Chronic urticaria

Chronic urticaria, also known as chronic urticaria, is a chronic dermatological condition characterized by the appearance of a rash on the skin in the form of redness, itching, and swelling. This condition can significantly affect patients' quality of life, as the symptoms can be painful and interfere with normal daily activities. Let's take a closer look at the causes, symptoms, and treatments for chronic urticaria.

Epidemiology

The epidemiology of chronic urticaria involves the study of the prevalence and risk factors for this condition. Chronic urticaria is a condition that can affect people of all ages and genders, excluding age restrictions. Let's review the main aspects of the epidemiology of chronic urticaria:

1. Prevalence: Chronic urticaria is a fairly common skin condition. Prevalence estimates vary, but various reports suggest it may range from 0.1% to 3% of the population.
2. Gender and age: Chronic urticaria can occur in people of any gender and age. It can start in childhood and continue throughout life. However, it is most often diagnosed in adults.
3. Risk Factors: Risk factors that contribute to the development of chronic urticaria include allergies, stress, physical stress, autoimmune disorders, and genetic predisposition. Exposure to the disease may be increased in individuals who have a family history of urticaria.
4. Seasonality: Symptoms of chronic urticaria may increase or worsen during different seasons. For example, some patients may experience increased symptoms in the spring or fall due to pollen and allergic reactions.
5. Diagnosisand treatment: The diagnosis of chronic urticaria is made by a physician based on clinical symptoms and, if necessary, additional laboratory tests. Treatment usually includes antihistamines, glucocorticosteroid creams and, in some cases, immunomodulatory drugs.
6. Prognosis: The prognosis of chronic urticaria can be varied. In some patients, symptoms may recur continuously, while in others they may disappear or improve significantly over time.

Chronic urticaria can be a challenge for patients and clinicians because of its nature and multiple possible causes. Further research into the epidemiology and molecular basis of this disease will help to better understand and manage it.

Causes of the chronic urticaria

The causes of this condition can be varied and are not always completely clear. The following are the main factors that can trigger or accompany the development of chronic urticaria:

1. Allergies: Reactions to allergens such as certain foods, pollens, dust, medications or poisonous plants can cause hives in some patients. This is called allergic urticaria.
2. Stress: Psychological stress and emotional tension can affect the function of the immune system and trigger urticaria rashes.
3. Physicalstress: Physical stress, such as intense exercise, overheating, or cold, can cause hives, known as physical hives, in some people.
4. Autoimmune disorders: Some autoimmune diseases, such as systemic lupus erythematosus or sarcoidosis, may present with chronic urticaria.
5. Infections: In rare cases, infections such as viruses, bacteria, or parasites can cause hives rashes.
6. Genetic predisposition: Some people may have a genetic predisposition to developing hives, especially if their family members have had a history of the condition.
7. Repeated exposure: Sometimes hives can occur after repeated exposure to known triggers such as certain foods, medications, or physical factors.

It is important to note that each patient's reasons for developing chronic urticaria may be unique, and doctors may use different testing methods to determine the specific factors that triggered the condition in a particular case.

Risk factors

Chronic urticaria can occur in people without obvious predisposing factors, but there are a number of risk factors that can increase the likelihood of developing this condition. Here are some of them:

1. Allergies: A history of allergic reactions or allergic conditions may be associated with the development of chronic urticaria.
2. Family history: If family members have a historyof chronic urticaria, this may increase the risk of developing it.
3. Stress and emotional stress: Psychological stress and emotional tension can trigger or worsen the symptoms of urticaria.
4. Physicalstress: Physicalstress, overheating, or cold can cause hives in some people. This is called physical urticaria.
5. Uncontrolled allergies: People with uncontrolled allergic reactions to certain foods, medications, or allergens in the environment may be more susceptible to chronic hives.
6. Repeatedexposure: Repeated contact with known triggers (e.g., certain foods or medications) can cause repeated episodes of hives.
7. Autoimmune disorders: People with autoimmune diseases such as systemic lupus erythematosus may have a higher risk of developing chronic urticaria.
8. Infections: Some infections, including viruses and bacteria, may be accompanied by hives rashes.
9. Environmental factors: Contact with irritants in the environment, such as chemicals or poisonous plants, can also trigger hives.
10. Gender and age: Chronic urticaria can occur in people of any gender and age, but it is more common in adults.

