Papular urticaria is a very common reaction to insect bites. It is more commonly seen in youngsters than in grown-ups. Spots with itchy red bumps of 0.2 to 2 cm in width may appear every few days during the summer or autumn months. In some cases, each spot builds up a blister that usually contains liquid.
Despite the fact that the general frequency rate is unknown, papular urticaria has a tendency to occur during spring and summer months. Common symptoms of urticaria can differ from person to person, and as a rule, they tend to create blood red, raised spots on the pores and skin. It creates a bothersome skin sensitivity that may include tiny bumps. Here are a few ways through which you can treat the disease:
Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. They may also burn or sting. Often the patches of rash move around. Typically they last a few days and do not leave any long-lasting skin changes. Fewer than 5% of cases last for more than six weeks. the condition frequently recurs.
Hives frequently occur following an infection or as a result of an allergic reaction such as to medication, insect bites, or food. Psychological stress, cold temperature, or vibration may also be a trigger. In half of cases the cause remains unknown. risk factors include having conditions such as hay fever or asthma.diagnosis is typically based on the appearance. Patch testing may be useful to determine the allergy
Prevention is by avoiding whatever it is that causes the condition. treatment is typically with antihistamines such as diphenhydramine and ranitidine. in severe cases, corticosteroids or leukotriene inhibitors may also be used. keeping the environmental temperature cool is also useful. for cases that last more than six weeks immunosuppressants such as ciclosporin may be used.
About 20% of people are affected. cases of short duration occur equally in males and females while cases of long duration are more common in females. cases of short duration are more common among children while cases of long duration are more common among those who are middle aged. hives have been described at least since the time of hippocrates. the term urticaria is from the latin urtica meaning" nettle.
Sign n symptoms
Welts (raised areas surrounded by a red base) from hives can appear anywhere on the surface of the skin. Whether the trigger is allergic or not, a complex release of inflammatory mediators, including histamine from cutaneous mast cells, results in fluid leakage from superficial blood vessels. Welts may be pinpoint in size, or several inches in diameter.
Angioedema is a related condition (also from allergic and nonallergic causes), though fluid leakage is from much deeper blood vessels in the subcutaneous or submucosal layers. Individual hives that are painful, last more than 24 hours, or leave a bruise as they heal are more likely to be a more serious condition called urticarial vasculitis. Hives caused by stroking the skin (often linear in appearance) are due to a benign condition called dermatographic urticaria.
Hives can also be classified by the purported causative agent. Many different substances in the environment may cause hives, including medications, food and physical agents. In perhaps more than 50% of people with chronic hives of unknown cause, it is due to an autoimmune reaction.
Medications- Drugs that have caused allergic reactions evidenced as hives include codeine, sulphate of morphia, dextroamphetamine, aspirin, ibuprofen, penicillin, clotrimazole, trichazole, sulfonamides, anticonvulsants, cefaclor, piracetam, vaccines, and antidiabetic drugs. The antidiabetic sulphonylurea glimepiride, in particular, has been documented to induce allergic reactions manifesting as hives. Drug-induced hives has been known to have an effect on severe cardiorespiratory failure.[medical citation needed]
Food- The most common food allergies in adults are shellfish and nuts. The most common food allergies in children are shellfish, nuts, eggs, wheat, and soy. One study showed balsam of peru, which is in many processed foods, to be the most common cause of immediate contact urticaria. A less common cause is exposure to certain bacteria, such as streptococcus species or possibly helicobacter pylori. Infection or environmental agent
Hives including chronic spontaneous hives can be a complication and symptom of a parasitic infection, such as blastocystosis and strongyloidiasis among others.The rash that develops from poison ivy, poison oak, and poison sumac contact is commonly mistaken for urticaria. This rash is caused by contact with urushiol and results in a form of contact dermatitis called urushiol-induced contact dermatitis. Urushiol is spread by contact, but can be washed off with a strong grease- or oil-dissolving detergent and cool water and rubbing ointments.
