Urticaria and Angioedema

Category: Miscellaneous Articles Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD

Have you ever been stung by a bee or wasp or bitten by a mosquito and developed an itchy, red, spongy, raised, flat bump? If so, then you have experienced an “urticaria wheal”.

“Wheals” usually are caused by histamine-itching, a build of water, and swelling that can appear anywhere on skin.  The most likely causes of acute (sudden) urticaria are allergy to pets, latex or foods, such as shellfish, nuts, fruit and dairy. Also quite common are insect bites or stings as well as medication allergy, such as antibiotics, ACE inhibitors and aspirin.  Some other triggers of urticaria are sudden temperature change, emotional stress, and even pressure on the skin.

Episodes of urticaria can last from 48 hours up to 6 weeks and may come and go. However, if the wheals persist for longer, your condition would be considered chronic.

Initially, avoiding the aggravating factor, such as a new medication, food, pets, as well as extreme cold or hot temperatures is wise.  You can apply creams such as hydrocortisone or menthol in aqueous cream to soothe the skin and even take an antihistamine. Pay close attention to spices and preservatives such as sodium benzoate and food colorings such as tartrazine and consult your physician if you were started on new medication.

Sometimes, high doses of 1st generation antihistamine such as Benadryl, Atarax, may be necessary for longer periods to control the irritation and rash.  Because of their association with drowsiness, 1st generation antihistamines are best used at night. If grogginess, which can last a couple of days or longer, is bothersome,  2nd generation antihistamines such as Clarinex, Allegra, and Zyrtec that cause less drowsiness can be used and are very effective for maintenance treatment during the day.

In addition to antihistamines, corticosteroids are useful for up to three weeks for an acute phase.  Finally, if antihistamines and corticosteroids do not relieve the urticaria, other medications such as Doxipen, Zantac or Tagament can be used.

The key to managing urticaria is to know the cause, to avoid it when possible, and to have an antihistamine and cortisone cream on hand.

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