Dermographic urticaria: modern ideas about the diagnosis and treatment of the disease

Published: 11/03/2021 10:00:00 Updated: 11/03/2021

Urticaria is an allergic disease, the causes of which in children and adults can be very different. The main symptom of the disease is the appearance of blistering rashes on the skin, which are very itchy and resemble a nettle burn.

According to statistics, 25% of the entire population of the planet has encountered this pathology at least once in their lives, mainly children and women under the age of 40. With constant contact with the allergen, the disease becomes chronic, and in half of all cases it is accompanied by Quincke's edema.

Reasons for the development of urticaria

Hives never develop on their own; there is always a reason for this.
In some cases, identifying it is not difficult, but sometimes it is difficult to do. Most often, urticaria in children appears after using certain medications or eating certain foods. The most allergenic foods for babies are honey, nuts, fish, food additives, spices, sausages, and processed foods. Therefore, they are not recommended for children under 3 years of age.

Also, provoking factors include:

• insect bites;
• the presence of parasites in the body;
• plant pollen;
• mold;
• chemicals, including household chemicals;
• latex;
• ultraviolet radiation;
• vibration.

However, it is not always possible to find out what exactly the patient developed allergic urticaria to. In about a third of all patients with this diagnosis, the causes of the disease, even after numerous tests and analyses, remain unknown.

Treatment of the disease

If the allergen is known, then the main recommendation is to avoid, if possible, contact with the substance that provokes hives. That is why accurate diagnosis is important - it is necessary to understand which group of chemical compounds can lead to the development of urticaria. It often happens that the same substance is found in different foods or in different pharmaceuticals. And an allergy to pets can affect only one breed or spread to almost all pets, from cats to hamsters.

Therapy is needed if the disease has become a recurrent form - this happens if it is impossible to stop contact with the provocateur. In a situation where test results show the presence of an infectious focus, it is necessary to determine the infectious disease. It is likely that the urticaria will go away after healing.

If a patient is diagnosed with an allergy to dust, food or plants, then lifestyle changes are required: frequent wet cleaning, following a proper diet and avoiding walking during the flowering period of plants. Concomitant treatment is designed to alleviate symptoms when they reappear.

Symptoms of urticaria

The main manifestation is the appearance on the skin of red or pink spots of various shapes, and blisters, the size of which can reach several centimeters.
A slight swelling may appear, which gradually disappears over the course of a day, rarely two. If the swelling affects the deeper layers of the skin or mucous membranes, angioedema may result - a life-threatening condition that requires immediate medical intervention.

The rash of allergic urticaria is always accompanied by unbearable itching, and some patients describe it as an unbearable burning sensation. Violent scratching of such areas can lead to infection of the epidermis with further complications in the form of pustules and wounds.

Minor manifestations of urticaria include:

• headache;
• elevated temperature;
• sleep disorder;
• anxiety;
• loss of appetite.

According to the nature of the course, allergic diseases are divided into two types.
Acute urticaria is diagnosed most often. Blisters and swelling of the skin in this form appear completely suddenly, sometimes against the background of a person’s excellent health. Most often caused by some external reasons, food. It also happens after using medications, especially when self-medicating. Symptoms go away on their own within a few days to several weeks.

Chronic urticaria is a condition in which symptoms continue to persist for more than 6 weeks after the first rash on the skin. This variant is characterized by a wave-like course, when periods of complete absence of symptoms (recovery) are abruptly replaced by exacerbations with the appearance of a new portion of spots and blisters. This is accompanied by unbearable itching and rapid development of Quincke's edema. The emerging elements of the rash can merge with each other, covering more and more new areas of the skin.

Sometimes periods of complete well-being without symptoms can last for a long time - up to 10 years.

Children's urticaria is an allergic skin disease, which most often develops against the background of an existing exudative diathesis and appears due to food products introduced as complementary foods.

It has been noticed that this type of allergy mainly develops in babies who are bottle-fed or eat foods that are not appropriate for their age.

