Clinical Aspects Of Urticaria

A urticaria or hives or wheal is an erythematous or white, nonpitting, edematous plaque that changes in size and shape by peripheral extension or regression during the few hours or days that the individual lesion exists. The evolution of urticaria is a dynamic process. New lesions evolve as old ones resolve. Hives result from localized capillary vasodilation, followed by transudation of protein-rich fluid into the surrounding tissue; they resolve when the fluid is slowly reabsorbed.

Clinical manifestation

In common, all allergy shows urticaria, an elevated local oedema on skin, red/white decolourisation, vary on size. Lesions vary in size from the 2 to 4 mm edematous papules of cholinergic urticaria to giant hives, a single lesion of which may cover an extremity. They may be round or oval; when confluent, they become polycyclic. A portion of the border either may not form or may be reabsorbed, giving the appearance of incomplete rings. Hives may be uniformly red or white, or the edematous border may be red and the remainder of the surface white. This variation in color is usually present in superficial hives. Thicker plaques have a uniform color.

Hives may be surrounded by a clear or red halo. Thicker plaques that result from massive transudation of fluid into the dermis and subcutaneous tissue are referred to as angioedema. These thick, firm plaques, like typical hives, may occur on any skin surface, but typically involve the lips, larynx (causing hoarseness or a sore throat), and mucosa of the gastrointestinal (GI) tract (causing abdominal pain) . Bullae or purpura may appear in areas of intense swelling. Purpura and scaling may result as the lesions of urticarial vasculitis clear. Hives usually have a haphazard distribution, but those elicited by physical stimuli have characteristic features and distribution.

Symptoms.

Hives itch. The intensity varies, and some patients with a widespread eruption may experience little itching. Pruritus is milder in deep hives (angioedema) because the edema occurs in areas where there are fewer sensory nerve endings than there are near the surface of the skin.

Diagnosis Technique

Detailed anamnesis

Angioedema (giant Urticaria,quinke’s oedema) if the urticaria is in imense size, followed by depper oedema until subcutaneous layer on palpebra,genetalia and lips for instance.Cholinergic urticaria if the urticaria is in small size,diffused, and very itchy.Dermographic urticaria (Physical urticaria) if the urticaria emerges due to a linear pressure matched with the part of the pressure/scratch. Dermographisme test is positive (it emerges when the skin is scratched). Old Urticaria emerges in minutes or hours after being exposed to cold air/water.it could be mild/local until severe (followed by hypotension, loss of consciousness, and dyspnoea).Solar urticaria emerges after being exposed to sunrays.Allergic urticaria, if it is caused by allergic to food or drugs Idiopathic urticaria, if the cause is unknown. Chronic urticaria, if urticaria constantly emerges everday for 6 weeks. 

Accurate physical examination of the urticaria and accopanied general/systeic disease.

Physical urticaria suspicion is examined with dermographism test,physical test (exercise)

c.       Laboratory examination/Supporting examination

Blood,urine and faeces examination to check a hidden infection. Tooth,ear,nose,throat,lungs and aginal examination to seek infection factor.If necessary, advanc allergy examination, could be done such as IgE, amount of eosinofil, complment proportion, and skin sratch/needle stick test.Cold urticaria suspicion is examinedwith ice tube test, cryogloblin, and cold heolysin