Wheals - Causes, Symptoms and Therapy

A careless grip on the nettles or an insect bite - they're there, the wheals. Often, these bumps are then accompanied by a nasty itching, which makes things even more uncomfortable. But why exactly wheals develop and what can be done in case of emergency? Our contribution to the topic clarifies.

contents

• Emergence of wheals
• Wheals due to existing allergy disease
• Wheals by contact with toxins
• Wheals due to existing pre-existing conditions
• symptoms
• diagnosis
• therapy

Emergence of wheals

As wheals the medicine refers to whitish to reddened lesions (lesions) on the skin, which occur in different sizes and are filled with tissue water. They may be pinhead-sized and thus barely recognizable, or even palm-sized and associated with a highly visible redness. The characteristic distinction to other skin irritations is the clear grandeur of the wheals above the skin level. In very extreme cases, the skin elevations are therefore reminiscent of a badly healed scar, with wheals, unlike such scar tissue, usually waning again after a short time.

Wheals on the skin can be caused by harmless triggers such as a grip in the stinging nettles. B. also be an allergic reaction. (Image: Jürgen Fälchle / fotolia.com)

The whole body can be affected by wheals, which means that skin elevations can occur on the extremities, ie the arms and legs, as well as on the head and torso. The actual distribution of wheals on the body in this regard is very much dependent on the causative factors. Basically, however, the elevations are caused by an increased release of tissue hormones in the affected skin tissue, which then cause tissue irritation.

In many cases, said tissue hormones are histamine. Its release in the body occurs whenever the immune system is alarmed by irritating foreign substances such as allergens or toxic substances. Histamine acts as a messenger in such cases, which increases the permeability of the smallest skin blood vessels of the epidermis (epidermis). This allows the water contained in the blood to diffuse into the environment, which allows the blood's own defense cells a rapid distribution in the affected tissue section. However, the water retention also causes local swelling of the skin area. In addition, histamine also leads to classic inflammatory reactions such as itching, burning or pain, which are also part of the immune response to existing irritation.

Wheals due to existing allergy disease

The stimulus factors that cause the immune system to release tissue hormones like histamine are very versatile. However, a particularly large range of causes of histamine-induced wheals take on allergies. In this case, an actually non-hazardous substance is wrongly classified as dangerous by the body's immune system and thus fought. In the course of this immunological miscalculation, there is an excessive immune reaction in the entire body, which is characterized by an increased release of histamine.

Now many think of allergic wheals first to contact allergies, for example, an allergy to additives in toiletries such as soaps or lotions, or to contact allergies to certain chemical substances in cleaning products. And certainly, these forms of allergy are definitely a possible cause of wheals. However, allergy forms that are not directly associated with skin reactions at first glance may provoke wheals. Both pollen and food allergies, as well as allergies to drugs or drug substances, namely, in principle, as allergic cause of Hauteffloreszenzen into consideration. Patients should therefore be thoroughly examined for suspected allergy to allergy.

As allergic triggers for wheals are not only contact allergies in question, but quite other allergies such as pollen or food allergies. (Image: Jürgen Fälchle / fotolia.com)

The histamine can cause numerous allergic reactions in the body in the presence of allergy disease, including, among other things, the above-described increase in vascular permeability in the skin tissue. Typical accompanying symptoms of wheal formation can be here:

• itching,
• erythema,
• difficulty in breathing,
• runny nose,
• Conjunctivitis,
• diarrhea
• and nausea and vomiting.

As part of allergic reactions, the wheal is used for medical purposes to perform allergy tests. For this purpose, small amounts of various allergens are applied to a test area of ​​the skin, and then it is awaited whether an allergy reaction takes place or not. Outside of these test conditions, the degree of wheals on the body can be determined relatively accurately for local causes in the case of allergy causes:

• drug allergy: Here, the wheals often occur on the trunk of the body, where they can expand in extreme extreme allergy but also on the extremities. Very often the wheals in this context are observed as a reaction immediately during or after a delay after antibiotic therapy. This is especially true for antibiotics from the group of penicillins, against which many people are allergic. Also not infrequently, wheal formation occurs with existing allergy to medicinal agents after administration of analgesics such as Novalgin, paracetamol or ibuprofen.
• Contact allergy: People who suffer from contact allergies, such as allergy to latex, nickel, chemical additives, or fragrances in personal care products, are often particularly distressed by wheals. In addition to other skin irritations such as redness or itching, it is often the cardinal symptom of such an allergy and usually manifests itself only seconds after contact with the respective allergen. The skin changes usually remain localized on the skin area in which the contact with the allergen has occurred.
• Food allergy: In contrast to locally relatively limited allergy wheals, wheals can spread as an allergic reaction to food all over the body. This is due to the fact that histamine release from food allergy is only initiated when the allergen (such as peanuts, gluten, lactose, or seafood) is taken into the blood via digestive processes. Thereafter, the allergen passes through the bloodstream from the digestive tract into other areas of the body, which include the skin layers.
• Light or sun allergy: If there is an allergy to the UV rays of the sun, wheals appear mainly in those parts of the body that are directly exposed to the sun. Typical is the wheal formation here, for example, in the décolleté area, the neck region, the face or on the arms and hands. Most of the skin surveys here remain very small and are roundish nature. The formation of wheals can take a few hours to a day.
• Plant or pollen allergyWhen it comes to pollen allergy, the main symptoms are usually reddened eyes and a stuffy nose. However, wheals can also be the result of such an allergy. The same applies to allergies to certain plant substances. The wheal formation is known in this regard, for example, in the presence of allergy to the contents of the carnation, the Ginkgo biloba, the passion flower, the monk's pepper, the nettle and the ginseng.

In the context of allergy tests the wheal formation is used to determine incompatibilities regarding specific substances. (Image: Matthias Stolt / fotolia.com)

Wheals by contact with toxins

In addition to allergens and certain toxins are able to trigger a histamine release as a defense reaction of the immune system and cause the formation of wheals. Above all, certain plant and insecticides are known to provoke corresponding skin irritations. Insect bites, in particular, make the formation of wheals even more likely when people scratch around at the puncture site. In this way, the toxins get the opportunity to continue to spread in the epidermis, which is increasingly stimulated histamine release.

Even with plant toxins, the distribution rate in the tissue often determines the extent of wheals. In addition, of course, the particular dose of the poison is crucial for wheal formation. A particularly aggressive poison possesses in this regard the bear claw. The poisonous plant causes after skin contact in addition to wheals and proper burns, which can lead to unbearable pain. In addition to insect and plant toxins, moreover, some environmental toxins may not be underestimated as possible triggers of wheals.

The origin of wheals is by contact with toxins almost the same as in allergies, with the difference that the body's immune system right here classified a toxic foreign matter as dangerous. The release of histamine as a defense mechanism is therefore due to the correct interpretation of body defense. Typical toxins leading to wheals in this context are:

• Herbal poisons (for example, from bear's claw, blue-green algae, poisonum, dieffenbachie or prickly bean),
• Animal poisons (e.g., of venomous amphibians, fish, insects, jellyfish, snakes, sea urchins or spiders)
• and environmental toxins and chemicals (e.g., ammonia, formaldehyde, palladium, platinum or rhodium).

It should be noted that in case of suspected poisoning an emergency doctor should be called immediately. Even though wheals are generally harmless, they are usually accompanied by a number of other accompanying symptoms, especially those that come into contact with toxic substances, which can sometimes be life-threatening. In the worst case, there is a risk of cardiovascular shock and death if the poisoning is not treated in time.

Allergy, poisoning or normal irritant reaction?

There are some cases where the boundaries between allergic and poisoning reactions are blurring. Take, for example, the wasp sting, so the resulting wheals are partly due to the mere immune reaction to the venom of the wasp. In some cases, however, a particular allergy to the wasp pheromones co-released during the sting can be triggered, which aggravates the allergic reactions and thus also the extent of hives. As with a normal poisoning in such a case, with the hives whatsoever, because a wasp sting can also lead to life-threatening side effects.

In a wasp sting, wheals may be due to the "normal" immune response, but also enhanced by allergic reactions. (Image: Janina Dierks / fotolia.com)

Other whiteheads provoked by insect bites or bites are not always clearly responsible for poisoning. In many cases, irritating salivary secretions of the insects also play a role here. Said secretions typically contain anticoagulant substances which allow the insects to slobber their blood without being thickened during the dying process after being bitten in a host. For the human immune system, these anticoagulants are foreign substances against which the body's defense with an increased release of histamine and thus promotes the formation of wheals.

