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Urticaria

Disease Details

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Description: Urticaria, commonly known as hives, is an allergic skin reaction that causes red, itchy, and swollen welts to appear on the skin.
Type: Urticaria, commonly known as hives, is typically classified as an allergic or non-allergic skin reaction. It is usually not inherited in a straightforward Mendelian pattern. However, there are rare familial cases of chronic urticaria and hereditary angioedema, which can follow an autosomal dominant pattern of genetic transmission.
Signs And Symptoms: Hives, or urticaria, is a form of skin rash with red, raised, itchy bumps. They may also burn or sting. Hives can appear anywhere on the surface of the skin. Whether the trigger is allergic or not, a complex release of inflammatory mediators, including histamine from cutaneous mast cells, results in fluid leakage from superficial blood vessels. Hives may be pinpoint in size or several inches in diameter, they can be individual or confluent, coalescing into larger forms.About 20% of people are affected. Cases of short duration occur equally in males and females, lasting a few days and without leaving any long-lasting skin changes. Cases of long duration are more common in females. Cases of short duration are more common among children while cases of long duration are more common among those who are middle aged. Fewer than 5% of cases last for more than six weeks. The condition frequently recurs. In half of cases of hives, the cause remains unknown.Angioedema is a related condition (also from allergic and nonallergic causes), though fluid leakage is from much deeper blood vessels in the subcutaneous or submucosal layers. Individual hives that are painful, last more than 24 hours, or leave a bruise as they heal are more likely to be a more serious condition called urticarial vasculitis. Hives caused by stroking the skin (often linear in appearance) are due to a benign condition called dermatographic urticaria.
Prognosis: In those with chronic urticaria, defined as either continuous or intermittent symptoms lasting longer than 6 weeks, 35% of people are symptom free 1 year after treatment, while 29% have a reduction in their symptoms. Those with a longer disease duration typically have a worse prognosis, with greater symptom severity. Chronic urticaria is often accompanied by an intense pruritus, and other symptoms associated with a reduced quality of life and a high burden of co-morbid psychiatric conditions such as anxiety and depression.
Onset: Urticaria, commonly known as hives, typically has an acute onset, with symptoms appearing within minutes to hours after exposure to a trigger.
Prevalence: The prevalence of urticaria (hives) varies, but it is estimated that around 15-20% of people will experience at least one episode of acute urticaria in their lifetime. Chronic urticaria, which lasts for six weeks or longer, affects approximately 0.5-1% of the population.
Epidemiology: Chronic urticaria is usually seen in those older than 40 years, it is more common in women. The prevalence of chronic urticaria is 0.23% in the United States.
Intractability: Urticaria, commonly known as hives, is not generally considered to be an intractable disease. Many cases are acute and resolve on their own or with standard treatments such as antihistamines. Chronic urticaria, which lasts for six weeks or longer, can be more challenging to manage, but it is still often treatable with a combination of medications and lifestyle changes. In some cases, underlying causes such as autoimmune disorders or allergies need to be addressed. Therefore, while chronic urticaria can be persistent, it is not typically intractable.
Disease Severity: Urticaria, commonly known as hives, varies in severity:

1. **Mild:** Symptoms are limited to small, itchy red or skin-colored welts (wheals) on the skin. These may resolve within a few hours to a day without treatment.

2. **Moderate:** More extensive formation of wheals, potentially accompanied by swelling (angioedema) especially around the eyes, lips, hands, or feet. Symptoms might last several days and can be uncomfortable, often requiring antihistamines or other treatments.

3. **Severe:** Large, widespread wheals and significant angioedema. Symptoms may last for weeks (chronic urticaria) and can be debilitating. Severe cases might affect breathing and require immediate medical attention, including corticosteroids or immunosuppressive drugs.