In addition to these factors, chronic urticaria can develop in anyone.

Pathogenesis

The pathogenesis of chronic urticaria is not fully understood, and the exact mechanisms of its development are not completely clear. However, the release of substances called histamines and other inflammatory mediators in the skin are thought to play a major role in the pathogenesis. Here are the basic steps in the pathogenesis of chronic urticaria:

1. Mastocyte activation: M astocytes are cells that contain granules containing histamine and other substances. When exposed to various stimuli such as allergens, stress or physical stress, mastocytes are activated and release their contents into the surrounding tissues.
2. Histamine release: Histamine is one of the key mediators of inflammation. When mastocytes are activated, they release histamine, which causes blood vessels to dilate and increases the permeability of the vascular wall.
3. Vasodilation and swelling: The release of histamine leads to vasodilation (dilation of blood vessels) and edema (swelling) at the site of the rash. This is manifested as redness and swelling of the skin.
4. Itching and discomfort: Histamine is also a major cause of the itching and discomfort characteristic of chronic urticaria.
5. Rashes: As a result of the release of histamine and other inflammatory mediators, the characteristic rashes of urticaria - a rash of redness and areas of swelling - appear on the skin.

Chronic urticaria differs from acute urticaria in the duration of symptoms. In some patients with chronic urticaria, symptoms may persist for weeks, months or even years.

It is important to note that the pathogenesis of chronic urticaria can be multifaceted and may involve a variety of mechanisms. An accurate understanding of the pathogenesis helps physicians to choose the best treatments and control symptoms in patients with this condition.

Symptoms of the chronic urticaria

Chronic urticaria is characterized by recurrent or prolonged skin rashes that may be accompanied by a variety of symptoms. Symptoms of chronic urticaria may vary in intensity and include the following:

1. Skin rashes: The main symptom of chronic urticaria is skin rashes. These can be red, flushed areas with swelling that look like mosquito bites or areas of nettle-like rash. The rashes can be different sizes and shapes and often change location.
2. Itchingand burning: The most unpleasant symptom for most patients is the itching that accompanies the rash. The itching can be mild and aching or intense and sharp. It can cause considerable discomfort.
3. Skin swelling: Rashes are often accompanied by swelling of the skin around them. This leads to an increase in the size of the rashes and a feeling of tightness and heaviness in the area of the affected skin.
4. Skinredness: The skin at the site of the rash usually becomes red and hot to the touch.
5. Symptoms lasting more than 6 weeks: To be diagnosed with chronic urticaria, symptoms must last more than 6 weeks.
6. Distribution of rashes: Chronic urticaria can affect different areas of the skin on the body, and the rashes may move or change shape.
7. Exacerbations and Improvements: Patients with chronic urticaria may experience periods of worsening symptoms (exacerbations) and temporary improvement.
8. Associated symptoms: In some cases, chronic urticaria may be accompanied by other symptoms such as headache, fatigue, insomnia and depression.

The symptoms of chronic urticaria can be very uncomfortable and can affect a patient's quality of life. The good news is that modern treatments and symptom management techniques can provide significant relief for patients with this condition. It is important to see your doctor for proper diagnosis and treatment.

Stages

Chronic urticaria can manifest in different stages, which include the following:

1. Exacerbation stage: In this stage, patients experience intense symptoms such as severe itching, redness of the skin and swelling. The rashes may appear in different parts of the body and may change in shape and size. Exacerbations can last from a few days to a few weeks.
2. Improvement stage: After a period of exacerbation, there may be temporary periods of improvement when symptoms become less severe or even disappear completely. In this stage, patients may feel better and enjoy the absence of symptoms.
3. Remission stage: Some patients may go into complete remission, when symptoms of chronic urticaria are completely absent for a long time, sometimes even years. However, remission can be temporary and symptoms may return.
4. Relapse stage: Most patients with chronic urticaria have alternating periods of exacerbation and improvement. After improvement or remission, there may be new periods of relapse with recurrence of symptoms.
5. Management and control stage: To manage chronic urticaria, doctors prescribe treatment and symptom control measures. In this stage, the goal is to minimize symptoms and prolong periods of improvement or remission.

