still the most effective treatment to obtain rapid symptom relief,” said Dr. Barniol. “Our results do not support the addition of corticosteroid to antihistamines as the first-line treatment of uncomplicated acute hives. Even if short-term treatment with corticosteroids does not cause clinically significant toxicity, recurrent or long-term treatment may have deleterious effects.”
Differential diagnosis: Important to distinguish from other rashes that can mimic urticaria. Erythema multiforme, targetoid lesions. Papular urticaria: insect bite-induced hypersensitivity, typically clustered or linear. Urticaria pigmentosa (mast cell syndrome).
A new episode of urticaria and/or angioedema can be an anxiety-inducing event for both the patient and the physician(s) seeing them in primary care, urgent care, or the emergency department. These events are commonly mistaken for “allergic” reactions and often mistreated. The most common causes of new onset urticaria in older children and adults, with or without angioedema, and normal vital signs or hypertension, are post-infection or acute idiopathic urticaria. These patients are not helped by systemic steroids, which may cause morbidity.
Urticaria (hives) is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). It is generally classified as acute or chronic. Second-generation, non-sedating, non-impairing histamine type 1 (H1)-receptor antihistamines represent the mainstay of therapy for both acute and chronic urticaria. Angioedema can occur in the absence of urticaria and can be broadly divided into histamine-mediated and non-histamine-mediated angioedema.
Approximately 10% to 20% of the population will experience
acute urticaria at some time in their life.
Acute urticaria is a common condition that presents with wheals and/or angioedema. However, these symptoms are also frequent in anaphylaxis, a life-threatening reaction that should be immediately diagnosed and treated. In both, mast cells play a central role in the physiopathology.
We review acute urticaria (<6 weeks in duration). We review the recent international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. In addition, we review some of the controversy regarding the administration of steroids for acute urticaria.
May be associated with angioedema, as in the case of histamine-mediated reactions including anaphylaxis.
Common causes of urticaria:
Allergic reactions (food, medications, arthropods).
Infection (viral, bacterial, parasitic).
Direct Non-allergic Mast Cell activation (radiocontrast, foods, stinging nettle, medications e.g. NSAIDs, narcotics).
Systemic Disease (autoimmune disorders, vasculitis, malignancy).
Scombroid Syndrome (ingestion of improperly stored fish):
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