Nanotechnology (nan) is not currently a standard treatment or diagnostic tool for urticaria. Treatments primarily focus on managing symptoms and identifying potential triggers.
Healthcare Professionals: Disease Ontology ID - DOID:1555
Pathophysiology: The skin lesions of urticarial disease are caused by an inflammatory reaction in the skin, causing leakage of capillaries in the dermis, and resulting in an edema which persists until the interstitial fluid is absorbed into the surrounding cells.Hives are caused by the release of histamine and other mediators of inflammation (cytokines) from cells in the skin. This process can be the result of an allergic or nonallergic reaction, differing in the eliciting mechanism of histamine release.
Carrier Status: Urticaria, commonly known as hives, is a condition characterized by the sudden appearance of itchy, red welts on the skin. It is not typically described in terms of carrier status because it is not an inherited genetic disease in the traditional sense. Instead, urticaria is often triggered by factors such as allergens, infections, medications, or stress. There is no known "carrier" state for urticaria.
Mechanism: Urticaria, commonly known as hives, is a skin condition characterized by red, itchy, and swollen welts.

**Mechanism:**
The primary mechanism behind urticaria involves the release of histamine and other inflammatory mediators from mast cells in the skin. This can result from various triggers, including allergens, physical stimuli (such as pressure, cold, or heat), infections, stress, or certain medications. When these triggers activate mast cells, they release histamine, which increases the permeability of blood vessels, leading to fluid leakage and the characteristic swelling and redness.

**Molecular Mechanisms:**
1. **Mast Cell Activation:**
- **IgE-Mediated:** In allergies, specific antigens cross-link IgE antibodies bound to the surface of mast cells through high-affinity IgE receptors (FcεRI). This leads to degranulation and the release of histamine and other pro-inflammatory cytokines.
- **Non-IgE-Mediated:** Certain drugs, physical factors, or endogenous peptides can directly activate mast cells without IgE involvement.

2. **Histamine Release:**
- Histamine binds to H1 and H2 receptors on blood vessels, leading to vasodilation, increased vascular permeability, and subsequent plasma exudation into the surrounding tissues, causing the edema and erythema characteristic of urticaria.

3. **Other Mediators:**
- **Leukotrienes and Prostaglandins:** These also contribute to the inflammatory process and vascular changes seen in urticaria.
- **Bradykinin and Platelet-Activating Factor (PAF):** These molecules can further exacerbate the vascular permeability and recruit more inflammatory cells to the site.

4. **Signal Transduction:**
- Activation of downstream signaling pathways, including the mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase (PI3K) pathways, play a role in the degranulation process and expression of pro-inflammatory genes.

Overall, urticaria is a multifaceted condition with a complex interplay of immune cells, signaling molecules, and genetic factors influencing its manifestation and severity.
Treatment: Urticaria, commonly known as hives, is typically treated with the following:

1. **Antihistamines**: Over-the-counter or prescription antihistamines (such as cetirizine, loratadine, or diphenhydramine) are often used to relieve itching and reduce swelling.

2. **Avoiding Triggers**: Identifying and avoiding potential triggers, such as certain foods, medications, or stress, can prevent episodes.

3. **Cool Compresses**: Applying a cool, damp cloth or ice pack to the affected area can help alleviate itching and swelling.

4. **Topical Treatments**: Over-the-counter creams or lotions containing hydrocortisone may reduce itching and inflammation.

5. **Prescription Medications**: For chronic or severe cases, a doctor may prescribe stronger antihistamines, corticosteroids, or other medications such as omalizumab or cyclosporine.

6. **Lifestyle Changes**: Wearing loose, comfortable clothing and avoiding hot showers can help minimize symptoms.

It's important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to the individual case.
Compassionate Use Treatment: For urticaria, also known as hives, compassionate use treatments, off-label, or experimental treatments may include:

1. **Omalizumab (Xolair)**: While approved for chronic idiopathic urticaria, it may be used off-label for other types of severe urticaria not responsive to standard therapies.

2. **Cyclosporine**: An immunosuppressant used off-label for chronic urticaria that doesn't respond to antihistamines.

3. **Methotrexate**: Sometimes used off-label for severe cases of chronic urticaria.

