Urticarial Vasculitis: Symptoms, Causes, and Treatment Options

Q: Urticarial Vasculitis: Symptoms, Causes, and Treatment Options

Hello, thank you for your inquiry. <br>Here are my responses：<br>1. <br>How is anaphylactic shock determined? Although I was experiencing stomach pain, I was still responsive at the time... <br>--> Perhaps "shock" is a bit severe, but you did have swelling of the lips and eyelids

Urticarial vasculitis?

Hello, doctor.
I have a tendency to be allergic and sneeze (which started about nine years ago).
I have also experienced mild urticaria intermittently.
However, starting in April of this year, I suddenly developed widespread urticaria.
I went to a dermatology clinic and took medication for six days along with an injection, which helped me recover.
Last week, urticaria flared up again.
I initially thought I could manage it by observing and applying the topical medication given by the dermatologist, but the urticaria worsened.
Eventually, my eyelids and lips became swollen, and I also experienced stomach pain.
I consulted a family medicine doctor, who prescribed antihistamines and antacids, believing that the stomach pain was triggered by the medication I took for a urinary tract infection.
The next day, the stomach pain became unbearable, and my lips and eyelids were swollen, so I rushed to the emergency room.
The doctor diagnosed me with anaphylactic shock, administered an injection, and prescribed steroids, antihistamines, and medications for gastric ulcers and bloating.
1.
How is anaphylactic shock diagnosed? At that time, even though I had stomach pain, I was still responsive.
2.
Is there a connection between stomach pain and urticaria? The doctor mentioned that the injection would significantly improve both the urticaria and stomach pain—could they be related? Or do I need further gastrointestinal examinations?
3.
I found information online stating that swelling urticaria and generalized urticaria are different; is it possible for both to occur simultaneously? (As I have experienced both conditions.)
4.
After urticaria subsides in certain areas (especially around the legs, knees, and ankles), I have noticed many bruises (some large patches and some small spots).
I found online that this could be urticarial vasculitis, but there is limited information available.
It is described as an autoimmune disease; can this condition be cured, or can it only be managed?
I apologize for the many questions, and thank you for your response!

Miao Mi, 20~29 year old female. Ask Date: 2021/06/23

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses:
1.
How is anaphylactic shock determined? Although I was experiencing stomach pain, I was still responsive at the time...
--> Perhaps "shock" is a bit severe, but you did have swelling of the lips and eyelids, which we refer to as angioedema, indicating a state close to actual shock.
Emergency departments typically handle such cases with extra caution.
Whether it reaches the severity of shock also depends on blood pressure status, which is unrelated to responsiveness.
2.
Is there a connection between stomach pain and urticaria? The doctor mentioned that the injection would significantly alleviate both urticaria and stomach pain—could they be related? Or do I need further gastrointestinal examinations? --> I believe there may be a connection.
Severe allergies can also manifest gastrointestinal symptoms, including diarrhea.
If your symptoms have improved, further gastrointestinal examinations may not be necessary.
3.
Information online states that localized urticaria is different from generalized urticaria; is it possible for both to occur simultaneously? (As I have experienced both conditions.) --> In principle, the mechanisms are the same; the localized swelling is due to the allergy occurring at a deeper level, causing "angioedema." Allergic reactions can manifest at varying depths in the skin, so some individuals may only experience urticaria, while others may have both conditions simultaneously, with the latter typically indicating a more severe situation.
4.
After urticaria resolves in certain areas (especially around the legs, knees, and ankles), there are many bruises (some large, some small).
I found online that this could be urticarial vasculitis, but there is limited information available, stating it is an autoimmune disease.
Can this condition be cured, or is it only manageable? --> This needs to be assessed by your physician who can examine the lesions.
The skin symptoms of urticarial vasculitis tend to last longer and do not resolve as quickly as urticaria, which can appear and disappear rapidly.
Therefore, it is essential to closely observe the skin manifestations and inquire about the medical history.
Generally, urticarial vasculitis is an immune issue with many underlying causes, and whether long-term medication is necessary depends on the evaluation and examination by the treating physician.
Therefore, if you are concerned, I recommend consulting a specialist in allergy, immunology, and rheumatology nearby.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is here to assist you.

Reply Date: 2021/06/23

More Info

Urticarial vasculitis is a condition that combines features of urticaria (hives) and vasculitis (inflammation of blood vessels). Understanding this condition involves recognizing its symptoms, causes, and treatment options, especially in the context of your experiences with allergic reactions and hives.

Symptoms
Urticarial vasculitis typically presents with hives that may last longer than the typical urticaria (more than 24 hours) and can be associated with deeper skin lesions. Patients often experience swelling, redness, and sometimes pain in the affected areas. In your case, the swelling of the eyelids and lips, along with abdominal pain, suggests a systemic reaction that could be related to urticaria or an allergic response. The bruising you mentioned after the hives may indicate a more serious underlying issue, such as vasculitis, which can affect blood vessels and lead to leakage of blood into the skin.

Causes
The exact cause of urticarial vasculitis can vary. It may be triggered by infections, medications, or underlying autoimmune diseases. In your situation, the onset of hives after taking medication for a urinary tract infection raises the possibility of a drug-induced hypersensitivity reaction. Additionally, autoimmune conditions can lead to chronic urticarial vasculitis, where the immune system mistakenly attacks the body’s own tissues.

Diagnosis
Diagnosing urticarial vasculitis typically involves a thorough clinical evaluation, including a detailed history of symptoms and potential triggers. Skin biopsies can be performed to confirm the diagnosis by showing signs of vasculitis in the skin. The distinction between regular urticaria and urticarial vasculitis is crucial, as the latter may require different management strategies.

Treatment Options
Treatment for urticarial vasculitis often includes antihistamines to relieve itching and swelling. In cases where symptoms are severe or persistent, corticosteroids may be prescribed to reduce inflammation. Given your experience with anaphylaxis, it’s essential to have a plan in place for managing severe allergic reactions, which may include carrying an epinephrine auto-injector.

1. Anaphylaxis Diagnosis: Anaphylaxis is typically diagnosed based on clinical symptoms, including difficulty breathing, swelling, and gastrointestinal distress. While you were responsive, the combination of symptoms you experienced—especially the swelling and abdominal pain—could indicate a severe allergic reaction. Medical professionals often assess the severity of symptoms and the rapidity of onset to determine if anaphylaxis is occurring.

2. Connection Between Abdominal Pain and Hives: There can indeed be a connection between gastrointestinal symptoms and urticaria. Allergic reactions can affect multiple systems in the body, leading to hives and gastrointestinal distress simultaneously. If the abdominal pain persists, further evaluation may be warranted to rule out other gastrointestinal issues.

3. Different Types of Urticaria: It is possible to experience both urticarial vasculitis and typical urticaria simultaneously. The presence of both conditions may complicate the clinical picture, and it’s essential to work closely with a healthcare provider to manage these symptoms effectively.

4. Bruising and Urticarial Vasculitis: The bruising you observed after the hives could indeed be a sign of urticarial vasculitis. This condition can be chronic and may require ongoing management. While some patients may experience remission, others may have persistent symptoms that need to be controlled with medication.

Conclusion
Urticarial vasculitis can be a complex condition requiring careful management and monitoring. It’s crucial to maintain open communication with your healthcare provider, especially regarding any new symptoms or changes in your condition. If you have concerns about your diagnosis or treatment, seeking a second opinion from a specialist in dermatology or immunology may provide additional insights and reassurance. Remember, while some autoimmune conditions can be chronic, many patients find effective ways to manage their symptoms and lead fulfilling lives.

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