A 12-year-old boy is brought to the office for evaluation of hives. He has no significant past medical history and no history of allergies. He has just joined the middle school soccer team and noticed that he gets hives about 10 minutes into practice. The hives are itchy and consist of irregular blotches on his legs and trunk, about 10–20 cm in size, and they persist for about 30 minutes. He does not experience swelling of the lips or oropharynx and denies any wheezing or shortness of breath. His physical examination is normal without skin lesions or oral swelling at that moment, and his lungs are clear. After evaluation, he is diagnosed with urticaria.
1. Discuss the likely cause of the patient’s urticaria.2. Describe the cellular mechanism of urticaria and how it leads to the signs and symptoms experienced by the patient.3. Describe the relationship between the patient’s symptoms and the concept of inflammation.4. What pharmacological and non-pharmacologic treatment options are available?5. Discuss the complications of urticaria.6. What teaching would be appropriate to provide the parent and child about urticaria?

Answer: 1. The patient cause of urticaria could probably due to Physical stimuli, such as pressure, cold, heat, exercise or sun exposure. Since he has just joined the middle school soccer it could be due to exercise.

2. The cellular mechanism of urticaria is due to the fact that Urticaria is a dermal edema resulting from vascular dilatation and leakage of fluid into the skin in response to molecules released from mast cells. Histamine is a major molecule produced by mast cells which causes vascular dialatation and fluid movement to the skin leading to urticaria and the signs and symptoms felt by the patient. However, the clinical spectrum and pattern of lesions indicate that other molecules, including prostaglandins, leukotrienes, cytokines, and chemokines, produced at different times after mast cell activation contribute to the symptom and the variable evolution of this disease.

3. Urticaria itself is a form of inflammation which is the response or body defense mechanism against foreign organisms and molecules.

4. Pharmacology treatments involves the use of antihistamines and epinephrine in some cases. These drugs blocks the histamine production by mast cells. While non pharmacological treatments involves to avoid the triggers such as food, sun exposure, scratching and rubbing, medications etc.

5. The complications of urticaria may includes

a. Anaphylaxis (a life-threatening, whole-body allergic reaction that causes breathing difficulty)

b. Swelling in the throat can lead to life-threatening airway blockage.

6. It would be appropriate to teach the patient to avoid the triggers of urticaria and to how to treat it incase of emergency.

Explanation: urticaria is seen as a side effect of drugs but is poses a threat to patient's life and must not be taken for granted. The answers discuss above are some of the relevant information needed incases of emergency. Explanations are also made at the cost of providing the answers.