Dermographic urticaria: modern ideas about the diagnosis and treatment of the disease

Chronic urticaria is accompanied by the appearance of itchy blisters and/or angioedema for more than 6 weeks. It can be spontaneous or induced. The latter includes symptomatic/urticarial dermographism (syn. urticaria factitia, mechanical urticaria, dermographic urticaria (DC)), cold, pressure-delayed, solar, heat, cholinergic, contact urticaria and vibration angioedema.

In a broad sense, dermographism is a local reaction of skin vessels in the form of stripes of different (usually red or white) colors at the site of streak mechanical irritation of the skin. A change in skin color at the site of mechanical action during dermographism is caused by a reaction (spasm or dilation) of the arterial and venous vessels of the skin.

Dermographism, in relation to urticaria, refers to a condition in which itching and blistering occurs within minutes of mechanical irritation of the skin, such as from a blunt object or clothing. It is customary to divide dermographism into urticarial, i.e. symptomatic with the development of a “blister-erythema-itching” reaction in the area of ​​skin irritation, and non-urticarial (white, red and black).

Separately, we consider simple dermographism, which occurs in 2–5% of healthy individuals in response to significant (moderate and strong) mechanical irritation of the skin in the form of erythema and blisters in the contact area. Despite the absence of itching (an important diagnostic sign of the condition), the reaction can be quite noticeable. It is believed that this response is associated with a physiological hyperreaction of the skin. Treatment in this case is usually not required.

In contrast to simple dermographism, DC almost always involves both itching, blistering and erythema, and a mild skin irritation is often required for a reaction to occur.

DC is considered the most common form of induced urticaria, with a prevalence of 4.2–17% and a mean duration of approximately 6 years. DC is most common in young adults, can occur together with other types of disease, such as chronic spontaneous urticaria, and can lead to a significant decrease in quality of life.

As with other types of urticaria, the pathogenesis of DC is associated with degranulation of mast cells and the release of biologically active substances, primarily histamine, which leads to symptoms of the disease. It is currently assumed that degranulation of mast cells is caused by the formation of an antigen (“autoallergen”), released during mechanical stimulation of the skin, which causes the formation of specific IgE antibodies directed against this antigen. The role of IgG/IgM antibodies is discussed.

DC is usually idiopathic in nature. In other cases, the disease may occur in a transient, short-lived form after taking certain medications, such as penicillin and famotidine, scabies, mastocytosis, dermatomyositis, injuries such as from a coral reef, or insect bites.

DC manifests itself in the form of typical blisters and itching, repeating the trace of an irritating object. Manifestations of the reaction increase within 5–10 minutes after exposure to the stimulus and resolve within 30–60 minutes (Fig. 1). Sometimes the patient may complain of severe itching even in the absence of visible rashes and swelling on the skin. Blisters can be of various shapes: oblong, linear, square, diamond-shaped, etc. Rashes often appear in places of friction, pressure from clothing (for example, underwear), when wearing watches, socks, as well as around the waist and sometimes when swimming in the shower or after drying with a towel. Touching the face, scratching, or rubbing slightly itchy eyelids or lips can lead to dermographic angioedema.

Diagnostics

To confirm the diagnosis, a provocative test is necessary. It is advisable that the patient stop taking antihistamines (AGDs) at least 2-3 days before the study.

To accurately diagnose dermographism, a calibrated instrument is used - a dermographometer. It looks like a pen with a smooth steel tip 0.9 mm in diameter (Fig. 2). The pressure at the tip can be varied by turning the screw on the top of the tool. Scale values ​​from 0 to 15 are equal to corresponding tip pressure values ​​from 20 to 160 g/mm2.

Using a dermatographometer, line irritation of the skin in the upper back is carried out in the form of three parallel lines (up to 10 cm long) with a pressure of 20, 35 and 60 g/mm2, respectively. A positive result for DC will appear at the challenge site within 10 to 15 minutes as a linear, pruritic, wheal-like rash and erythema at a pressure of 36 g/mm2 (353 kPa) or less. An urticarial reaction without pruritus with a provocation of 60 g/mm2 (589 kPa) or more indicates simple dermographism. The result is assessed 10 minutes after testing.

When a dermographometer is not available, the test can be performed using any smooth, blunt object such as a ballpoint pen or wooden spatula (Figure 3). The combination of itching, wheal, and erythema confirms the diagnosis. A new provocative testing device, the FricTest®, has recently been developed. This simple and inexpensive tool can reliably confirm the diagnosis of DC.