Forms

There are several forms of chronic urticaria that patients may experience. The most common forms are:

1. Chronic idiopathic urticaria: This is the most common type of chronic urticaria that has no specific known cause. Patients with this form may experience periodic exacerbations of symptoms, prolonged periods of improvement, and relapses.
2. Autoimmune chronic urticaria: This type of chronic urticaria is associated with autoimmune mechanisms in which the body's own antibodies attack skin cells. This condition can be associated with other autoimmune diseases such as rheumatoid arthritis.
3. Physical urticaria: In this form of chronic urticaria, symptoms occur in response to physical exposure such as mechanical friction, cold, heat, sunlight, and other physical factors. Symptoms may appear quickly after exposure and may last for several hours.
4. Cholinergic urticaria: This form of chronic urticaria is associated with increased acetylcholine activity in the body, which can be triggered by physical activity, increased body temperature, or stress. Patients with cholinergic urticaria may experience itching and rashes after an increase in body temperature, such as during physical activity.
5. Chronic contact urticaria: This type of chronic urticaria is triggered by contact with certain substances such as latex, rubber, cosmetics, or even water. Symptoms may develop on areas of the skin in contact with the irritant.
6. Chronic urticaria due to infections or disease: Sometimes chronic urticaria can develop as a result of infections (such as staphylococcal infection) or as a symptom of other diseases, such as thyroid disease or cancer.

Complications and consequences

Chronic urticaria, like any other chronic condition, can cause various complications and negative effects on the patient. Here are some of them:

1. Psychological problems: The constant itching, rashes and discomfort associated with chronic urticaria can lead to psychological problems such as depression, anxiety and social isolation. Patients may suffer a reduced quality of life due to the constant discomfort.
2. Deterioration of quality of life: Chronic urticaria can affect the patient's normal lifestyle, interfering with work, school and social interactions. The constant itching and unpredictability of symptoms can create significant discomfort.
3. Triggering other conditions: In rare cases, chronic urticaria may be associated with other allergic or immunologic conditions, such as arthritis or thyroid disease. This can complicate treatment and management of the condition.
4. Treatment side effects: Some medications used to treat chronic urticaria may cause side effects such as drowsiness or dizziness. Patients should monitor these effects and consult their doctor if problems occur.
5. Medication dependence: Patients with chronic urticaria may have to take antihistamines or other medications for long periods of time to control symptoms. This can cause medication dependence and may require constant monitoring by a physician.
6. Skin complications: Constant scratching and rubbing of the skin caused by itching and rashes can lead to skin irritation and even infections. This may require additional treatment and care.

It is important to emphasize that not every patient with chronic urticaria will experience these complications, and many patients can successfully manage their condition with proper treatment and cooperation with their physician. Regular evaluation and consultation with your doctor can help minimize risks and improve the quality of life for the patient with chronic urticaria.

Diagnostics of the chronic urticaria

Diagnosing chronic urticaria may involve several steps, including a physical examination, history (gathering medical and life history), physical examination, and laboratory tests. Here are some of the key steps in diagnosing this condition:

1. Medical history and medical history: The doctor collects detailed information about symptoms, their duration and intensity. It is important to find out if there have been any known triggering factors such as certain foods, medications, physical activity or stress.
2. Physical Examination: The doctor performs a general physical examination and a skin examination to assess the nature and distribution of the rash. This helps rule out other skin conditions that may mimic the symptoms of urticaria.
3. Laboratory tests: Laboratory tests may include blood tests such as general blood tests and biochemical tests to rule out other medical conditions that may cause anaphylactic reactions or allergic symptoms.
4. Provocationtests: In some cases, your doctor may recommend provocation tests to detect allergic reactions to certain substances. This may include skin tests or test applications under a doctor's supervision.
5. Keeping track ofsymptoms: Chronic urticaria is characterized by relapses and changes in symptoms, so it is important to keep a diary of symptoms to track their pattern and contributing factors.
6. Clinical criteria: The physician may use clinical criteria, such as the diagnostic criteria for chronic urticaria, to determine the presence of this condition.

