About Chronic Urticaria (Chronic Hives)

Overview

Chronic urticaria is a skin disorder characterized by the recurrent appearance of wheals (hives) and angioedema (swelling) for a duration of more than six weeks. It is a common condition that can significantly impact a person's quality of life.

Chronic urticaria can be divided into two main forms:

• Chronic Spontaneous Urticaria (CSU): In this type, hives and swelling appear randomly, without any clear cause or trigger. It happens on its own, without being linked to specific factors.
• Chronic Inducible Urticaria (CIndU): This type of hives is triggered by specific factors, such as pressure, temperature changes, or physical activity. People with CIndU experience symptoms when exposed to these triggers.

A specific kind of CIndU is physical urticaria, which includes different forms like:

• Symptomatic Dermographism: Hives appear when the skin is scratched or rubbed.
• Delayed Pressure Urticaria: Hives develop after pressure is applied to the skin, like from sitting or wearing tight clothing.

Causes and Risk Factors

The exact causes of chronic urticaria (hives) aren't fully understood, but research suggests that several body systems may be involved, including:

• Immune system: There might be an abnormal immune response that triggers hives.
• Inflammation: Inflammation in the body can contribute to the development of hives.
• Coagulation system: This system, which helps control blood clotting, may also play a role in the condition.

One key process in chronic urticaria involves the degranulation of mast cells and basophils. These are types of white blood cells that release chemicals like histamine when triggered. When these cells release their contents (degranulate), it can cause the skin to break out in hives, or "wheals."

Non-modifiable risk factors for chronic urticaria cannot be controlled or changed. They include genetic factors. There may be a genetic predisposition to developing chronic urticaria.

Modifiable risk factors for chronic urticaria can be influenced by individual habits and lifestyle. They include:

• Environmental irritants: Exposure to certain environmental irritants may trigger or exacerbate symptoms of chronic urticaria.
• Infections: Bacterial, fungal, and viral infections can sometimes lead to the development of chronic urticaria.
• Stress: Emotional or physical stress can potentially worsen symptoms of chronic urticaria.
• Medications: Certain medications, such as pain medications and antibiotics, have been associated with the onset of chronic urticaria.
• Food and alcohol: Consumption of certain foods or alcohol can trigger symptoms in some individuals.
• Temperature changes: Exposure to extreme temperatures, such as heat or cold, may provoke episodes of chronic urticaria.

Remember, these risk factors may vary from person to person. It is important to consult with a healthcare professional for an accurate diagnosis and personalized advice.

Symptoms

Common symptoms of chronic urticaria include:

• Raised or swollen welts on the skin (hives or wheals)
• Itching, which can sometimes be severe
• Hives that appear and reappear over a period of 6 weeks
• Hives that may change in size, fade, and reappear

As chronic urticaria progresses or becomes more severe, other common symptoms may occur. These can include:

• Swelling of the lips, eyelids, or throat (angioedema)
• Gastrointestinal (GI) symptoms such as functional dyspepsia and gastroesophageal reflux
• Arthralgias (joint pain)
• Headache
• Fatigue

It's important to note that these symptoms are not exclusive to chronic urticaria and can also be associated with other conditions. If you experience any of these symptoms or suspect you have chronic urticaria, it is recommended to consult with a healthcare professional for an accurate diagnosis and appropriate management.

Diagnosis

To diagnose chronic urticaria, the following examinations, tests, and procedures may be performed:

• Physical Examination: The doctor will look at the skin to check for hives or welts, ask about any symptoms, and try to identify patterns that could help in the diagnosis.
• Medical History: The doctor will ask about your medical history, lifestyle, and any potential triggers, such as certain foods, medications, or stress, that might cause or worsen the hives.
• Blood Tests: Blood tests can be done to check for signs of an underlying condition, such as an autoimmune disorder or infection, that might be causing the chronic hives.
• Skin Prick Tests: These tests involve placing small amounts of common allergens on your skin to see if you have an allergic reaction. This can help rule out allergies as the cause.
• Other Allergy Tests: If the doctor suspects an allergic trigger, additional allergy tests may be done, including blood tests for specific allergens.
• Physical Urticaria Testing: If physical triggers (like heat, pressure, or scratching) are suspected, specific tests may be done to see how your body reacts to those triggers, such as a pressure test for delayed pressure urticaria.
• Autologous Serum Skin Test: In some cases, doctors may perform a test using your own blood to see if it causes hives when injected into your skin, helping to check for an autoimmune response.
• Trigger identification: Identifying the subtype of chronic urticaria and determining trigger thresholds.
• Special instruments: Urticaria activity score (UAS), angioedema activity score (AAS), CU quality of life questionnaire (CU-Q2oL), angioedema quality of life questionnaire (AE-QoL), and urticaria control test (UCT) are used to assess disease activity, impact, and control.

Remember that these are general guidelines. Your healthcare provider will determine which specific examinations, tests, and procedures are necessary for your individual situation.

Treatment Options

The goals of treatment for chronic urticaria are to control the itch, prevent new hives from developing, and avoid triggers that cause hives. Here are the recommended treatment options and how they work:

• Soothing lotions or anti-itch creams: These provide temporary relief from itching.
• Antihistamines: They help control itching and swelling by blocking the effects of histamine.
• Corticosteroids: Prescribed for severe hives, they reduce inflammation and treat itching.
• Leukotriene receptor antagonists: These can be used as an alternative to antihistamines.
• Immunosuppressives: Medications like methotrexate, cyclosporine, and omalizumab may be prescribed for more severe cases.
• Omalizumab: Injected medication that can treat chronic hives when antihistamines fail.
• Light therapy: Involves exposure to artificial light to help treat chronic urticaria.
• Modification of lifestyle:
  • Avoid stressful situation
  • Avoid known triggers.

In addition to standard treatments, vitamin D3 supplementation, addressing intestinal dysbiosis (an imbalance in gut bacteria), and treating chronic infections may be considered for cases of chronic urticaria that don’t respond to typical treatments. Remember to consult with a healthcare professional for personalized advice.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.