Review of modern treatment methods

After establishing the diagnosis, it is necessary to explain to the patient the mechanism of development of the disease, recommend the exclusion of provoking factors, such as mechanical irritation of the skin, and clarify the possibility of reducing the severity of stress and anxiety.

Histamine is the main mediator involved in the development of symptoms of urticaria, so the disease usually responds well to treatment with antihistamines (AHDs), like other forms of urticaria. The goal of treatment is to reduce the severity of itching and rash as much as possible, although even with therapy, minor erythema and itching may persist.

It is advisable to start therapy with standard daily doses of non-sedating 2nd generation antihypertensive drugs (drugs of choice), the use of which in most cases produces a good effect. Schoepke et al. noted an improvement in the course of DC in more than 49% of patients receiving antihypertensive drugs. Drugs can be prescribed for several months if the disease lasts for a long time, or as needed for occasional symptoms. Since itching, as a rule, intensifies at certain times of the day, often in the evening, it can be recommended to take an antihistamine 1 hour before its peak, including 1st generation antihistamines that have a sedative effect, such as hydroxyzine. In more severe cases of the disease, it is possible to use off-label high daily doses of antihypertensive drugs (in this case, the drugs are prescribed at intervals of 12 rather than 24 hours). A combination of two or more antihypertensive agents may be required.

An additional effect may occur when a histamine H2 receptor blocker such as ranitidine, famotidine or cimetidine is added to treatment. However, the effectiveness of such treatment has not been shown in all studies.

Omalizumab, a monoclonal anti-IgE antibody, has been successfully used to treat patients with induced urticaria, including DC, at a dose of 150–300 mg. Many patients reported complete resolution of symptoms within a few days after the first injection. No significant side effects were identified.

There is positive experience with the use of ketotifen. In separate studies, scientists noted the effectiveness of ultraviolet irradiation and PUVA therapy. However, in most patients the improvement was short-lived and DC symptoms returned 2–3 days after stopping phototherapy.

Lawlor et al. did not note a significant improvement in the course of DC when treated with the calcium channel blocker nifedipine.

The effectiveness of anti-leukotriene drugs, cyclosporine and IV immunoglobulin, which are used for other types of urticaria, is still unknown.

Conclusion

Thus, DC can lead to a decrease in quality of life, but is not a life-threatening disease and has a favorable prognosis. The diagnosis of the disease is made based on the clinical picture and the results of provocative tests. In the absence of an obvious cause for DC, it is important to select and continue adequate therapy until spontaneous remission occurs. The drugs of choice are 2nd generation antihypertensive drugs with a possible increase in their dose and/or the appointment of alternative treatment (for example, omalizumab, histamine H2 receptor blockers) in resistant and severe cases. Further research is needed to develop pathogenetically based treatments for DC.