Once all the necessary tests have been performed, the doctor will be able to diagnose chronic urticaria and consider the possible causes of the condition. After diagnosis, the doctor will develop an individualized treatment plan and recommendations for managing the condition.

Differential diagnosis

The differential diagnosis of chronic urticaria involves identifying and ruling out other medical conditions and skin diseases that may mimic the symptoms of urticaria. Below are some of the possible conditions to consider in the differential diagnosis:

1. Allergic urticaria: Allergic urticaria may have similar symptoms to chronic urticaria, but it is usually caused by allergic reactions to specific allergens such as food, medications, or bee stings. Clinical and allergy tests can help in the differential diagnosis.
2. Autoimmune diseases: Some autoimmune diseases, such as systemic lupus erythematosus or rheumatoid arthritis, may present with skin rashes that may resemble hives. Blood tests and clinical signs can help distinguish between the two.
3. Infectious diseases: Some infectious diseases, such as viral or bacterial infections, can cause skin rashes and itching. These infections can be the source of hives-like symptoms.
4. Dermatitis: Different types of dermatitis, including contact dermatitis and atopic dermatitis, can cause similar symptoms such as itching and rashes on the skin.
5. Drug allergies: Some medications can cause allergic reactions, including rashes and itching. Differential diagnosis may include identification of drug allergens.
6. Physical factors: Some physical factors such as cold, heat, or pressure can cause skin reactions known as physical urticaria.

An accurate differential diagnosis often requires consultation with physicians from various specialties, including dermatologists, allergists, and rheumatologists. Medical examinations, laboratory tests, and clinical signs can help rule out other conditions and establish an accurate diagnosis of chronic urticaria.

Treatment of the chronic urticaria

Treatment of chronic urticaria is aimed at relieving symptoms and preventing relapses. The treatment approach may involve several methods and depends on the severity and nature of the condition. Here are some common treatments for chronic urticaria:

1. Avoidance of triggers: If specific factors are known that may cause an exacerbation of urticaria, such as certain foods, medications, or physical stimuli (cold, heat, pressure), it is recommended to avoid them.
2. Antihistamines: Your doctor may prescribe antihistamines to help reduce itching and rashes on the skin. There are both oral (as tablets or syrups) and topical (ointments and creams) forms of antihistamines.
   1. Systemic antihistamines such as cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra), and desloratadine (Clarinex) are often prescribed to reduce itching and skin rashes. They are available as tablets, capsules, and syrups.
   2. Topical antihistamine creams and ointments can be used to treat urticaria topically.
3. Glucocorticosteroids: In some cases, especially in more severe forms of urticaria, topical glucocorticosteroids (these come in the form of ointments, creams, and lotions.) may be prescribed to reduce inflammation and itching. Topical glucocorticosteroids such as hydrocortisone may be used to reduce inflammation and itching on the skin.
4. Immunotherapy: In cases where urticaria is caused by autoimmune mechanisms, your doctor may consider immunotherapy such as omalizumab.
5. Cooling and cooling ointments: Cooling methods such as cold compresses or cooling ointments may be used to treat physical urticaria (related to cold or pressure).
6. Medications to reduce inflammation: In some cases, especially in severe forms of chronic hives, your doctor may prescribe some anti-inflammatory medications such as pentoxifylline (Trental) or colchicine.
7. Antibiotics: Sometimes, if an infection is suspected as a triggering factor, your doctor may prescribe antibiotics.
8. Oral steroids: In cases of severe chronic hives that do not respond to other treatments, your doctor may consider short-term oral steroid prescriptions.
9. Diet: If hives are associated with food allergies, your doctor may recommend following a special diet, eliminating allergens from your diet.
10. StressReduction: Because stress can exacerbate symptoms, it is important to address stress and find ways to reduce it.
11. Other methods: Additional treatments may include the use of antihistamine injections, vasodilators, and other agents, depending on the individual patient.

Treatment of chronic urticaria should be individualized, and patients should collaborate with their physician to develop an effective treatment strategy. Regular contact with the physician and adherence to recommendations will help manage this condition and improve quality of life.