Dermatographic urticaria (also known as dermatographism or" skin writing") is marked by the appearance of weals or welts on the skin as a result of scratching or firm stroking of the skin. Seen in 4–5% of the population, it is one of the most common types of urticaria, in which the skin becomes raised and inflamed when stroked, scratched, rubbed, and sometimes even slapped.
The skin reaction usually becomes evident soon after the scratching, and disappears within 30 minutes. Dermatographism is the most common form of a subset of chronic hives, acknowledged as" physical hives.
It stands in contrast to the linear reddening that does not itch seen in healthy people who are scratched. In most cases, the cause is unknown, although it may be preceded by a viral infection, antibiotic therapy, or emotional upset. Dermographism is diagnosed by taking a tongue blade and drawing it over the skin of the arm or back. The hives should develop within a few minutes. Unless the skin is highly sensitive and reacts continually, treatment is not needed. Taking antihistamines can reduce the response in cases that are annoying to the patient.
Pressure or delayed pressure
This type of hives can occur right away, precisely after a pressure stimulus or as a deferred response to sustained pressure being enforced to the skin. In the deferred form, the hives only appear after about six hours from the initial application of pressure to the skin. Under normal circumstances, these hives are not the same as those witnessed with most urticariae. Instead, the protrusion in the affected areas is typically more spread out. The hives may last from eight hours to three days. The source of the pressure on the skin can happen from tight fitted clothing, belts, clothing with tough straps, walking, leaning against an object, standing, sitting on a hard surface, etc. The areas of the body most commonly affected are the hands, feet, trunk, abdomen, buttocks, legs and face. Although this appears to be very similar to dermatographism, the cardinal difference is that the swelled skin areas do not become visible quickly and tend to last much longer. This form of the skin disease is, however, rare.
Cholinergic or stress
Main article: cholinergic urticaria
Cholinergic urticaria (cu) is one of the physical urticaria which is provoked during sweating events such as exercise, bathing, staying in a heated environment, or emotional stress. The hives produced are typically smaller than classic hives and are generally shorter-lasting.
Multiple subtypes have been elucidated, each of which require distinct treatment.
Further information: chronic cold urticaria
The cold type of urticaria is caused by exposure of the skin to extreme cold, damp and windy conditions; it occurs in two forms. The rare form is hereditary and becomes evident as hives all over the body 9 to 18 hours after cold exposure. The common form of cold urticaria demonstrates itself with the rapid onset of hives on the face, neck, or hands after exposure to cold. Cold urticaria is common and lasts for an average of five to six years. The population most affected is young adults, between 18 and 25 years old. Many people with the condition also suffer from dermographism and cholinergic hives.
Severe reactions can be seen with exposure to cold water; swimming in cold water is the most common cause of a severe reaction. This can cause a massive discharge of histamine, resulting in low blood pressure, fainting, shock and even loss of life. Cold urticaria is diagnosed by dabbing an ice cube against the skin of the forearm for 1 to 5 minutes. A distinct hive should develop if a patient suffers cold urticaria. This is different from the normal redness that can be seen in people without cold urticaria. Patients with cold urticaria need to learn to protect themselves from a hasty drop in body temperature. Regular antihistamines are not generally efficacious. One particular antihistamine, cyproheptadine (periactin), has been found to be useful. The tricyclic antidepressant doxepin has also been found to be an effective blocking agent of histamine discharge. Finally, a medication named ketotifen, which keeps mast cells from discharging histamine, has also been employed with widespread success.Solar urticaria
This form of the disease occurs on areas of the skin exposed to the sun; the condition becomes evident within minutes of exposure.
This type of urticaria is also termed rare, and occurs upon contact with water. The response is not temperature-dependent and the skin appears similar to cholinergic form of the disease. The appearance of hives is within one to 15 minutes of contact with the water, and can last from 10 minutes to two hours. This kind of hives do not seem to be stimulated by histamine discharge like the other physical hives. Most researchers believe this condition is actually skin sensitivity to additives in the water, such as chlorine. Water urticaria is diagnosed by dabbing tap water and distilled water to the skin and observing the gradual response. Aquagenic urticaria is treated with capsaicin (zostrix) administered to the chafed skin. This is the same treatment used for shingles. Antihistamines are of questionable benefit in this instance, since histamine is not the causative factor.
