How seldom does it burn spontaneously

When the skin burns like fire

Pharmacists can also make an important contribution to providing information about the clinical picture. "A large number of those affected only go to the pharmacy and not to the doctor," says Staubach. It is a disease of all ages and can affect anyone. One in four will suffer from urticaria at some point in their life. In spontaneous urticaria, the most common subtype, the wheals develop spontaneously. In the case of inducible urticaria, the trigger factors are often known, such as cold, pressure or temperature increases in the core of the body.

The disease is easy to recognize: Characteristic are the severely itchy wheals, as they also arise after contact with nettles (urtica), from which the disease gets its name. Sometimes angioedema can also occur, for example on the eyelids or lips. Both symptoms are due to the degranulation of mast cells in the skin. In response to a stimulus, these inflammatory cells release various pro-inflammatory mediators, primarily histamine. The latter causes the blood vessels to widen, the walls of which become more permeable. This allows limited water retention in the skin. If this process takes place in the upper layers of the skin, wheals develop, and angioedema in deeper layers. In addition, the messenger substances released can attach to nerve endings and induce itching there.

Penicillin wrongly suspected

The stimuli that lead to mast cell degranulation are diverse. In addition to immunological mechanisms, these can be complement activation, cytokines, neural influences as well as direct hinstamine liberators or physical stimuli. "The most common cause of urticaria is infections," explains Staubach. "Even those that do not cause symptoms, for example Helicobacter pylori infections." Urticaria can also be traced back to ENT infections, inflamed teeth or gastrointestinal infections. When looking for the cause, the antibiotic is often wrongly suspected and the actual trigger, the infection itself, is overlooked. In principle, any drug can cause hives, but antibiotics rarely do this, but non-steroidal anti-inflammatory drugs such as diclofenac are much more common.

Autoimmune reactions and intolerances, for example to dyes or preservatives in food or a diet rich in histamine, can also trigger the formation of wheals. Mental stress has been discussed as a trigger for urticaria, but studies have not proven a connection, reports the doctor. The cause is probably not an option, but it could worsen an existing disease. Possible allergic reactions should also be considered in acute cases, but are much less common than often assumed.

As a rule, the symptoms subside on their own after a few days. Therefore, the acute form of urticaria is only treated symptomatically. According to Staubach, second generation antihistamines should be used here. If at all, cortisone should only be used as shock therapy, i.e. in high doses for no longer than a week. In the acute form, a time-consuming search for the cause and extensive diagnostics are not necessary.

Low quality of life

If the symptoms last longer than six weeks, it is called a chronic form. A doctor must be consulted here. The wheals appear continuously or in bursts. In the long run, the associated itching and disfigurement can severely impair the quality of life. "We know from studies that the quality of life of patients with chronic urticaria corresponds to that of people with severe heart disease," reports Staubach.

Here, too, second-generation antihistamines are used, often in high doses of up to four times the recommended daily dose. It is also important to determine the cause in order to avoid it or, if possible, eliminate it. For example, if the urticaria is caused by an infection, antibiotic therapy is often enough to make the hives disappear as well. If you are intolerant to food additives, you should avoid them. Since the beginning of March 2014, a new treatment option has been available for all patients who continue to have symptoms despite high-dose antihistamines. The anti-IgE preparation omalizumab, which has been used in asthma therapy for almost ten years, has now also been approved for chronic, spontaneous therapy-resistant urticaria.

Overall, the chronic form of urticaria also has a good prognosis, even if the trigger cannot be identified. It usually heals on its own at some point, even without therapy. "Urticaria comes spontaneously and it goes spontaneously," says Staubach. »That gives us courage.« /