It is important to emphasize that the choice of treatment depends on the nature and severity of chronic urticaria, as well as on the individual characteristics of the patient. Only a doctor can correctly select the treatment regimen, and patients should follow his recommendations. It is necessary to discuss all questions and doubts with a medical specialist.

Prevention

Preventing chronic urticaria can be difficult because its exact causes are not always known. However, following some precautions and taking care of your health can help reduce your risk of developing this condition:

1. Avoiding triggers: If you have known triggers such as certain foods, medications, or physical stimuli (such as cold, heat, or pressure), try to avoid contact with them.
2. Vigilance when introducing new medications: If you are prescribed new medications, check with your doctor or allergist to make sure they are safe for you and will not cause allergic reactions.
3. Diary: Keeping a diary recording the foods you eat, medications, and products you use can help you and your doctor identify the link between specific factors and hives exacerbations.
4. Stress reduction: Practicing relaxation, meditation and stress management techniques can help reduce the risk of exacerbations.
5. Skin care: Avoid hot showers and baths, use mild skin care products, avoid heavy friction and pressure on the skin.
6. Good nutrition: E ating a healthy and balanced diet can help strengthen the immune system and reduce the risk of allergic reactions. If you suspect an allergy to certain foods, avoid them.
7. Consultation with an allergist: If you have had severe hives or suspected allergic reactions, a consultation with an allergist can help identify allergens and develop a personalized prevention plan.

It is important to remember that the prevention of urticaria can be individualized and depends on the specific causes and provoking factors in each patient. Regular follow-up with a doctor and adherence to recommendations will help manage the condition and prevent exacerbations.

Forecast

The prognosis for chronic urticaria can vary depending on the individual characteristics of each patient and how well the disease is controlled. It is important to note that chronic urticaria is not usually a fatal or life-threatening condition, but it can significantly affect a patient's quality of life.

Here are a few key points to consider in the prognosis of chronic urticaria:

1. Individual differences: Prognosis may depend on how the body responds to treatment and what factors trigger exacerbations. In some patients with chronic urticaria, symptoms may disappear completely after a short course of treatment, while others may require long-term maintenance therapy.
2. Treatment effectiveness: The prognosis depends on how well symptoms are controlled with medications and treatments. Some patients may achieve long-term remission (no symptoms), while others may experience periodic worsening of urticaria.
3. Provoking factors: Ifprovoking factors (such as certain foods, medications, or physical stimuli) are known and avoided, the prognosis may be more favorable.
4. Adherence to recommendations: It is important that the patient adheres to the doctor's recommendations and takes the medication as prescribed. Improper treatment or premature discontinuation of treatment can lead to exacerbations.
5. Seek medical attention in atimely manner: The sooner you see a medical professional and begin treatment, the easier it is to control symptoms and prevent exacerbations.

Chronic urticaria can be a chronic condition, and in some cases it can persist for many years. However, with the right approach to treatment and management of the condition, most patients can achieve an improved quality of life and a reduction in symptoms.

Chronic urticaria and the army.

The question of how chronic urticaria may affect military service depends on a variety of factors, including the severity of the condition, the effectiveness of treatment, and the requirements of specific armed forces.

If you have a diagnosis of chronic urticaria, it is important to consult with your military doctor or the medical professional responsible for enlistment and medical eligibility to learn how the condition may affect your military service. Doctors will consider the severity and control of your chronic urticaria, as well as the presence of possible allergic reactions to medications used for treatment.

In some cases, if chronic urticaria is uncontrollable or accompanied by severe symptoms, decisions may be made about temporary or permanent exemption from military service. However, this decision will depend on the specific circumstances and policies of your country's armed forces.

Remember, it is important to consult medical professionals and military service representatives for accurate information and guidance regarding your military service, as each case may be unique.

Literature used

Karaulov A.V., Yutskovsky A.D., Gracheva T.S. Chronic urticaria: modern features of treatment. Klinicheskaya dermatologiya i venerologiya. 2013;11(3):76-81

Skorokhodkina O.V. Klucharova A.R. Modern principles of treatment of acute and chronic urticaria, Practical Medicine. 2012

Modern possibilities of therapy of chronic urticaria in children. Namazova-Baranova L.S., Vishneva E.A., Kalugina V.G., Pediatric Pharmacology. 2018