4. **Biologics**: Other monoclonal antibodies, besides omalizumab, are being studied for urticaria, such as dupilumab.

5. **JAK Inhibitors**: Experimental use of Janus kinase inhibitors, such as tofacitinib or ruxolitinib, in severe or refractory cases of urticaria.

6. **Plasmapheresis**: An experimental therapy for severe chronic urticaria that may involve removing antibodies from the blood.

These treatments should be considered under the guidance of a healthcare professional, often when standard therapies fail or are unsuitable.
Lifestyle Recommendations: **Lifestyle Recommendations for Urticaria:**

1. **Avoid Triggers**: Identify and avoid known triggers such as certain foods, medications, or environmental factors.
2. **Wear Loose Clothing**: Opt for loose-fitting, soft clothing made from natural fibers to prevent irritation.
3. **Stay Cool**: Avoid overheating by staying in a cool environment and using cold compresses to soothe the skin.
4. **Use Gentle Products**: Choose mild, fragrance-free soaps and skin care products to avoid irritation.
5. **Healthy Diet**: Maintain a balanced diet and stay hydrated.
6. **Stress Management**: Practice stress-reducing techniques like meditation, yoga, or deep breathing exercises.
7. **Sun Protection**: Use sunscreen and avoid prolonged sun exposure to prevent exacerbation.

Implementing these lifestyle changes can help manage symptoms and reduce the frequency of urticaria flare-ups.
Medication: Drugs that have caused allergic reactions evidenced as hives include codeine, sulphate of morphia, dextroamphetamine, aspirin, ibuprofen, penicillin, clotrimazole, trichazole, sulfonamides, anticonvulsants, cefaclor, piracetam, vaccines, and antidiabetic drugs. The antidiabetic sulphonylurea glimepiride, in particular, has been documented to induce allergic reactions manifesting as hives.
Repurposable Drugs: There are several drugs that are potentially repurposable for treating urticaria (hives). Some of these include:

1. **Antihistamines:** These are the first line of treatment and include drugs such as cetirizine, loratadine, and fexofenadine.
2. **H2 Blockers:** Drugs like ranitidine and famotidine, which are typically used for treating gastric issues, can also help with urticaria.
3. **Corticosteroids:** Prednisone and other corticosteroids can be used for short-term control of severe urticaria.
4. **Immunosuppressants:** Drugs such as ciclosporin and methotrexate may be considered in chronic or severe cases.
5. **Biologics:** Omalizumab, originally developed for asthma, has shown efficacy in treating chronic urticaria.

"NAN" typically stands for "Not a Number" in computational contexts and doesn't apply here. Therefore, it is not relevant to the treatment of urticaria.
Metabolites: In the context of urticaria (hives), some notable metabolites implicated include histamine, leukotrienes, and prostaglandins. Histamine, released from mast cells, plays a central role in the symptoms of urticaria such as itching and swelling. Leukotrienes and prostaglandins also contribute to inflammation and vasodilation.
Nutraceuticals: Nutraceuticals are food-derived products that offer health benefits, including the prevention and treatment of disease. For urticaria, several nutraceuticals may help manage symptoms:

1. **Omega-3 Fatty Acids:** Found in fish oil, they have anti-inflammatory properties and may reduce the severity of urticaria.
2. **Vitamin D:** Some studies suggest that Vitamin D supplementation can help improve symptoms of chronic urticaria.
3. **Quercetin:** A flavonoid found in fruits and vegetables, it has antihistamine and anti-inflammatory effects.
4. **Probiotics:** These can help balance gut bacteria, potentially improving immune system regulation and reducing urticaria episodes.

Always consult with a healthcare provider before starting any new supplement regimen, especially for managing medical conditions like urticaria.
Peptides: Urticaria, commonly known as hives, involves peptides such as histamine released from mast cells. Histamine triggers the symptoms of urticaria, causing redness, swelling, and itching. Nanomedicine approaches, including nanoparticles, are being researched for enhanced delivery of antihistamines and targeted therapies to improve treatment efficacy and reduce side effects.