Hives (Urticaria)

by Carlo Raj, MD

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    00:02 Let’s talk about urticaria, hives.

    00:06 With urticaria hives, what does this mean to you? It’s an IgE mediated.

    00:10 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.

    00:20 Isotype switching, IgE then lands upon your IgE receptors as a mast cell.

    00:25 What did you release? Ah, histamine, histamine, histamine.

    00:30 Histamine has what kind of effect on your blood vessels? Vasodilation, good.

    00:36 Welcome to hives.

    00:38 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 edematous, erythematous.

    00:52 Caused by food, medication, exercise, temperature, vibration, stress, those things that you can expect in which hives are going to develop.

    01:00 And two to three episodes per week for six weeks is a chronic urticaria.

    01:06 Be familiar to define or how to define chronic urticaria, which is two to three episodes per week for six weeks.

    01:14 That is extremely cumbersome.

    01:18 Morphology: Rapid development of edematous, E&E.

    01:23 Edematous, why? Histamine, vasodilation, edema.

    01:27 Erythematous wheal formation.

    01:30 There are three terms here that you want to keep in mind: urticaria, hives, and wheal formation.

    01:36 To you, it’s a type 1 hypersensitivity with vasodilation, edema, and erythema.

    01:44 These lesions evolve and dissipate rapidly within 24 hours.

    01:49 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.

    02:00 Press upon that wheal, please, W-H-E-A-L.

    02:04 What’s going to happen? Blanching, 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.

    02:28 Diagnosis: Rapidity of evolution, clinically distinctive, and biopsy rarely performed.

    02:35 The history is going to tell you what’s going to happen.

    02:37 Take a look at the image here, high formation on the thigh, in the leg of this individual.

    02:42 If swelling as deeper, you then consider this to be angioedema.

    02:47 Don’t memorize that.

    02:49 So at this point, we’re in the skin.

    02:51 And so therefore, with high formation, you have edematous formation in the epidermis.

    02:56 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 type of angioedema.

    03:07 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.

    03:22 Management: You need to identify what’s actually causing the type 1 hypersensitivity.

    03:27 Antihistamines, obviously, sedating such as maybe diphenhydramine.

    03:31 Moderately sedating will be cetirizine, and non-sedating if at all required based on the patient’s habits and behavior.

    03:39 Maybe you’re thinking about loratadine.

    03:40 But antihistamine, you’re going after the histamine so that you can take care of the hives.

    About the Lecture

    The lecture Hives (Urticaria) by Carlo Raj, MD is from the course Inflammatory Skin Diseases.

    Included Quiz Questions

    1. Histamine induced vasodilation
    2. IgM related vasodilation
    3. IgE mediated vascoconstriction
    4. Type II reaction
    5. Suppression of histamine release
    1. Treat with diphenhydramine and exclude the triggers
    2. Use topical steroids
    3. Must confirm diagnosis with biopsy before starting treatment
    4. Administer biological agents
    5. Short term treatment with oral steroids
    1. Acquired type angioedema
    2. Chronic utricaria
    3. Lymphedema
    4. Allergic contact dermatitis
    5. Simple allergic reaction

    Author of lecture Hives (Urticaria)

     Carlo Raj, MD

    Carlo Raj, MD

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