Update: October 2018
Urticaria is a polyetiological disease (dermatosis),
the main clinical manifestation of which is transient
urtikarny rashes, that is, blisters (elevations above the skin) and
This is the 3rd most common allergic manifestation after
bronchial asthma and drug allergies.
Manifestations of urticaria are rashes, resembling nettle burns,
accompanied by so severe itching that sometimes leads to
нервным расстройствам у patients.
In clinical practice, urticaria is relatively
often. Over the course of a lifetime, this disease faces 20%.
people in the population (Matews K.P., 1983). Moreover, the acute reaction
occurs much more often (60-75%) than chronic (25-30%). In this
article we will look at the types, symptoms and treatment of urticaria folk
means and medicines.
Causes of urticaria
Urticaria may be acute or chronic.
The duration of the chronic form on average is 3-5 years
(can stretch up to 20 years). The acute form is allergic.
immediate response, up to 6 weeks.
The cause of the acute form of urticaria in children and
adults are different allergens: food, dust, pollen,
animal hair, medicines, etc. And also not rarely
cases of such a reaction occurring after exposure are recorded
vibration, pressure, ultraviolet, low air temperatures,
increased physical exertion, thermal effects on the skin.
Chronic reaction is most often caused by internal
The main factors causing the occurrence of urticaria in
children and adults are:
- external causes – physical, chemical, mechanical
- internal – diseases of internal organs, nervous
According to the results of research in 2011 – provoking factors
- Idiopathic urticaria (chronic disease with unclear
reasons) – 40-90%
- Autoimmune processes in 40-60%
- Sun, cold, pressure (physical causes) -20-30%
- Infectious diseases 10-20%
- Intolerance to certain foods (food
- Hormonal disorders, inflammatory processes – 10%
Symptoms of urticaria in children and adults
Blisters resemble traces of mosquito bites or stinging nettle.
Initially, they are red or pink in color, different sizes from 0.5
to 15 cm. Over time, accumulation of exudate and compression
skin capillaries, and the elements of the rash become light. Rash can
located on the face, arms, and with progressive
flow can extend to free areas of the body,
gaining a generalized nature, while the rash is accompanied
itching and burning.
If a генерализованная уртикарная сыпь появляются у детей первых
years of life, this may indicate her hereditary
nature. Urticaria in adults with symptoms similar to
hereditary, almost always acquired.
Like any other chronic disease occurs with periods
remissions and exacerbations. When a patient relapses,
headache, weakness, dyspepsia, fever,
vomiting, restlessness, sleep disturbance due to severe itching of the skin.
Clinical manifestations of urticaria are associated with reaction.
hypersensitivity immediate-delayed type. Common link
the pathogenesis of any clinical form of the disease is swelling
papillary layer of skin that develops as a result of
permeability of the capillary wall of the microvasculature. These
changes are associated with the action of histamine, which is secreted by obese
by cells. Their activation (degranulation) can occur in different ways.
reasons. In this regard, there is a classification of urticaria by
- Mechanical (dermatographic) urticaria. With this form
itching often precedes the appearance of rash. Rash presented
linear blisters that appear during the combing. Linear
skin elevations occur after mechanical irritation –
pressure belts, applying pressure to the skin. Urtikarny
dermographism without itching can be observed as a short-term phenomenon.
with the disappearance of blisters within 30 minutes. It occurs in 3-5%
population and does not require treatment.
- Slow urticaria from pressure. Provoking factor
is a prolonged local exposure to vertical pressure.
They usually manifest as hyperemic, sometimes painful foci with
deeper spread of edema. Characteristic places
location: on the hands, on the feet, on the buttocks and the back
- Vibration. Blisters appear on the skin in places.
exposure to vibrating surfaces or parts of objects. Similar
urticaria symptoms in children may be diagnostic
a sign of hereditary vibration angioedema
- Thermal contact urticaria. Occurs when local
exposure to heat on the skin. Described hereditary form of it
diseases where blisters appear 4-6 hours after
- Cold urticaria (see more cold allergy
symptoms, treatment). Characterized by blistering after
local exposure to cold. Reaction to cold exposure
It is manifested by a rash, but not on the cooled skin, but around it. Areas
skin that has been in direct contact with cold is not
is amazed. In some patients, in response to exposure to cold,
neurotransmitter spikes are recorded, others have a synthesis
anaphylatoxins through the complement system. Considering the mechanism
development, some authors attribute the cold version of the urticaria to
spontaneous, not physical.
- Aqua. Rash occurs
shortly after contact with water. Blisters
small, itchy, surrounded by erythematous spots. Possible and
another reaction to contact with water is an aquatic itch without rash.
- Solar. (see sun allergy, symptoms,
treatment). Characterized by the development of itching and edema after several
minutes after exposure to light. Rash occurs только на
- Physical urticaria (adrenergic). Arises
only after exercise – blood pressure decreases,
there is vascular edema, rash, wheezing. In some
Cases marked by association with prior use
specific or non-specific foods (celery, shellfish,
shrimps, tomatoes, nuts). Moreover, these products can safely
be consumed by patients without subsequent exercise.
hives. Arises в результате усиленного потоотделения и
increase body temperature. A rash usually occurs after physical
exercise, emotional stress, taking a hot shower. Blisters
pale pink, small (1-5 mm), are located generalized,
surrounded by erythema.
- Food urticaria caused by non-IgE-dependent degranulation
mast cells. Develops as a result of exposure to obese
cells of chemical compounds – histamine liberators (opiates,
various food additives, preservatives, dyes, flavor enhancers
and so forth). Clinical symptoms may also occur while consuming
In the food of some products (seafood, pineapple, strawberries,
pork, chocolate, papaya).