Chizzola maculae is a very specific skin lesion due to fluoride exposure. The size of a coin, these lesions may resemble small blue bruises or be wholly pink. Doctors george waldbott and v. A. Cecilioni named the lesions after a town in italy, where they were common in young women and children. According to waldbott, chizzola maculae are early symptoms of fluoride intoxication.
The condition was first distinguished in 1980. People with exercise urticaria (eu) experience hives, itchiness, shortness of breath and low blood pressure five to 30 minutes after beginning exercise. These symptoms can progress to shock and even sudden death. Jogging is the most common exercise to cause eu, but it is not induced by a hot shower, fever, or with fretfulness. This differentiates eu from cholinergic urticaria.
Eu sometimes occurs only when someone exercises within 30 minutes of eating particular foods, such as wheat or shellfish. For these individuals, exercising alone or eating the injuring food without exercising produces no symptoms. Eu can be diagnosed by having the patient exercise and then observing the symptoms. This method must be used with caution and only with the appropriate resuscitative measures at hand. Eu can be differentiated from cholinergic urticaria by the hot water immersion test. In this test, the patient is immersed in water at 43 °c (109.4 °f). Someone with eu will not develop hives, while a person with cholinergic urticaria will develop the characteristic small hives, especially on the neck and chest.
The immediate symptoms of this type are treated with antihistamines, epinephrine and airway support. Taking antihistamines prior to exercise may be effective. Ketotifen is acknowledged to stabilise mast cells and prevent histamine release, and has been effective in treating this hives disorder. Avoiding exercise or foods that cause the mentioned symptoms is very important. In particular circumstances, tolerance can be brought on by regular exercise, but this must be under medical supervision
The cause of chronic hives can rarely be determined. In some cases regular extensive allergy testing over a long period of time is requested in hopes of getting new insight. No evidence shows regular allergy testing results in identification of a problem or relief for people with chronic hives. regular allergy testing for people with chronic hives is not recommended.
Acute versus chronic
Acute urticaria is defined as the presence of evanescent wheals which completely resolve within six weeks. Acute urticaria becomes evident a few minutes after the person has been exposed to an allergen. The outbreak may last several weeks, but usually the hives are gone in six weeks. Typically, the hives are a reaction to food, but in about half the cases, the trigger is unknown. Common foods may be the cause, as well as bee or wasp stings, or skin contact with certain fragrances. Acute viral infection is another common cause of acute urticaria (viral exanthem). Less common causes of hives include friction, pressure, temperature extremes, exercise, and sunlight.
Chronic urticaria (ordinary urticaria) is defined as the presence of evanescent wheals which persist for greater than six weeks. Some of the more severe chronic cases have lasted more than 20 years. A survey indicated chronic urticaria lasted a year or more in more than 50% of sufferers and 20 years or more in 20% of them.
Acute and chronic hives are visually indistinguishable.