Literature

1. Zuberbier T., Aberer W., Asero R., Bindslev-Jensen C., Brzoza Z., Canonica GW, Church MK, Ensina LF, Gimenez-Arnau A., Godse K., Goncalo M., Grattan C., Hebert J., Hide M., Kaplan A., Kapp A., Abdul Latiff AH, Mathelier-Fusade P., Metz M., Nast A., Saini SS, Sanchez-Borges M., Schmid-Grendelmeier P., Simons FE , Staubach P., Sussman G., Toubi E., Vena GA, Wedi B., Zhu XJ, Maurer M. The EAACI/GA (2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update // Allergy. 2014; 69:868–887.
2. Dontsov R. G., Uryvaev Yu. V. Dermography in healthy people: dependence of the types of reactions of skin vessels on the strength of irritation // Ros. physiol. magazine 2006: 232–237.
3. Taskapan O., Harmanyeri Y. Evaluation of patients with symptomatic dermographism // J Eur Acad Dermatol Venereol. 2006; 20: 58–62.
4. Breathnach SM, Allen R., Ward AM, Greaves MW Symptomatic dermographism: natural history, clinical features laboratory investigations and response to therapy // Clin Exp Dermatol. 1983; 8:463–476.
5. Silpa-archa N., Kulthanan K., Pinkaew S. Physical urticaria: prevalence, type and natural course in a tropical country // J Eur Acad Dermatol Venereol. 2011; 25:1194–1199.
6. Humphreys F., Hunter JA The characteristics of urticaria in 390 patients // Br J Dermatol. 1998; 138:635–668.
7. Kozel MM, Mekkes JR, Bossuyt PM, Bos JD The effectiveness of a history-based diagnostic approach in chronic urticaria and angioedema // Arch Dermatol. 1998; 134:1575–1580.
8. Schoepke N., Mlynek A., Weller K., Church MK, Maurer M. Symptomatic dermographism: an inadequately described disease // J Eur Acad Dermatol Venereol. 2015; 29: 708–712.
9. Zuberbier T., Grattan C., Maurer M. Urticaria and Angioedema // Dordrecht: Springer. 2010: 1 online resource (156 p.).
10. Horiko T., Aoki T. Dermographism (mechanical urticaria) mediated by IgM // Br J Dermatol. 1984; 111:545–550.
11. Grimm V., Mempel M., Ring J., Abeck D. Congenital symptomatic dermographism as the first symptom of mastocytosis // Br J Dermatol. 2000; 143:1109.
12. Rahim KF, Dawe RS Dermatomyositis presenting with symptomatic dermographism and raised troponin T: a case report // J Med Case Rep. 2009; 3: 7319.
13. Kolhir P.V. Urticaria and angioedema. M.: Practical Medicine, 2012.
14. James J., Warin RP Factitious wealing at the site of previous cutaneous response // Br J Dermatol. 1969; 81:882–884.
15. Borzova E., Rutherford A., Konstantinou GN, Leslie KS, Grattan CE Narrowband ultraviolet B phototherapy is beneficial in antihistamine-resistant symptomatic dermographism: a pilot study // J Am Acad Dermatol. 2008; 59: 752–757.
16. Schoepke N., Abajian M., Church MK, Magerl M. Validation of a simplified provocation instrument for diagnosis and threshold testing of symptomatic dermographism // Clin Exp Dermatol. 2015; 40: 399–403.
17. Kolkhir P.V., Kochergin N.G., Kosoukhova O.A. Antihistamines in the treatment of chronic urticaria: a review of the literature // Treating Physician. 2014: 25.
18. Boyle J., Marks P., Gibson JR Acrivastine versus terfenadine in the treatment of symptomatic dermographism - a double-blind, placebo-controlled study // J Int Med Res. 1989; 17 Suppl 2: 9B-13B.
19. Matthews CN, Boss JM, Warin RP, Storari F. The effect of H1 and H2 histamine antagonists on symptomatic dermographism // Br J Dermatol. 1979; 101:57–61.
20. Sharpe GR, Shuster S. In dermographic urticaria H2 receptor antagonists have a small but therapeutically irrelevant additional effect compared with H1 antagonists alone // Br J Dermatol. 1993; 129:575–579.
21. Metz M., Altrichter S., Ardelean E., Kessler B., Krause K., Magerl M., Siebenhaar F., Weller K., Zuberbier T., Maurer M. Anti-immunoglobulin E treatment of patients with recalcitrant physical urticaria // Int Arch Allergy Immunol. 2011; 154: 177–180.
22. Vieira Dos Santos R., Locks Bidese B., Rabello de Souza J., Maurer M. Effects of omalizumab in a patient with three types of chronic urticaria // Br J Dermatol. 2014; 170:469–471.
23. Metz M., Ohanyan T., Church MK, Maurer M. Retreatment with omalizumab results in rapid remission in chronic spontaneous and inducible urticaria // JAMA Dermatol. 2014; 150: 288–290.
24. Cap JP, Schwanitz HJ, Czarnetzki BM Effect of ketotifen in urticaria factitia and urticaria cholinergica in a crossover double-blind trial // Hautarzt. 1985; 36:509–511.
25. Logan RA, O'Brien TJ, Greaves MW The effect of psoralen photochemotherapy (PUVA) on symptomatic dermographism // Clin Exp Dermatol. 1989; 14:25–28.
26. Lawlor F., Ormerod AD, Greaves MW Calcium antagonist in the treatment of symptomatic dermographism. Low-dose and high-dose studies with nifedipine // Dermatologica. 1988; 177:287–291.