- Лекарственная hives. Arises на фоне приема НПВС,
ACE inhibitors, muscle relaxants, calcium antagonists, hormonal
drugs (insulin, oral contraceptives).
With acute urticaria, symptoms, rashes are resolved
independently, as a result of treatment or cancellation of the caller
factor a. The following forms of spontaneous urticaria are distinguished:
- Аллергическая hives. Arises в результате воздействия
эндогенного (аутологичного) или экзогенного factor a. Primary
contact with the allergen causes sensitization, and secondary –
immediate type of allergic reaction. Subsequent release of IgE
triggers mast cell degranulation and release
- Autoimmune urticaria develops due to antibodies (IgG) to
FcRI and IgE receptors. As a result of the binding of IgG molecules c
corresponding receptors on the surface of mast cells
histamine release occurs. This concept is confirmed in
48% of cases of chronic idiopathic urticaria.
- Urtikarny (узелковый васкулит). Detected in 5% of cases.
chronic urticaria. The clinical picture is associated with
нарушением функции иммунной systems, при котором образуются
complexes of pathological antibodies with antigens. Aggressive
the impact of these complexes on the vascular wall causes a reaction
similar to the reaction to histamine. More on symptoms
- Комплемент-индуцированная hives. Antigen-antibody complex
launches a cascade of biochemical reactions between complement proteins,
present in the blood. The result is anafilatoksiny
(С3а, С4а, С5а), which provoke histamine release.
The diagnosis is made visually and is based on availability
characteristic of the urticaria primary element – blister. Bright
Urtikar dermographism at the site of injury is confirmatory
criterion. The diagnostic program is always formed
individually on the basis of anamnesis and clinical picture.
So, if you suspect an allergic urticaria “golden
standard “is to conduct skin tests with specific
allergens. If you suspect contact, cold, akvagennuyu and
thermal urticaria carry out diagnostic tests with
alleged provoking factors.
Urticaria treatment is advisable to start only after
establish the cause of its occurrence. As a rule, treatment
carried out in two directions: elimination (elimination)
etiological factor and the appointment of pharmacotherapy.
The first direction includes:
- Appointment of a hypoallergenic diet with alimentary
- Plentiful drink for the speedy removal of allergens from
- Elimination or reduction of external influences provoking
the appearance of blisters with contact, cold, thermal,
aqua and vibrating urticaria;
- Observance of optimum temperature condition, exception
stressful situations and limitation of physical activity during
cholinergic and adrenergic urticaria;
- Restriction of drug intake with medication
In most cases, the causative factor cannot be identified,
therefore, medication therapy is prescribed, which is based on
use of antihistamine drugs.
Antihistamine and other drugs:
Antihistamines are especially effective in cases where
manifestations are associated with changes in vascular permeability and other
effects of local action of histamine, such as irritation
nerve fibers responsible for pruritus (see an overview of all
Drowsiness as a result of anticholinergic and
antiserotonergic effects of these drugs sold in
CNS, the most significant adverse side effect
traditional antihistamines. This explains the popularity
non-sedative antihistamines that do not penetrate well
across the blood-brain barrier and have a weak
anticholinergic and anti-serotoninergic effects or not
them at all.
Preparations of the 2nd generation, such as Tsetrin, Zyrtec, Zodak, Erius,
Claritin – do not have the sedative property and to date
are most preferred for treating urticaria in children
and adults, both acute and chronic.
With the ineffectiveness of antihistamine drugs prescribed
short-course glucocorticoid drugs (Disropane,
Prednisolone, Celeston) or hormonal ointments (see the list of all
hormonal creams and ointments in the article ointment for psoriasis). If a
allergic reaction becomes generalized, and
complicated by life-threatening conditions such as
anaphylaxis, angioedema, or Stevens-Johnson syndrome,
It is advisable to appoint epinephrine.
In addition to antihistamine and corticosteroid drugs for the treatment
Allergic urticaria shown:
- laxatives, diuretic drugs according to indications
- enterosorbents – Enerosgel, Polysorb, activated carbon,
Polyphepan, Filtrum STI
Folk methods for the treatment of urticaria
Folk remedies for the treatment of urticaria are successfully used with
old times, among them we give the most effective and
time-tested. However, persons with pollinosis, allergic
reactions to certain types of medicinal plants, follows with
use the suggested methods, or refuse
them in the presence of individual intolerance:
- Сок укропа — из предварительно промытого укропа извлекают
fresh juice and using a clean napkin for 30 minutes applied to
places rash. This popular way removes unbearable skin itching
- Similar applications can be made from flowers and grass
meadow clover. For clover juice, raw materials first
mince, then squeeze and apply to the rash on
half an hour.
- In the absence of nettle allergy, can be taken orally
an infusion of its flowers, which helps purify the blood and
accelerates the elimination of allergens from the body. How to cook water
the infusion is written on the packaging of pharmaceutical herbal remedies, in
day should drink about 2 glasses in 3-4 doses.
- To reduce the intensity of itching and speedy healing
damaged skin is well helped by 20 minute baths with water
infusion of wild rosemary herb. 1 liter is enough for bathing
Forecast заболевания неоднозначный, поскольку зависит от формы
manifestations of the disease. More optimistic prognosis for idiopathic and
allergic urticaria, less favorable in physical,
infectious or autoimmune. Hives remission occurs
only half a year later or even a year after the debut of the disease in 50%
Автор: Мельникова Светлана Георгиевна врач-дерматолог