It is often confused with an allergy: understanding and managing chronic urticaria

It is often confused with an allergy: understanding and managing chronic urticaria
It is often confused with an allergy: understanding and managing chronic urticaria

Do you have red, swollen patches on your skin, often accompanied by intense itching? They tend to disappear then come back and preferably at night… Like 1% of the population, you may suffer from chronic spontaneous urticaria (CSU). (Too) often labeled “allergy”, this benign pathology actually corresponds to chronic skin inflammation whose origin is still poorly understood. Definition, symptoms, treatment… We take stock with Dr Véronique Lustgarten-Grillot, allergist in Nice.

What is chronic spontaneous urticaria?

It is a chronic inflammatory dermatosis (more than six weeks) characterized by the occurrence, on a regular basis (at least 2 to 3 times a week, sometimes daily), of superficial urticaria lesions. This urticaria appears in the form of red patches and/or transient swellings, also called angioedema. Hives appear then disappear fleetingly and without a trace.

So it’s not an allergic problem…

It is neither an allergy nor an intolerance. UCS, a locally inflammatory condition of the skin and mucous membranes, is due to the hyperactivity of cells called mast cells which release histamine.

In case of allergy or other pathology, hives are not the only symptom; there are signs apart from swelling of the skin and mucous membranes.

What is the origin of this disorder?

We do not know. This reaction can be favored by a multitude of benign stimuli such as stress, exposure to cold, to the sun, physical exercise, pressure on the skin, an infectious context or the taking of certain medications. Certain foods are also “histamine-releasing” and can encourage the release of histamine and therefore hives. These include, for example, strawberries, kiwis, citrus fruits, certain fish (tuna, mackerel, etc.) or cheeses (gouda, emmental, etc.), certain cold meats, chocolate, coffee, champagne or more wine. However, in a large number of cases, we cannot find the triggering element.

What consequences?

Chronic hives are benign and harmless. It does not expose you to serious manifestations such as anaphylactic shock or asphyxia, even if certain angioedemas can be impressive because they are localized in the tongue or throat.

UCS can, on the other hand, have repercussions on private and/or professional life because it is visible. It can also create anxiety because patients do not always know what they are suffering from. They were often told that it was allergic, the diagnosis of hives often being made after several months of medical wandering.

Who to consult?

You can first see your doctor, then a dermatologist or an allergist if you suspect an allergy. We try to find out if there is a food, drug, environmental or contact cause… If all these causes are ruled out, we then look for an underlying pathology (such as diabetes or a thyroid problem). via a blood test. In 99% of cases, no cause is found.

Are there effective treatments?

To date, there is no treatment that can definitively cure hives – relapses are always possible – but it is possible to relieve the symptoms. Thus, we offer antihistamine treatment which helps control seizures. It is necessary to take them daily and they are generally very well tolerated. On the other hand, the treatment is only effective for the time it is taken. It must therefore often be continued for several months or years.

Contrary to popular belief, cortisone is not recommended at all for chronic urticaria; it even aggravates the disease and makes it resistant to antihistamines.

Should we ban certain foods?

Secondly, in addition to antihistamines, the patient can be advised to limit “histamino-releasing” foods. But no food is prohibited in the context of chronic spontaneous urticaria. Strict diets are sources of anxiety and therefore most often counterproductive.

What if nothing works?

If treatments fail, there are “biotherapies” (drugs that act directly on the patients’ immune system) which complement antihistamines. But these situations are rare; in the vast majority of cases, first-line treatment is sufficient.

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