1.4 Course

Urticaria typically involves the greatly changing appearance of the skin which many patients describe as follows time and again: “In the evening my skin is completely normal, next morning it looks like a piece of crumble, the itchiness is hardly bearable and by the time I finally get to the doctor in the late morning, it has disappeared”. Wheals usually appear daily, may, however, also appear less frequently with symptom-free intervals. During a bout wheals can most frequently be detected, however also flares and deep skin swellings (angioedema) are not uncommon. 50 % of the patients with urticaria get both wheals and angioedema. About 40 % of the patients with urticaria only experience wheals, less than 10 % only angioedema. It is not known yet why urticaria frequently lasts longer and takes a more severe course in patients who also have angioedema.

Illustration 5: Occasionally wheals can burn or be painful. (Source: Allergy Centre Charité)

The worst for urticaria patients is the often unbearable itchiness that is experienced as a torture. When we think about being touched at just one spot or are stung by a mosquito, we can think of nothing else but the itchiness in such connection it is understandable that patients suffering from this itchiness for days, months and years all over the body, almost “go mad” and have lost their quality of life. In addition, the human body has difficulty to adapt to itchiness – contrary to other stimulants such as, for instance heat or pressure. The itchiness in the case of hives by the way calls for a rub (unlike to the itchiness associated, for example, with neurodermatitis). i.e. skin scratched by fingernails is rarely found. On the contrary, it is often reported that the itchy spots of the skin have to be “rubbed” with the fingertips for a long time. The affected spots are frequently perceived as hot, after the episode dies down – as dry. Sometimes patients also speak of the skin burning, or downright pain in case of angioedema in the affected skin (Ill. 5).

Many patients complain of headaches or joint pain during an episode of urticaria. The first thing to be determined is whether the wheals, itchiness and swelling are the result of pain treatment and whether they were triggered by the ingestion of acetylsalicylic acid (ASS, e.g. in Aspirin®), or other chemically related drugs (e.g. Diclofenac, Ibuprofen) – many drugs are known to induce urticaria or to trigger urticaria (see Section “Acute spontaneous urticaria”). Patients suffering from urticaria should take another pain killer, e.g. Paracetamol instead of acetylsalicylic acid, Diclofenac or Ibuprofen. However, pain may also indicate an infection. It is known that chronic infections, i.e. those that persist of a longer period in the body and which do not directly show symptoms, may support urticaria. Headaches and joint pains, may, however trigger symptoms of urticaria, possibly due to the release of high quantities of histamine and other substances.

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