O. Yu. Olisova, Doctor of Medical Sciences, Professor N. G. Kochergin, Doctor of Medical Sciences, Professor O. A. Kosoukhova, P. V. Kolhir1, Candidate of Medical Sciences

GBOU VPO First Moscow State Medical University named after. I. M. Sechenova Ministry of Health of the Russian Federation, Moscow

1 Contact information

Complications of urticaria

It is important to know what hives look like and to be able to provide first aid correctly.
This will help prevent the development of severe complications that can lead to death. Often urticaria is accompanied by Quincke's edema, which is also called angioedema. Its development in the larynx area is especially dangerous, as it can compress the trachea and impair breathing.

Another serious complication is anaphylactic shock. This is a life-threatening immediate allergic reaction that occurs when the human body is hypersensitive to a particular allergen. Usually develops upon repeated contact with the allergen and requires immediate medical attention.

Causes of the disease

The causes of urticaria in children are:

• sensitivity to allergens;
• consumption of allergens in food, their inhalation;
• taking certain medications;
• bites of some insects;
• tactile contact with the allergen (urticaria in a child may appear after sleep due to a reaction to the dye in the bedding fabric or washing powder). Source: L.V. Luss Causes and treatment of urticaria in children, swelling in children // Medical Council, 2015, No. 14

Upon contact with an allergen, inflammation occurs, fluid accumulates in the body tissues, and a rash and swelling appear. This reaction of the body is an attempt to reduce the amount of harmful substances.

Chronic urticaria, which can appear as early as one year of age, occurs due to:

• chronic or long-term gastrointestinal diseases;
• chronic inflammation;
• viral infections;
• parasite infestation;
• fungal diseases;
• disturbances in the functioning of the nervous system;
• hereditary predisposition.

The disease can be provoked by overheating or hypothermia of the skin, exposure to UV or water, when combing or injury by elements of clothing, due to severe stress. With such urticaria (it is called “cholinergic”), children do not have an elevated body temperature, and external manifestations quickly disappear (in a few minutes, maximum half an hour). Source: I.I. Balabolkin. Urticaria in children: clinical and pathogenetic variants, diagnosis and treatment // Russian Pediatric Journal, 2022, 20(2)

Diagnosis of urticaria

Before starting treatment, it is important to understand what exactly a person has such a strong allergic reaction to.
Only by removing this provoking factor from your usual life can you not be afraid that the symptoms of urticaria will appear again, and this is possible even after proper therapy. Most often, this type of allergy appears to food. It is possible to determine what exactly caused the rash by a blood test: the level of IgE antibodies to a mixture of food allergens is detected. First of all, you need to diagnose the presence of an allergic reaction to:

• nuts;
• vegetables and legumes;
• citrus fruits and fruits;
• seafood;
• cereal and sesame flour;
• fruits and melons;
• baby formula;
• fish;
• meat;
• mushrooms;
• loose leaf tea;
• goat milk.

In addition to food, allergic manifestations can also occur to other substances that surround us almost everywhere in life:

• mold fungi;
• pollen from early flowering trees;
• pollen of late-flowering trees;
• weed pollen;
• epithelium of domestic animals;
• house dust;
• house dust mite;
• poultry feather.

To identify the exact type of allergen, allergy tests are performed on certain foods.
It often happens that rashes appear due to seasonings and herbs used in cooking: paprika, cumin, cloves, basil, ginger, tarragon, thyme, marjoram, dill, bay leaf, black pepper, vanilla. Some types of fish may also be allergenic: cod, halibut, mackerel, and squid meat. But sometimes an allergic reaction in the form of urticaria develops to such familiar products as:

• cucumber;
• apricot;
• cherry;
• tomato;
• plum;
• grape;
• persimmon;
• carrot;
• beet;
• watermelon.

All tests are carried out only by a specialist laboratory technician. You cannot independently determine the presence of an allergy in the form of urticaria to a particular food product or substance. This can be life-threatening, since it is possible to develop not only Quincke's edema, but also anaphylactic shock.

