Introduction
Clive E.H. Grattan, Emek Kocatürk and Sarbjit S. Saini Urticaria and Angioedema 18
Synonyms: Wheals – hives, nettle rash Angioedema – Quincke edema, angioneurotic edema
Key features
Urticaria is characterized by transient skin or mucosal swellings due to plasma leakage. Superficial dermal swellings are wheals, and deep swellings of the skin or mucosa are termed angioedema. Wheals (hives) are characteristically pruritic and pink or pale in the center, whereas angioedema is often painful, less well-defined, and shows no color change
There are several recognizable clinical patterns of urticaria and different causes. The latter include allergy, autoimmunity, drugs, dietary pseudoallergens, and infections. Many cases of spontaneous urticaria remain unexplained (“idiopathic”) even after an extensive evaluation; they may also be multifactorial
C1 esterase inhibitor deficiency and angiotensin-converting enzyme (ACE) inhibitors need to be considered as causes of recurrent angioedema without wheals
Diagnosis is based primarily on the history and clinical examination.
Determination of the etiology or triggers, as well as exclusion of other diagnoses, may require further investigations, including blood tests, physical and dietary challenges, skin tests, and skin biopsy
Urticaria is a common disorder that may cause considerable distress and last for years, but the symptoms can usually be alleviated by appropriate management