Govt bans 344 drugs, including phensedyl, corex
Sr. No. Product name (irrational fdc)
1 aceclofenac + paracetamol + rabeprazole
2 nimesulide + diclofenac
3 nimesulide + cetirizine + caffeine
4 nimesulide + tizanidine
5 paracetamol + cetirizine + caffeine
6 diclofenac + tramadol + chlorzoxazone
7 dicyclomine + paracetamol + domperidone
8 nimesulide + paracetamol
9 paracetamol + phenylephrine + caffeine
10 diclofenac+ tramadol + paracetamol
11 diclofenac + paracetamol + chlorzoxazone + famotidine
12 naproxen + paracetamol
13 nimesulide + serratiopeptidase
14 paracetamol + diclofenac + famotidine
15 nimesulide + pifofenone + fenpiverinium + benzyl alcohol
16 omeprazole + paracetamol + diclofenac
17 nimesulide + paracetamol injection
18 tamsulosin + diclofenac
19 paracetamol + phenylephrine + chlorpheniramine + dextromethorphan + caffeine
20 diclofenac + zinc carnosine
21 diclofenac + paracetamol + chlorpheniramine maleate + magnesium trisillicate
22 paracetamol + pseudoephedrine + cetrizine
23 phenylbutazone + sodium salicylate
24 lornoxicam + paracetamol + trypsin
25 paracetamol + mefenamic acid + ranitidine + dicylomine
26 nimesulide + dicyclomine
27 heparin + diclofenac
28 glucosamine + methyl sulfonyl methane + vitamini d3 + maganese + boron + copper + zinc
29 paracetamol + tapentadol
30 tranexamic acid + proanthocyanidin
31 benzoxonium chloride + lidocaine
32 lornoxicam + paracetamol + tramadol
33 lornoxicam + paracetamol + serratiopeptidase
34 diclofenac + paracetamol + magnesium trisilicate
35 paracetamol + domperidone + caffeine
36 ammonium chloride + sodium citrate + chlorpheniramine maleate + menthol
37 paracetamol + prochlorperazine maleate
38 serratiopeptidase (enteric coated 20000 units) + diclofenac potassium & 2 tablets of doxycycline
39 nimesulide + paracetamol suspension
40 aceclofenac + paracetamol + famotidine
41 aceclofenac + zinc carnosine
42 paracetamol + disodium hydrogen citrate + caffeine
43 paracetamol + dl methionine
44 disodium hydrogen citrate + paracetamol
45 paracetamol + caffeine + codeine
46 aceclofenac (sr) + paracetamol
47 diclofenac + paracetamol injection
48 azithromycin + cefixime
49 amoxicillin + dicloxacillin
50 amoxicillin 250 mg + potassium clavulanate diluted 62.5 mg
51 azithromycin + levofloxacin
52 cefixime + linezolid
53 amoxicillin + cefixime + potassium clavulanic acid
54 ofloxacin + nitazoxanide
55 cefpodoxime proxetil + levofloxacin
56 azithromycin, secnidazole and fluconazole kit
57 levofloxacin + ornidazole + alpha tocopherol acetate
58 nimorazole + ofloxacin
59 azithromycin + ofloxacin
60 amoxycillin + tinidazole
61 doxycycline + serratiopeptidase
62 cefixime + levofloxacin
63 ofloxacin + metronidazole + zinc acetate
64 diphenoxylate + atropine + furazolidonee
65 fluconazole tablet, azithromycin tablet and ornidazole tablets
66 ciprofloxacin + phenazopyridine
67 amoxycillin + dicloxacillin + serratiopeptidase
68 azithromycin + cefpodoxime
69 lignocaine + clotrimazole + ofloxacin + beclomethasone
70 cefuroxime + linezolid
71 ofloxacin + ornidazole + zinc bisglycinate
72 metronidazole + norfloxacin
73 amoxicillin + bromhexine
74 ciprofloxacin + fluticasone + clotrimazole + neomycin is
75 metronidazole + tetracycline
76 cephalexin + neomycin + prednisolone
77 azithromycin + ambroxol
78 cilnidipine + metoprolol succinate + metoprolol tartrate
79 l-arginine + sildenafil
80 atorvastatin + vitamin d3 + folic acid + vitamin b12 + pyridoxine
81 metformin + atorvastatin
82 clindamycin + telmisartan
83 olmesartan + hydrochlorothiazide + chlorthalidone
84 l-5-methyltetrahydrofolate calcium + escitalopram
