A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore: Inspection (viewing) of the skin and sclera (white part of the eye) [Leading symptom: wheals (usually on reddened skin)] According to the appearance of urticaria, the following forms … Hives (Urticaria): Examination
Acute spontaneous urticaria with a duration of illness less than 6 weeks does not require laboratory diagnosis. In most cases, these conditions are nonallergic urticaria, which often occurs associated with infections. This usually resolves spontaneously within one to two weeks. In contrast, chronic spontaneous urticaria requires extended diagnostics. Laboratory parameters of the 1st order – … Hives (Urticaria): Test and Diagnosis
Medical history (history of illness) represents an important component in the diagnosis of urticaria (hives). Family history What is the general health of your relatives? Are there any diseases in your family that are common? Social history What is your profession? Are you exposed to harmful working substances in your profession? Current medical history/systemic medical … Hives (Urticaria): Medical History
Skin and subcutaneous (L00-L99). Acute urticaria Allergic urticaria Aquagenic urticaria – hives after water contact. Bullous pemphigoid – blistering autoimmune disease of the skin. Cholinergic urticaria – hives caused by sweating or intense exertion. Chronic urticaria – for example, based on allergic contact dermatitis when using acrylate or methacrylate-based nail cosmetics. Idiopathic urticaria – hives, … Hives (Urticaria): Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by urticaria (hives): Injury, poisoning, and certain other sequelae of external causes (S00-T98). Acute dyspnea (shortness of breath) in angioedema. Skin and subcutaneous (L00-L99) Chronic urticaria Psyche – nervous system (F00-F99; G00-G99) Depression (individuals who experienced a first attack of urticaria … Hives (Urticaria): Complications
Classification of urticarial diseases. Forms Subforms Definition Spontaneous urticaria Acute spontaneous urticaria (asU) Spontaneous wheals and/or angioedema (vascular edema) <6 weeks Chronic spontaneous urticaria (csU). Spontaneous wheals and/or angioedema >6 weeks. Physical urticaria Cold contact urticaria Triggering factors may include cold objects, air, liquid, wind Delayed pressure urticaria Triggering factor is static pressure; wheals appear … Hives (Urticaria): Classification
Therapeutic target The goal of treatment is complete symptom control Therapy recommendations Acute urticaria (acute spontaneous urticaria, asU): Sedating antihistamines (2nd generation): initiation of therapy as i.v. therapy; oral maintenance therapy for 1-2 weeks). If no symptom control after 2 to 4 weeks or earlier* Increase dosage of antihistamine (up to 4 times daily dose; … Hives (Urticaria): Drug Therapy
Optional medical device diagnostics – depending on the results of the history, physical examination, and obligatory laboratory parameters – for differential diagnostic clarification In the focus search (search for pathogenic foci): Abdominal sonography (ultrasound examination of the abdominal organs). X-ray of the thorax (X-ray thorax/chest), in two planes. Sinus sonography Computed tomography (CT; sectional imaging … Hives (Urticaria): Diagnostic Tests
To prevent urticaria (hives), attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Food/additives, e.g., milk, eggs, fish (food allergens). Spicy food Food preservatives and / or food coloring. Physical activity Heavy exertion Mechanical irritation/pressure Environmental stress – intoxications (poisonings). Solar radiation Strong cold / heat
The following symptoms and complaints may indicate urticaria (hives): Leading symptoms Urticae (wheals), usually on reddened skin (elevated erythema) [wheal duration usually up to one day]. Painful/burning angioedema (sudden swelling of the skin or mucous membranes; seen in about 50% of cases of acute urticaria) [symptomatic for up to two (three) days] Severe pruritus (itching). … Hives (Urticaria): Symptoms, Complaints, Signs
Pathogenesis (development of disease) Urticaria is characterized by edema (water retention) of the dermis (skin), which is an expression of an increase in vascular permeability (vascular permeability). The mediators (messengers) are released mainly from mast cells (cells of the body’s defense system that have stored certain messengers, including histamine and heparin). One can distinguish an … Hives (Urticaria): Causes
General measures Avoidance of: Heavy exertion Too long and intense exposure to the sun Strong cold or heat Mechanical irritation Pressure Review of permanent medication due topossible effect on the existing disease. Angioedema: therapy with ACE inhibitors? Regular checkups Regular medical checkups Nutritional medicine Nutritional counseling based on nutritional analysis Nutritional recommendations according to a … Hives (Urticaria): Therapy
