Urticaria and Angioedema are diseases that are confusing to most people, as well as many physicians. Urticaria means hives, or welts. Up to 25% of people have hives at one point in their lives. At times, angioedema accompanies urticaria. Angioedema is actual swelling of any part of your body, which can become tense or hard. Some people will just have hives or just have swelling. The hives and swelling can flare up once and awhile, appear frequently, or even daily.
Welts or hives that are very itchy may be called urticaria. Sudden swelling of the lips, tongue, fingers or feet can be angioedema (swelling below the surface of the skin). This is an odd problem and can be very frustrating.
Most often, these bouts last a few days but can be uncomfortable. An allergic exposure can cause this such as a food or drug allergy or possibly a pet. Many times it can just appear and the cause is not determined. Antihistamines are helpful.
It is difficult to find the cause of urticaria or angioedema. In fact, the cause of hives or angioedema is only found in approximately 1% of cases. In reality, most of the causes for angioedema and urticaria are idiopathic. Idiopathic means we do not know the cause or the trigger for urticaria and/or angioedema.
Still, there are a few commonalities or theories about what causes these reactions:
- Foods are frequently blamed, as are allergies to cats, dogs, or pollen from trees, grasses or weeds. Other times we see that Angioedema and urticaria can be triggered by physical causes — heat, cold, sun exposure, pressure, vibration, and even water (aquagenic urticaria) may cause a breakout.
- Liver disease, additional chronic diseases and cancers are related to angioedema and urticaria.
- Systemic diseases can cause angioedema and urticaria. This is generally related to auto-antibody formation, where our own antibodies attack our receptors attached to white blood cells. Anti-Thyroid antibodies that affect the thyroid can also trigger a release of mediators from our white blood cells.
- Cholinergic urticaria is blotchy, itchy skin that appears when heat is involved. Exercise, taking a hot shower, or getting embarrassed may cause cholinergic urticaria.
- Certain heart medications that are in the class of ACE inhibitors are known to cause Angioedema. ACE inhibitors can also cause a dry cough as one of their side effects.
- Almost any other medication can cause angioedema, but the most common cause is the drug class of ACE inhibitors. If a medication is the cause, angioedema will generally occur within the first few hours after taking the medication or it will appear only while taking the medication.
For some, urticaria and angioedema can be serious, resulting in swelling of the throat that requires epinephine. However, most cases resolve in a short time. If these bouts occur repeatedly or if they last for more than 6 weeks though, then it is considered chronic urticaria and it’s important to see an allergist. We treat approximately thirty patients a month with urticaria (hives) and angioedema (swelling) per month.
Urticaria & Angiodema Terms
- Angioedema: Swelling of any part of the body.
- Antihistamine: Blocks the bad effects of histamine.
- Cholinergic Urticaria: Itching or blotching on the skin that appears when heat is involved such as with exercise, taking a hot shower, or getting embarrassed.
- Epinephrine: A medicine that will reverse allergic reactions. It can reverse urticaria and angioedema and some severe reactions.
- Epipen® and Epipen Jr.®: are auto injectors, self injecting epinephrine.
- Histamine: This is released by our white blood cells, and will cause itching and swelling.
- Idiopathic: No cause is determined-the cause is unknown
- Mediators: Chemical substances produced in our cells that are part of allergic reactions.
- Prednisone: Prednisone is a steroid medication that reduces allergic reactions and inflammation
- Systemic Disease: A disease that involves other parts of the body like the liver, thyroid, heart, blood pressure, diabetes, cancers.
- Urticaria: Hives or welts.
More About Urticaria Angiodema: