Angioedema and urticaria implications

Urticaria and angioedema are very common processes: acute urticaria affects about fifteen to twenty five percent of general population at some point of life. Urticaria is defined as the emergence of hives (raised inflammation of skin with a reddish color) of a diverse size, with itching, on any place of skin which disappear in matter of minutes or hours, leaving aside a skin with normal aspect. Urticaria can emerge alone or associated to angioedema.

Angioedema is the emergence of hives on deeper layers of skin or inside the mucosa. In this case the color of skin is normal and there is almost no itching. It usually affects loose skin (lips, eyelids, ears and genitals) or to hands and feet. The angioedema can appear alone, but is more frequently found accompanied by urticaria. According the episodes of the condition, it can be classified as:

• Acute Urticaria; with a duration less than six weeks. This condition covers about seventy percent of urticaria manifestations. The cause can be identified on half of the cases. For an isolated episode of urticaria or angioedema are not required diagnostic studies, except in the case that they have been triggered by medicines, foods or bites of insects. It should be considered that many cases are multifactorial and that many of them are mostly precipitating than causatives of a sprout.
• Chronic Urticaria; it lasts more than six or eight weeks and it can be recurrent or continuous. It can be due to alimentary allergies or chemical allergies which weren’t diagnosed. This condition can be associated with infections or chronic infestations (gastritis caused by Helicobacter pylori, parasitization caused by Anisakis simplex found on fishes or on nematodes, chronic dental infections and sinusitis among others), autoimmune condition of the thyroid gland and other diseases. In most of the half of the cases (chronic idiopathic urticaria) the cause of the condition cannot be determined.

Chronic Idiopathic Urticaria

It can be presented with an almost continuous sprout (lesions that change of location and size, but they are always present) or as relapsing episodes with periods without symptoms. This condition is self-limited in half of the cases which spontaneously disappear after six months. On this type of urticaria there cannot be found any cause, although there are known some factors that worsen the symptoms:

• Medicines such as beta-blockers, codeine, anti-inflammatory medicines, cardiovascular drugs and aspirin among others.
• Some foods or drinks like spicy foods, chocolate and cocoa products, shellfish, meats and pork sausages, canned fish, nuts, alcoholic drinks and cheeses among others.
• Some situations like a profuse sweating and heat, sudden changes of temperature, friction with other surfaces and scratching of skin.
• Psychological causes like situations of anxiety, tension or stress play a partial role on about thirty three percent of the cases.

The diagnosis is done when other types of urticaria are discarded by clinical history of the patient and specific tests. There can be found an increment on the amount of mast cells on histopathology.