Overview
Causes
- IgE-mediated mast cell activation may be caused by the following:
- Drugs such as penicillins, cephalosporins, sulfa drugs, salicylates, NSAIDs, barbiturates, amphetamines, atropine, hydralazine, insulin, blood, and blood products
- Foods such as tree nuts, peanuts, eggs, shellfish, and tomatoes (The involvement of food additives or preservatives is controversial.)
- Insect venom
- Latex protein exposure
- Non–IgE-mediated mast cell activation may be caused by the following:
- Drugs such as morphine and other opiates, meperidine, polymyxin B, and acetylsalicylic acid can cause release of mediators by other mechanisms.
- Certain foods or beverages, such as aged cheeses or red wine, can contain histidine, which is similar to histamine. However, the evidence in the medical literature that they cause urticaria is rare.
- Radiocontrast media can directly induce mast cell mediator release.
- Medical conditions implicated by unknown pathogenesis include the following:
- Infectious agents such as group A beta-hemolytic streptococci; Epstein-Barr virus; hepatitis A, B, and C; adenovirus; and herpes simplex virus have been implicated. Other infectious processes such as chronic sinusitis, cutaneous fungal infections, and chronic gastroenteritis by enterovirus, H pylori, or other parasites have also been implicated.
- Hormonal causes via endocrine tumors or ovarian pathology are rare. Thyroid dysfunction (hypothyroidism and hyperthyroidism) is more common. Patients with chronic urticaria can have positive anti-thyroid antibodies in euthyroid condition.
- Physical causes (physical urticaria) can be numerous and include cold, pressure, vibration, sunlight, water, dermographism, and exercise.
- Cholinergic urticaria is a subset of physical urticaria. It can be triggered by heat, exercise, or emotional stress and is thought to be mediated by acetylcholine.
- Neuropeptides and neurokinins are thought to mediate development of urticaria in stress or physical urticaria.
Treatment
- Avoidance of specific drug, food, or activity
- If there is a severe reaction or angioedema of the airway, may use epinephrine(1:1000) The dose is 0.01ml/kg.with maximum of 0.3ml.
- Antihistamines- Atarax, Benadryl,Tavist, Claritin
- In rare instances, systemic steroids may be useful.
- Compassion and reassurance
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