Urticaria (Hives) Explained: Causes, Symptoms & Best Treatments

Urticaria is a vascular skin reaction caused by the release of histamine, leading to itchy, red, raised wheals (hives) that appear and disappear within 24 hours.

Mnemonic: "U.R.T.I.C.A.R.I.A. = Uplifting Red, Transient Itchy Circular Allergic Reaction Involving Angioedema"


CAUSES OF URTICARIA

  • Allergic Reactions (Food, Drugs, Insect Bites).
  • Physical Factors (Heat, Cold, Sunlight, Pressure).
  • Infections (Viral, Bacterial, Parasitic).
  • Autoimmune Causes (Chronic Idiopathic Urticaria).
  • NSAIDs, Aspirin, Opioids Can Worsen Symptoms.

Mnemonic: "A.P.I.A.N." (Allergy, Physical, Infection, Autoimmune, NSAIDs)


TYPES OF URTICARIA

  1. Acute Urticaria (Lasts <6 Weeks, Due to Allergy, Infection, or Drugs).
  2. Chronic Urticaria (Lasts >6 Weeks, Often Autoimmune, No Clear Cause).
  3. Physical Urticaria (Triggered by Physical Factors like Pressure, Cold, Heat).
  4. Dermatographic Urticaria (Hives Appear After Skin Scratching).
  5. Angioedema (Deep Swelling of Lips, Eyelids, Hands, or Throat – Can Be Dangerous).

- Mnemonic: "A.C.P.D.A." (Acute, Chronic, Physical, Dermatographic, Angioedema)


SYMPTOMS OF URTICARIA

  • Itchy, Red, Swollen Wheals (Disappear Within 24 Hours).
  • Wheals Appear Suddenly & Change Location.
  • Burning & Prickling Sensation in Some Cases.
  • Angioedema → Swelling of Lips, Eyes, Hands, Feet, or Throat.

Mnemonic: "I.W.B.A." (Itchy, Wheals, Burning, Angioedema)


DIFFERENTIAL DIAGNOSIS OF URTICARIA

  • Erythema Multiforme (Fixed, Target Lesions, No Itching).
  • Drug Rash (Lasts for Days, Doesn't Change Location).
  • Angioedema (If Without Wheals, Consider C1 Esterase Deficiency).
  • Scabies (Severe Itching, Burrows in Finger Webs & Axillae).

Mnemonic: "E.D.A.S." (Erythema, Drug Rash, Angioedema, Scabies)


DIAGNOSIS OF URTICARIA

  • Clinical Examination (Wheals, Itching, Transient Nature).
  • Physical Tests (Cold Test, Heat Test, Pressure Test for Physical Urticaria).
  • Blood Tests (Eosinophil Count, ESR, IgE Levels for Allergy & Autoimmune Causes).
  • Skin Prick Test (Identifies Allergens in Acute Urticaria).

Mnemonic: "C.P.B.S." (Clinical, Physical Test, Blood Test, Skin Prick Test)


TREATMENT OF URTICARIA

1. GENERAL MEASURES

  • Avoid Triggers (Food, Drugs, Heat, Cold, Perfumes).
  • Wear Loose, Cotton Clothing.
  • Apply Cooling Agents (Calamine Lotion, Cold Compress).

Mnemonic: "A.W.C." (Avoid Triggers, Wear Cotton, Cooling Agents)


2. MEDICAL MANAGEMENT

  • Non-Sedating Antihistamines (Loratadine, Cetirizine, Fexofenadine – 1st Line).
  • H2 Blockers (Ranitidine, Famotidine – Add if Needed).
  • Steroids (Prednisolone – For Severe Cases).
  • Adrenaline (Epinephrine – For Anaphylaxis).

Mnemonic: "A.H.S.A." (Antihistamines, H2 Blockers, Steroids, Adrenaline)


3. IMMUNOMODULATORS (For Chronic Urticaria Not Responding to Treatment)

  • Omalizumab (Monoclonal Antibody Against IgE).
  • Cyclosporine (For Severe Autoimmune Urticaria).

- Mnemonic: "O.C." (Omalizumab, Cyclosporine)


HOMOEOPATHIC MANAGEMENT OF URTICARIA

  • For Acute, Sudden, Burning Urticaria:
  • Apis, Urtica Urens, Belladonna, Rhus Tox.
  • For Chronic, Recurrent Urticaria:
  • Natrum Mur, Sulphur, Arsenicum Album, Lycopodium.
  • For Urticaria After Food or Drug Allergy:
  • Nux Vomica, Pulsatilla, Antimonium Crudum.

Mnemonic: "A.U.B.R." (Apis, Urtica Urens, Belladonna, Rhus Tox for Acute Urticaria)


FINAL REVISION WITH MNEMONICS

  • Definition = "U.R.T.I.C.A.R.I.A. = Uplifting Red, Transient Itchy Circular Allergic Reaction Involving Angioedema"
  • Causes = "A.P.I.A.N." (Allergy, Physical, Infection, Autoimmune, NSAIDs)
  • Types = "A.C.P.D.A." (Acute, Chronic, Physical, Dermatographic, Angioedema)
  • Symptoms = "I.W.B.A." (Itchy, Wheals, Burning, Angioedema)
  • Differential = "E.D.A.S." (Erythema, Drug Rash, Angioedema, Scabies)
  • Diagnosis = "C.P.B.S." (Clinical, Physical Test, Blood Test, Skin Prick Test)
  • General Measures = "A.W.C." (Avoid Triggers, Wear Cotton, Cooling Agents)
  • Medical Treatment = "A.H.S.A." (Antihistamines, H2 Blockers, Steroids, Adrenaline)
  • Immunomodulators = "O.C." (Omalizumab, Cyclosporine)
  • Homeopathy = "A.U.B.R." (Apis, Urtica Urens, Belladonna, Rhus Tox for Acute Urticaria)


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