The diagnosis of urticaria is made by anamnesis and physical examination. Before the laboratory findings, a careful history of the patient should be taken and then an examination is performed.
It should not be forgotten that drug and food allergies may be the underlying causes of urticaria. Food skin tests should definitely be done if patients have complaints especially about food. If foods increase their complaints, it may be important whether they increase when they are removed from the diet and added again.
It should be explained that drugs, especially those in the NSAID group, increase urticaria attacks and precautions should be taken.
Blood tests are requested in patients with urticaria, which can help to diagnose according to the patient’s history. These may include anomalies in the complete blood count and erythrocyte sedimentation rate. In urticaria cases, eosinophilia may guide the detection of parasitic infection or atopic condition.
Since there may be many diseases other than allergies among the causes of urticaria, these reasons should be revealed. ANA, thyroid peroxidase antibodies, complement profiles, hepatitis markers, and serum protein electrophoresis should be studied in urticaria whose cause is not determined except allergy.
Some specific diseases can only occur with angioedema. The C4 level is low in the disease we call hereditary angioedema. If it is necessary to look at the C4 level of the patient, it will be useful to measure the C1 inhibitor level and function.
Is Allergy Skin Test Necessary to Diagnosis of Urticaria?
Although there are many causes of urticaria, allergic diseases take an extremely important place for the causes of urticaria. It should be kept in mind that food drug and respiratory allergens may cause urticaria.
In patients suspected of urticaria by allergists, skin allergy test and / or blood allergy test may be required to determine the cause. If food allergy is considered among the causes of urticaria, an allergic food can be detected with a skin prick test. A treatment method is followed according to the detection of food allergy.
After the food has been identified, it is recommended that you remove the food and all foods containing that nutrient from the diet list.
Urticaria can sometimes multiply during pollen seasons. Especially in people with pollen allergy, urticarial rashes occur when patients eat fruit or vegetables because there is a cross reaction between pollens in fruits and vegetables. In this picture we call oral allergy syndrome, although the main cause is pollen allergy, cross-reacting fruit complaints occur. Therefore, it is necessary to perform skin tests in patients with urticaria to determine whether they have pollen allergy.
If the skin tests of the patients cannot be performed, sometimes they can be tested on blood tests to find food or other allergens to which they are allergic, but blood tests are less sensitive than skin tests.
Since urticaria complaints may develop later in patients with allergic rhinitis and asthma, determining the respiratory allergens of patients is important for both allergic rhinitis and asthma and urticaria.
How to Treat Urticaria?
After the diagnosis of urticaria, it is important to differentiate between acute urticaria and chronic urticaria. If the causes of acute or chronic urticaria can be detected, it is easier to organize the treatment.
In acute urticaria, sometimes the complaints are severe once and may not recur afterwards. Patients may not need medication. In particular, chronic urticaria lasting more than 6 weeks requires medication depending on the intensity of the complaints.
Urticaria treatment; If there is a certain disease before treatment, it is treated. Allergic urticaria angioedema completely resolves in a short time if contact with the allergen is stopped. If we can find the cause as a result of the examinations for the diagnosis of urticaria, it is very important to avoid the allergenic food or allergen. Until the results of the tests performed to determine the cause of chronic urticaria or acute urticaria, drug therapy may be recommended for the patient’s complaints. If we cannot determine the cause of urticaria, that is, idiopathic urticaria, drug treatment is required.
The first drugs used in the treatment of urticaria are antihistamine drugs. Normal doses of antihistamine drugs may not usually be sufficient. For this reason, higher doses of antihistamine drugs can be given or their combinations can be used to suppress the patient’s complaints. Unfortunately, the most important problem with antihistamine drugs is that they cause side effects such as sleepiness, distraction, concentration impairment and increased appetite. In another problem, its effectiveness disappears after a while and becomes ineffective. Therefore, even if patients use the drugs for a long time, they cannot see the same effect.
