Diagnosis and treatment for Urticaria or Hives

This article describes about how the diagnosis of hives and urticaria is done. Read to know more about the investigations for Urticaria and the treatment of Acute Urticaria and Angioedema.

The diagnosis of the utricaria depends on the clinical features and the history to recognize the cause. The area of involvement is another important criteria for diagnosis. The details of the causes and clinical features are given at Causes and features of Acute Utricaria.

Though clinical features is alone sufficient to diagnose acute utricaria but there are some investigations done to detect the cause and type of utricaria. These investigations include-

Investigations for acute utricaria

In routine blood investigation the total WBC count may be increased and in differential count there may be eosinophilia indicating the existence or allergy or atopy.

The immunoglobulins are checked and IgG levels may be high and complement levels may be low in immune mediated utricaria.

Some cases of cold utricaria which is common in countries having temperate climate cryoglobulins and cold hemolysins may be detected.

There are some systemic causes of utricaria like Hepatitis B etc so LE cells, Hepatitis B surface antigens etc may be helpful in diagnosis of cause in systemic causes of purpura.

In utricaria specially in children the stool examination should always be done to rule out any worm infestation as helminthic infestataion is a very common cause of utricaria in children.

Treatment of acute utricaria and angioedema

The first and foremost important thing in treatment is to avoid the trigger factor like a cold environment in cold utricaria, or the trigger factor for atopy which may lead to utricaria.

The most important drug used in treatment of utricaria is antihistaminic drugs. If the antihistaminic drugs are given in sufficient doses in many cases steroids can be avoided.

The preferred antihistaminics are sedative antihistaminics which include oral long acting chlorpheniramine maleate or Avil upto 8 to 12 mg and/or bromopheniramine 12 to 24 mg or hydroxyzine (Atarax) 10-50 mg.

In certain patients working in running transport like drivers, or in a factory or at any place in daytime non sedative antihistaminic is given to avoid accidents, these include terfenadine 60 mg twice a day or Loratidine 10 mg once daily or astemizole 10 mg once daily or cetrizine 10 mg dialy. Cetrizine though comes under non sedative antihistaminc but there is sedation, so it should also be avoided during work.

In case of angioedema hydroxyzine HCl (atarax) or cyproheptadine HCl is preferred as they have a wider spectrum of action, so it can be helpful in reducing edema as well as rashes so preferred in utricaria with angioedema.

Sometimes H1 blockers mentioned above combined with H2 blockers like ranitidine or famotidine is used for wider spectrum of action.

When antihistaminics fails then comes the role of corticosteroids and is given orally or parenterally as per the severity of the lesion.

In case of anaphylaxis when utricaria is associated with laryngeal edema, hypotension or shoch subcutaneous adrenaline is given in 1:1000 dilution which can be repeated after 20-25 minutes if there is no tachycardia.

In few cases tracheostomy, intravenous saline, dopamine etc may be required to combat anaphylaxis.

In majority of cases if treated carefully utricaria recovers completely from the acute attack and the person remains healthy throughout their lives.

Reference: http://dr-healthguide.blogspot.com

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