Hives are manifested by an eruption of pimples on the skin. After 6 consecutive weeks of urticaria, it is called chronic. What are the treatments ?
Urticaria is chronic when onset of symptoms occurs every 2-3 days or when they have been present for more than 6 consecutive weeks. Skin symptoms are the same as in acute urticaria. Many factors (food, stress, sun, medication…) can be the cause of chronic urticaria. How to diagnose chronic urticaria? How relieve an attack of urticaria?
Definition: what is chronic urticaria?
There are two forms of urticaria:
► Urticaria acute which often occurs in isolation, evolving for a few hours or even a few days and whose cause is most often allergic (food, drugs, insect bites, etc.).
► Chronic urticaria which is defined byappearance of papules repeatedly, every 2-3 daysor permanent for more than 6 consecutive weeks. Contrary to popular belief, in 90% of cases, chronic urticaria is not of allergic origin, with some exceptions, but linked to “immediate” hypersensitivity reactions. They are triggered by a non-specific mast cell stimulation, cells present in the dermis. Chronic urticaria presents in the same form as acute urticaria, with small raised red patches which appear over several flare-ups alternating with periods without any symptoms. These plaques are very itchy. They occur quite suddenly, and disappear just as suddenly.
Causes: why do I have chronic urticaria?
Many causes are possible: cold, pressure exerted on the skin, exertion, contact with water or the sun, a parasitosis, rubbing of clothing on the skin orwearing clothes that are too tighttaking some medications as well as a hepatic pathology or related to the thyroid. “Some food or drink such as strawberries, shellfish, chocolate, cheese or fermented products, alcohol, coffee and tea can also cause these reactions, as well as the stress”says Dr. Nina Roos, dermatologist.
What drugs can cause chronic urticaria?
Certain medications can cause an attack of chronic hives or make it worse. “Among them, analgesics, anti-inflammatories such as aspirin, morphine and its derivatives like codeineas well as antibioticsespecially those of the penicillin and beta-lactam family”, says Dr. Roos. Also involved is theiodinated contrast products used during radiological imaging, H1 antihistamines, and some topically applied drugs such asare anti-acne or muscle relaxants. Be careful with NSAID treatments or corticosteroids: the use of a single drug is recommended but when several drugs are essential, the lowest possible dosages should be considered, the doses divided and the drugs introduced by staggering them. Speak to your attending physician.
► Taking a risk drug as a beta-lactam antibiotic or penicillin is often associated with other risk factors such as the combination of an antibiotic and an NSAID, great fatigue, a major episode of stress, trauma, infection, and fever high or a heat spike. On the other hand, any surgical or dental proceduremay be a risk factor due to the administration in times of stress of several anesthetic, analgesic and antibiotic treatments.
What are the symptoms of chronic urticaria?
Chronic urticaria is characterized by rash with red bumps and patches of varying sizes and shapes. The plates are a little raised and itchy a lot. They can be located anywhere on the body and face.
“Because of its characteristics, questioning the patient is sufficient to make the diagnosis“, says our expert. Additional tests, such as skin tests, identify the allergen causing flare-ups.
“He associates avoidance of the responsible phenomenon from the push to the daily intake of one or more antihistamines, and this for several monthssays Dr. Roos. When a drug appears to have caused an attack of urticaria, it is sometimes necessary to carry out skin tests, especially in the case of antibiotics. Go to a dermatologist or an allergist familiar with this practice and then plan a reintroduction of the drug in question if these tests are negative.
Several tracks:
► Avoid the trigger as much as possible.
► Avoid medications containing aspirin and NSAIDs.
► Watch out for showers and baths too hot.
► Tame your stress through the practice of a physical or meditative activity.
► Follow your treatment until the end, even if you notice an improvement.
► Avoid covering yourself too much and overheating your home, in order to limit perspiration.
Who to consult in case of chronic urticaria?
Dermatologists and allergists are the professionals most familiar with this pathology. Even if the allergic origin of chronic urticaria is quickly eliminated. 40% of these urticaria evolve beyond a year, 30% beyond 2 years and almost 20% over 10 years.
The impact of chronic urticaria on quality of life
A study carried out in England assessed the impact of chronic urticaria on quality of life: 73% of patients avoid going out, almost 50% have difficulties in their daily life and professional (absenteeism, reduced performance, etc.). On the other hand 63% of patients are worried and stressed by their hives and 38% have sleep disorders.
Thanks to Dr Nina Roos, dermatologist in Paris.