3. Diagnosis of rashes

Idiopathic urticaria can only be diagnosed by an allergist.

.
To do this, he prescribes a series of examinations, the purpose of which is to identify the connection of skin manifestations with specific factors and causes, the elimination of which could prevent the development or exacerbation of urticaria. The patient undergoes the following tests:

• general clinical blood test;
• biochemistry;
• HIV testing;
• blood for the Wasserman reaction;
• general urine analysis;
• blood and feces to identify parasites and helminths.

An important diagnostic step is a conversation with the patient

, during which the possible dependence of skin rashes on food, chemicals, stress, heredity, and medications taken is clarified.
Sometimes it is recommended to keep a symptomatic diary
, where each exacerbation of urticaria is recorded. In this case, the patient should try to remember any previous factors that could affect the state of the body, and also write them down. Sometimes only such records allow us to trace a certain pattern.

If a significant period of careful observation does not give a clear picture, there are no chronic diseases and exacerbations are unsystematic, then a diagnosis of “idiopathic allergy” is made.

About our clinic Chistye Prudy metro station Medintercom page!

First aid for hives

It is important that you always have allergy medications in your home medicine cabinet, since urticaria in adults, and in children too, can appear at any time.
Allergy medications can be in the form of drops or tablets. Modern remedies do not cause drowsiness and have virtually no side effects. Doctors recommend having in your home medicine cabinet to eliminate urticaria and itching, Fenistil drops, which can be used from childhood, Erius tablets, which have a long-lasting antihistamine effect after administration, Loratadine, which helps cope with Quincke's edema, which often accompanies urticaria.

It is important to take the medicine at the first symptoms, without waiting for the general condition to worsen. If after 20 minutes from the moment of administration there is no improvement, you should call an ambulance.

Treatment of urticaria

The only way to get rid of the disease is to avoid contact with the allergen, which is previously detected by laboratory tests.
If testing does not reveal a provoking factor, and the urticaria is episodic, then taking antihistamines will quickly eliminate the symptoms. During treatment, it is recommended to follow a diet that, in case of urticaria, will help prevent the recurrence of the disease. The menu should include only hypoallergenic products: lean boiled meat, soups with recycled meat broth or vegetarian. It is better to choose rice, buckwheat, and oatmeal from cereals. Low-fat cottage cheese, natural yogurt, apples, dried fruit compote, excluding raisins, and whole grain bread are recommended.

Citrus fruits, nuts, fish and all seafood, chocolate products, smoked meats, coffee, eggs, honey, and store-bought baked goods should be excluded from the menu during treatment.

Treatment is carried out by a dermatologist and an allergist-immunologist. For topical application, ointments for urticaria are effective; they not only relieve itching, but also eliminate swelling, redness and a burning sensation on the skin. One of the most effective is Dimetinden gel, which must be applied in a thin layer to the affected area of ​​the skin up to 4 times a day.

A course of antihistamines is prescribed in the form of tablets. Your doctor may also prescribe calcium gluconate or calcium chloride for urticaria. They help reduce the symptoms of allergies, but they should only be administered under the supervision of a doctor in the treatment room.

If antihistamines do not provide the desired effect quickly, or for severe forms of hives, corticosteroids are used, which can be applied to the skin or taken in the form of tablets or injections.

Types of disease

In medicine, there are five main forms of this disease:

• chronic with periodic exacerbations;
• acute, arising and spreading rapidly;
• allergic (affects 70% of children);
• pseudo-allergic (provoked by disturbances in the functioning of the liver and digestive organs);
• hereditary non-allergic (accompanied by Quincke's edema, similar to allergic). Source: L.P. Sizyakina, A.A. Lebedenko, C.B. Maltsev, A.N. Posevina, L.A. Averkina Urticaria in children: a modern view of the problem // Medical Bulletin of the South of Russia, Reviews, 2015

Let's take a closer look at the types of urticaria, depending on the triggering factor:

