Urticaria (hives) and Angioedema (swelling) Bruce Sweet M.D. 2003

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ TOP

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ LAYERS

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ OF

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ SKIN

THE TISSUE UNDER SKIN (cells,nerves,blood vessels,etc.)

MAST CELL >>>>>>>>> * HISTAMINE RECEPTOR

- contains preformed chemicals - histamine attachment causes

- can release these chemicals hives, swelling, itching

(histamine & others) into tissues - antihistamines must block this

- if the mast cell is close to the skin receptor to control itch & swell

surface >>> hives “ welts” - antihistamines must get there first

- if the mast cell is in deep tissue away and stay longer to be effective

from surface >>> edema “swelling”

We cannot control the mast cell, but we can control

the effects of some of the released chemicals

WHAT MAKES THE MAST CELL UNSTABLE (LEAKY - release it's chemicals) ??

ALLERGIES-- drugs, foods, contact, etc. ; lasts hours-rarely a few days

PHYSICAL triggers -- heat , cold , pressure ; lasts years-often lifelong

CHRONIC IDIOPATHIC -- the immune system makes the mast cell leaky, very common, comes and goes, no consistent trigger, not serious ; lasts 6 weeks-years, often eventually goes but can return

INFECTIONS -- viral, strep. (lasts days) ; h.pylori or parasitic (lasts weeks ++)

EXERCISE -- exercise is the only trigger +/- specific food eaten prior to exercise

DRUGS -- that directly affect the mast cell through non-allergic mechanisms

- ASA, Ibuprofen (Advil TM,Motrin TM), plus other NSAIs (anti-inflammatory anti-arthritic)

- X-ray contrast dyes, opiates (morphine,demerol,codeine)

- ACE inhibitors (captopril,enalapril,ramipril, etc.) for heart & blood pressure

and ( Beta Blockers (atenolol, propanolol, pindolol, metoprolol,etc.) should be avoided in

individuals with recurrent hives(urticaria) or swelling(angioedema) )

MASTOCYTOSIS -- (urticaria pigmentosa) - rare, increased mast cells in the body

CHRONIC DISEASES -- rare, certain autoimmune diseases and cancers, weight loss, unwell

DERMATOGRAPHISM -- very common, scratching the skin causes a welt to appear exactly where scratched, more likely to develop chronic idiopathic urticaria

REMEMBER - if you are experiencing hives for ANY REASON, HEATING the skin up (hot shower-bath, exercise, comforter in bed) and SCRATCHING will make the mast cell leak more, AND always makes the itching WORSE!!!