Corticosteroids are other drugs that are effective in urticaria. Unfortunately, long-term use causes serious side effects. Corticosteroids are sufficient to control complaints especially in acute urticaria. Cortisone treatment can be applied for a short time in patients with intense urticaria complaints. Long-term cortisone treatment is not recommended, as it will bring side effects.
Patients who experience life-threatening angioedema and anaphylaxis attacks respond to adrenaline (epinephrine).
Many drugs have been used for the treatment of chronic urticaria, some of which have immunosuppressive properties. Immunosuppressive drugs such as cyclosproine have been treated with effective results, but due to the problems that may arise when we suppress the immune system, it should be used very carefully.
H2 receptor antagonists are used as stomach drugs that suppress histamine receptors in other adjunct drugs in patients with urticaria. The patient’s use of medications such as ranitidine and famotidine together with antihistamines may reduce the complaints of urticaria.
Are There New Drugs In The Treatment Of Urticaria?
Acute urticaria response to allergy medications is fine and may disappear without even being needed. Since chronic urticaria affects the life comfort of patients so much, it is applied singly or in combination with various drugs.
Chronic urticaria pose serious problems for patients. It can create problems that are so annoying that some patients can cause serious depression. Newly developed drugs in the treatment of urticaria have been extremely effective in eliminating these problems.
Oma, on the other hand, is a new drug treatment that has been used recently. Anti-IgE treatment completely removes the symptoms of the disease in the majority of chronic urticaria patients. Oma is a drug that prevents the effect of IgE antibody, which plays a role in the formation of allergic diseases. Oma started to be used in the treatment of chronic idiopathic urticaria at the age of 12 years and over whose symptoms could not be adequately controlled with these drugs, although still taking antihistamines or corticosteroids. It is used as a subcutaneous injection every 4 weeks. It is applied under the control of allergists. Although the duration of treatment is variable, it is 3 months, especially in chronic urticaria. In case of need, it can be used safely for longer periods, depending on the patient’s control of his complaints.
With Oma, urticaria is now treated more easily, and the quality of life of patients is greatly increased with the treatment that patients receive once a month. Many restrictions in their lives disappear over time.
No antihistamines or other drugs are required after Oma treatment. In this way, the quality of life for the patient increases without the side effects of other drugs.
There are many studies showing the effectiveness of oma in urticaria caused by physical stimuli such as pressure, heat, cold, sunlight. With its effectiveness in chronic inducible urticaria, it provides a comfortable life without complaints.
In the near future, patients will be treated more rapidly with anti-inflammatory and immunomodulatory agents. 5-Lipoxygenase inhibitors, PG-D receptor antagonists produced for the treatment of allergic diseases are expected to be effective in chronic urticaria.
There are innovations every day in the diagnosis and diagnosis of urticaria and new hopes are emerging for its treatment. After the causes of urticaria are investigated by allergists, they can be treated.
As a result :
Urticaria is the most common skin reaction that usually disappears within 24-48 hours without leaving a scar on the skin.
If skin rashes due to urticaria last less than 6 weeks, it is defined as acute urticaria. If these urticarial skin rashes last longer than 6 weeks, it is defined as chronic urticaria.
The most important causes of acute urticaria are drugs, foods and infections.
Finding the causes of chronic urticaria can be more difficult. Except for the causes of acute urticaria in chronic urticaria, it may predispose to urticarial eruptions in many non-allergic diseases.
Patients’ own observations and history can be extremely important when investigating the causes of urticaria.
It should not be forgotten that drug and food allergies may be one of the underlying causes of urticaria. Food skin tests should definitely be done if patients have complaints especially about food.
In the treatment of urticaria, if there is a disease lying on the ground, it is treated. Drugs required in the treatment of urticaria should be regulated by allergists.
Oma is a new drug treatment that has been used recently. Anti-IgE treatment completely removes the symptoms of the disease in the majority of chronic urticaria patients.
Allergy Specialists (now called Immunology and Allergy Diseases Specialist) are doctors who have received special training in asthma and allergic diseases seen in those older than 18 years of age, and have received an Immunology and Allergy Specialist diploma and are also Internal Diseases or Chest Diseases or Dermatology Specialists.