1. Medicinal. A type of drug allergy is a reaction to certain drugs. The most common provocateurs are iodides, streptomycin, sedatives, NSAIDs, and drugs containing gold. The rash may be accompanied by a runny nose, conjunctivitis and bronchial asthma. To cure this form of urticaria, you need to eliminate the allergen, adjust the diet, removing the brightest allergens from it - citrus fruits, red vegetables and fruits, nuts, cow's milk, fish.
2. Mechanical – appears when pressure is applied to the skin. Its causes have not been reliably studied, but the disease is associated with skin sensitivity, heredity and the condition of the blood vessels. Divided into several subspecies:
   dermographic – develops quickly due to friction or pressure, often caused by wearing tight clothing;
3. cold - a reaction to contact with something cold, drinks or foods;
4. heat – the rash appears when the environment is hot;
5. solar - occurs during prolonged exposure to the sun, manifested by swelling and red spots on the skin;
6. aquagenic - rare, but very dangerous, appears upon any contact with water;
7. papular - the result of an insect bite;
8. cholinergic - a rash appears when the child is nervous and sweats a lot.
9. Generalized. It differs in that the rash spreads throughout the body, including the mucous membrane of the oropharynx, which makes breathing difficult. Quincke's edema may develop. Such urticaria appears in children with atopic diseases and can be caused by antibiotics and NSAIDs. Rarely are food products allergens.
10. Idiopathic. The cause is unknown, but itchy blisters appear regularly over a period of 6 weeks at varying intervals. The process is considered chronic. Spontaneous occurrence and the lack of diagnostic methods make it difficult to control the course of the disease, treatment and prevention.

How long does it take to cure hives?

Within 4-6 weeks, acute urticaria resolves in almost all patients with this diagnosis.
However, sometimes the acute form can become chronic, and then the disease becomes incurable, with periods of exacerbation and complete remission with the absence of symptoms, which alternate with each other. To deal with this allergic reaction as quickly as possible, it is recommended:

1. Immediately consult a doctor at the clinic or call an ambulance.
2. Follow a hypoallergenic diet for several months.
3. Follow all doctor's orders and recommendations regarding treatment. Do not stop taking allergy medications at the first signs of improvement, but complete the full course.
4. Be sure to have modern antihistamines recommended by an allergist in your home medicine cabinet.

Author:

Pugonina Tatyana Alekseevna, Therapist

Prevention

To avoid the appearance of nettle rash, you should pay attention to:

1. Medicines. If you are in doubt about the presence of an allergy to medications, it is better to conduct a test first.
2. Food and supplements. Watch your diet and, if possible, eliminate or limit as much as possible the consumption of foods that cause an allergic reaction.
3. Pollen. If you are sure that plants are the cause of the rash, then during the flowering period, take antihistamines, wear clothes that cover as much of your body as possible, use masks and invisible respirators that filter the air, filtering out foreign particles.
4. Animal fur. The way out of this situation is to give the animal away. This applies not only to dogs, cats, parrots, but also to fish, whose food can also cause hives.
5. Household chemicals. Pay attention to the composition of the purchased products. Today there is a huge variety of hypoallergenic products: powders, shampoos, creams, soaps, etc. But even when buying children's products, you should carefully study the composition.
6. Dust. Regularly wet clean the room; if possible, remove carpets, books, heavy curtains, and soft toys. Periodically contact a dry cleaner, who will professionally process your items and get rid of dust mites.
7. Worm infestations. After going outside, visiting public places, or having contact with animals, be sure to wash your hands thoroughly with soap. Avoid eating unwashed foods and raw water.
8. Insect bites. Avoid places with wasp nests, beehives, and ant heaps. In warm weather, use insecticides.
9. Synthetic fabrics. When choosing clothes, pay close attention to its quality. Give preference to natural materials (cotton, linen, silk). Check if the clothes are dyed. After purchasing, be sure to wash the items, as chemical treatment is carried out during transportation. Wearing unwashed clothes can even lead to poisoning.
10. Cold allergy. Wear clothes and shoes that are appropriate for the season, and avoid long stays in the cold.
11. Sun. The optimal stay time is 1-2 hours, depending on the person’s phototype. You should also know that from 11.00 to 16.00 in summer, UV rays should be avoided due to increased radioactivity.
12. Alcohol. If a reaction in the form of a rash occurs to some food coloring, then it should be excluded from use. If it is not possible to find out the reason, then it is better to completely limit alcohol.