Let’s talk about urticaria, hives.
With urticaria hives, what
does this mean to you?
It’s an IgE mediated.
As soon as you hear IgE mediated,
what does that mean to you?
It means that now you’ve been
exposed to a particular antigen
in which you have now elicited
a type 1 hypersensitivity.
Isotype switching, IgE then lands upon
your IgE receptors as a mast cell.
What did you release?
Ah, histamine, histamine, histamine.
Histamine has what kind of
effect on your blood vessels?
Welcome to hives.
Now, once you have
vasodilation taking place
with the histamine being
released by the mast cell,
you have an area
that appears what?
Maybe a little
Caused by food, medication, exercise,
temperature, vibration, stress,
those things that you can expect in
which hives are going to develop.
And two to three episodes per week for
six weeks is a chronic urticaria.
Be familiar to define or how
to define chronic urticaria,
which is two to three episodes
per week for six weeks.
That is extremely cumbersome.
Morphology: Rapid development
of edematous, E&E.
Histamine, vasodilation, edema.
Erythematous wheal formation.
There are three terms here
that you want to keep in mind:
urticaria, hives, and
To you, it’s a type 1 hypersensitivity
with vasodilation, edema, and erythema.
These lesions evolve and dissipate
rapidly within 24 hours.
There’s every possibility that if you
were to take a glass slide, for example,
and apply pressure, apply pressure on this
hive or wheal formation with vasodilation.
Press upon that wheal,
What’s going to happen?
because when you press upon that wheal,
the fluid, edema, is
going to then disperse
so that erythema that you found upon what’s
known as a diascopic type of examination
is then going to give you your
blanched type of appearance.
Diagnosis: Rapidity of evolution,
and biopsy rarely performed.
The history is going to tell
you what’s going to happen.
Take a look at the image here,
high formation on the thigh,
in the leg of this individual.
If swelling as deeper, you then
consider this to be angioedema.
Don’t memorize that.
So at this point, we’re in the skin.
And so therefore, with high formation, you
have edematous formation in the epidermis.
But over a period of time, there is every
possibility that the fluid may then
be escaping deep down the tissue,
and we then refer to this being
acquired type of angioedema.
And when this occurs --
what am I doing?
It’s a fact that around the mucosal
region, I have angioedema, swelling,
therefore, making it difficult
for me to articulate clearly.
You need to identify what’s actually
causing the type 1 hypersensitivity.
Antihistamines, obviously, sedating
such as maybe diphenhydramine.
will be cetirizine,
and non-sedating if at all required based
on the patient’s habits and behavior.
Maybe you’re thinking
you’re going after the histamine so
that you can take care of the hives.