New Guidelines Say Urticaria May be a Symptom of Serious Illness

[Guest guest]

Hi,

I know some of us have facial swelling and intense itching from time

to time, which seems to make our rosacea worse. From the article

below, it appears that histamine alone may not be the cause for this.

Thyroid conditions, among other autoimmune conditions, may play a

factor. I know I've suffered from horrible hives near my mucuous

membranes and on my arms and legs. Hope this helps and is a

continuation of the article which Suzi L. posted earlier.

Take care,

Matija

New York (MedscapeWire) Jan 3 — According to new medical guidelines

developed by a joint task force of allergists, as many as 15% to 24%

of the US population will experience urticaria or angioedema during

their lifetime, which can be symptoms of an allergic reaction, a

common viral infection, or a serious illness.

The guidelines, The Diagnosis and Management of Urticaria: A Practice

Parameter, are published as a supplement to the December issue of

ls of Allergy, Asthma and Immunology, the scientific journal of

the American College of Allergy, Asthma and Immunology (ACAAI). Most

cases of urticaria are acute, lasting from a few hours to less than 6

weeks. Some cases are chronic, lasting more than 6 weeks.

" Urticaria, commonly known as hives, is one of the most common

dermatological conditions seen by allergists, " said co-editor Dr.

L. Goodman, of Allergy and Asthma Consultants in Englewood,

Colorado. " Traditional allergies to foods or medications and viral

illness are frequent causes of acute urticaria. "

" Chronic urticaria is more complex, given the vast number of

potential triggers and multiple causes, and the difficulty in

identifying them. The interaction between the immune system and some

autoimmune diseases, such as autoimmune thyroid disease, has come to

light as a potential important trigger for chronic urticaria, " Dr.

Goodman said.

Urticaria usually strikes suddenly. First the skin itches, then it

erupts into red welts. The itching may be severe, sometimes painful

or burning, and can keep people from working or sleeping.

" Urticaria is not just an allergic disease. It can be caused by

metabolic diseases, medications, infectious diseases, autoimmune

disease, or physical sensitivity, " said co-editor Dr. Alan A.

Wanderer, also of Allergy and Asthma Consultants.

In contrast to urticaria, angioedema is a deeper, subcutaneous

swelling, usually in the areas of the face or mucous membranes

involving the lips or tongue. If angioedema involves the upper

respiratory tract, life-threatening obstruction of the laryngeal

airway may occur.

Many patients with acute urticaria seek care from their primary care

physicians who, in many instances, can determine the probable cause

by reviewing the patient's history and performing a physical

examination and a few simple laboratory tests.

" The problem is first of all, making sure you are dealing with the

correct diagnosis of urticaria, and not some other disease process

that mimics urticaria. Chronic urticaria with angioedema presents a

challenge in its treatment in that it often requires long-term follow-

up, " Dr. Wanderer said.

" Treatment of chronic urticaria/angioedema is more difficult because

symptoms can persist for a long duration and affected patients are

frustrated as they expect their physician to pinpoint the cause of

their symptoms. Unfortunately, the cause can be established in only 1

out of 5 or 6 adult patients with chronic urticaria, " he said.

According to the literature on which the guidelines were based, the

duration of chronic urticaria/angioedema cannot be predicted.

Spontaneous remissions often occur within twelve months, but many

patients continue to have symptoms for years.

" It's common for patients with chronic urticaria or angioedema to go

from one physician to another, in part, because the physicians

themselves are frustrated identifying the cause of the problem. If a

patient has a perplexing form of urticaria or angioedema, it may be

useful for them to seek out an allergy specialist to make sure the

more serious, underlying diseases have been ruled out, " Dr. Wanderer

said.

" Some mastery of the treatment is important in terms of identifying

the right combination of medications that can suppress the urticaria

symptoms to the best extent possible with the least side effects, " he

said.

The mainstay of treatment for urticaria/angioedema is the use of

antihistamines. Nonsedating, second generation antihistamines are

usually preferred. When these fail, first generation antihistamines,

such as hydroxyzine, diphenhydramine, or doxepin, may be effective,

but should be used with caution because of their adverse effects.The

new medical guidelines were designed both for the allergy specialist

and primary care physicians. Diagnostic and management algorithms

give physicians a better understanding of acute and chronic urticaria

and provide a simplified method for diagnostic work-up.

The peer-reviewed, evidence-based practice parameter is one of a

series developed by the Joint Task Force on Practice Parameters,

representing the ACAAI, the American Academy of Allergy, Asthma and

Immunology, and the Joint Council of Allergy, Asthma and Immunology.

More information is available on the ACAAI Wev site at

http://allergy.mcg.edu/param/param.html.