85 pholcodine + promethazine
86 paracetamol + promethazine
87 betahistine + ginkgo biloba extract + vinpocetine + piracetam
88 cetirizine + diethyl carbamazine
89 doxylamine + pyridoxine + mefenamic acid + paracetamol
90 drotaverine + clidinium + chlordiazepoxide
91 imipramine + diazepam
92 flupentixol + escitalopram
93 paracetamol + prochloperazine
94 gabapentin + mecobalamin + pyridoxine + thiamine
95 imipramine + chlordiazepoxide + trifluoperazine + trihexyphenidyl
96 chlorpromazine + trihexyphenidyl
97 ursodeoxycholic acid + silymarin
98 metformin 1000/1000/500/500mg + pioglitazone 7.5/7.5/7.5/7.5mg + glimepiride
99 gliclazide 80 mg + metformin 325 mg
100 voglibose+ metformin + chromium picolinate
101 pioglitazone 7.5/7.5mg + metformin 500/1000mg
102 glimepiride 1mg/2mg/3mg + pioglitazone 15mg/15mg/15mg + metformin 1000mg/1000mg/1000mg
103 glimepiride 1mg/2mg+ pioglitazone 15mg/15mg + metformin 850mg/850mg
104 metformin 850mg + pioglitazone 7.5 mg + glimepiride 2mg
105 metformin 850mg + pioglitazone 7.5 mg + glimepiride 1mg
106 metformin 500mg/500mg+gliclazide sr 30mg/60mg + pioglitazone 7.5mg/7.5mg
107 voglibose + pioglitazone + metformin
108 metformin + bromocriptine
109 metformin + glimepiride + methylcobalamin
110 pioglitazone 30 mg + metformin 500 mg
111 glimepiride + pioglitazone + metformin
112 glipizide 2.5mg + metformin 400 mg
113 pioglitazone 15mg + metformin 850 mg
114 metformin er + gliclazide Mr. + voglibose
115 chromium polynicotinate + metformin
116 metformin + gliclazide + piogllitazone + chromium polynicotinate
117 metformin + gliclazide + chromium polynicotinate
118 glibenclamide + metformin (sr)+ pioglitazone
119 metformin (sustainded release) 500mg + pioglitazone 15 mg + glimepiride 3mg
120 metformin (sr) 500mg + pioglitazone 5mg
121 chloramphenicol + beclomethasone + clomitrimazole + lignocaine
122 of clotrimazole + ofloxaxin + lignocaine + glycerine and propylene glycol
123 chloramphennicol + lignocaine + betamethasone + clotrimazole + ofloxacin + antipyrine
124 ofloxacin + clotrimazole + betamethasone + lignocaine
125 gentamicin sulphate + clotrimazole + betamethasone + lignocaine
126 clotrimazole + beclomethasone + ofloxacin + lignocaine
127 becloemthasone + clotrimazole + chloramphenicol + gentamycin + lignocaine ear
128 flunarizine + paracetamole + domperidone
129 rabeprazole + zinc carnosine
130 magaldrate + famotidine + simethicone
131 cyproheptadine + thiamine
132 magaldrate + ranitidine + pancreatin + domperidone
133 ranitidine + magaldrate + simethicone
134 magaldrate + papain + fungul diastase + simethicone
135 rabeprazole + zinc + domperidone
136 famotidine + oxytacaine + magaldrate
137 ranitidine + domperidone + simethicone
138 alginic acid + sodium bicarbonate + dried aluminium hydroxide + magnesium hydroxide
139 clidinium + paracetamol + dicyclomine + activated dimethicone
140 furazolidone + metronidazole + loperamide
141 rabeprazole + diclofenac + paracetamol
142 ranitidine + magaldrate
143 norfloxacin+ metronidazole + zinc acetate
144 zinc carnosine + oxetacaine
145 oxetacaine + magaldrate + famotidine
146 pantoprazole (as enteric coated tablet) + zinc carnosine (as film coated tablets)
147 zinc carnosine + magnesium hydroxide + dried aluminium hydroxide + simethicone
148 zinc carnosine + sucralfate
149 mebeverine & inner hpmc capsule (streptococcus faecalis + clostridium butyricum + bacillus
Mesentricus + lactic acid bacillus)
150 clindamycin + clotrimazole + lactic acid bacillus
151 sildenafil + estradiol valerate
Avoid this combinations and be safe.