The stinging nettle, on the other hand, carries histamine in addition to weakly toxic substances such as acetylcholine in its stinging hairs, so that a local skin reaction does not have to involve any immunological process in order to produce the wheals. The amount of histamine in the stinging nettle is usually more aggressive than the actual plant poison, which, by the way, hardly matters when it comes to the edibility of nettles. It evaporates very quickly and can usually be made harmless by sufficiently washing the nettle under hot water or preparing it as a nettle tea.

Wheals due to existing pre-existing conditions

Speaking of stinging nettles: Occasionally wheals are associated with a present underlying disease, such as hives (urticaria), also called nettle fever. It describes a chronic skin condition that gets its name from the fact that, like the actual touch of a stinging nettle, it causes wheals, itching and redness. Under certain circumstances, the disease may also spread to the respiratory system, leading to swelling of the respiratory tract with concomitant respiratory distress, which makes the disease quite dangerous.

The causes of urticaria are being scientifically researched and one has not come to a conclusive conclusion. Both the triggering factors and the symptoms are similar to an allergic reaction to certain substances or stimuli, but the urticaria is currently described as a pseudoallergy or hypersensitivity reaction of the immune system, since in many cases the urticaria is the typical for an allergy, detectable in the blood factors absence. In the end, however, certain substances and stimuli also activate the sentinel cells and, as a result, increase the release of histamine with the symptoms described above. As triggering factors and possible causes are:

• Irritants in foods (e.g., preservatives, flavor enhancers or histamine-containing foods),
• Drugs in medicines (such as antibiotic agents, anti-inflammatories, antipyretics or analgesics),
• mental or physical stress (e.g., persistent stress, lack of rest, or existing infections),
• physical stimuli (e.g., heat, cold, sunlight, pressure or vibration)
• and organic causes (e.g., autoimmune processes, adrenal or thyroid dysfunction).

Sometimes it requires a combination of several of the factors mentioned, so that a urticaria erupts. Not infrequently, cases are observed where, for example, so far a drug for pain and fever was well tolerated, at the same time existing infection, however, developed a urticaria. Of course, this circumstance does not make conclusive causal research easy, and there is always a residual risk of recurrence after therapy has been completed.

There are a few other diseases that are typical for a wheal. Particular mention should be made of teething troubles such as measles. Here it is infectious viruses that put the immune system strong and cause this to an excessive defensive reaction. Also, histamine intolerance (histaminosis) is a condition in which wheals may be the main symptom. The disease is often falsely described as an allergy, but is in fact a chronic metabolic disorder in which histamine can not be broken down by the body.

There are several diseases that can be the cause of wheals. To name here are, for example, the measles. (Image: mikumistock / fotolia.com)

symptoms

The accompanying symptoms of wheals are usually based on the cause of the skin lesions. It can stay with whitish or slightly brightened elevations, but also come to reddened and very itchy to painfully burning efflorescences. In addition, cause-related symptoms such as dizziness, nausea and vomiting are conceivable, which is especially true for extreme allergic reactions and severe poisoning. In this context, it should also be pointed out once again that the histamine release which causes the wheals is only one of many immunological defense reactions that are conceivable. Severe reactions such as anaphylactic shock, sepsis or cardiovascular arrest can not be ruled out and require timely treatment. Overall, the following concomitant symptoms must be expected:

• fatigue,
• difficulty breathing,
• Eye redness,
• Stomach and stomach cramps,
• Conjunctivitis,
• high blood pressure,
• diarrhea,
• fever,
• erythema,
• palpitations,
• itching,
• dizziness,
• sniff
• and nausea and vomiting

diagnosis

Since wheals on the skin are recognizable in most cases, at least at second glance, a visual diagnosis to determine the efflorescences is usually sufficient. It then becomes trickier when it comes to researching causes, which in many cases requires an exclusion diagnosis. For this purpose, several diagnostic measures are available to the responsible physician to enable a limiting diagnosis:

• Anamnesis: In a doctor's consultation, the doctor first clarifies by means of specific questioning whether the patient has allergies or underlying illnesses, what he has eaten recently and whether contact with relevant irritants has occurred. Affected persons should also address any concomitant symptoms within the patient discussion, as these often give a first indication of possible causes.
• Laboratory diagnostics: To differentiate the possible causes, the doctor usually initiates a blood test according to the anamnesis. It can provide important details about blood status, such as inflammatory parameters (erythrocyte sedimentation rate, CRP and differential blood count) and allergy factors (immunoglobulins) and other values ​​(thyroid levels and autoantibodies), thus providing information on blood vessel abnormalities.
• Additional tests: Additional information may be used in the diagnosis of wheals for special tests such as an allergy or provocation test (such as a prick test). The use of blood pressure measurements and imaging techniques such as X-rays or CT is helpful in individual cases. For further diagnostics, after weighing the risks and benefits, skin punch biopsies and extended allergy tests are also possible.
• Diary: If a definitive diagnosis can not be made yet, further instruments are available that can narrow down the possible causes. For example, keeping a diary can be thought of as patients document their diet, activities, and the appearance of wheals.

In addition to an obvious gaze diagnosis, for example, blood tests, allergy tests and biopsies are carried out for further limitation or cause research. (Image: cameravit / fotolia.com)

therapy

It is not always necessary to take medicaments for wheals. It is often sufficient to avoid the triggering substance in the future or to stop applying it. For example, if the wheals are caused by incompatible foods, care products or medicines. In this case one speaks of a so-called elimination therapy. In contrast, poisoning, as well as chronic illnesses, require very careful treatment, not primarily because of hives, but because of the danger to patient health.

Medical therapy

The agent of choice in the presence of wheals, as well as in general allergic-induced over-reactions of the immune system, is a suitable antihistamine. It comes into play when wheal formation has become so manifest and it causes the accompanying symptoms of itching, secondary infections and skin redness in those affected such a high level of suffering that an elimination therapy alone would not lead quickly enough to the desired relief of the symptoms. Some standard preparations include Allegra, Claritin or Zyrtec.

Antihistamines weaken and block the action of the body's histamine by blocking the histamine receptors on the appropriate cells. As a result, the symptoms disappear quickly and sufferers experience relief quickly. The therapy can be further supported by the use of Korikosteroiden (cortisone), which is advised to use only in extreme emergency, since cortisone can sometimes bring even serious side effects. In contrast, antihistamines can be used both in the short and in the long term if, for example, a complete avoidance of the triggering agent can not be guaranteed.

If infections are responsible for wheal making, of course, other medicines must be used. Bacterial infections can be treated with antibiotics, whereby it must be checked in advance whether there is an antibiotic compatibility in order not to exacerbate the overreaction of the immune system. In viral infections such as measles, the drug treatment is a little more difficult. On the one hand there are not many active substances against viruses besides some aggressive antivirals, on the other hand said preparations often weaken the immune system additionally. It is therefore more likely to work with remedies that relieve the concomitant symptoms. In addition, vitamin A has been proven to accelerate the recovery process of measles.

detoxification

If contact with toxins is responsible for the wheals, comprehensive detoxification is often a priority before wheal treatment. These usually swell up as soon as the toxin has been removed from the body. It is conceivable, for example, the use of activated carbon in poisoning, which is caused by the consumption of appropriate toxins. With snake poison or also various plant poisons however a suitable antidote is usually administered. Inpatient treatment is usually essential, as the condition of the patient should be monitored by trained personnel until complete detoxification. If you experience severe concomitant symptoms, such as signs of shock, shortness of breath or heart problems, artificial respiration or other measures to secure vital signs may be necessary.

For more severe poisoning as the cause of wheal it may be necessary to undergo inpatient treatment. (Image: Eisenhans / fotolia.com)

home remedies

In the repertoire of home remedies for wheals especially measures to bear, although the therapy of the causes can not achieve, but are quite able to support the drug treatment and especially to relieve the agonizing accompanying symptoms such as itching and swelling. For example, cooling and anti-itching envelopes, cool packs, sprays or ointments can be applied to the wheals. The same effect can also be achieved via a (cool) but short full bath. If you add some baking soda or caustic soda to the water, the healing effect can be enhanced by the now basic pH of the bathwater.

Naturopathic support:

The supportive treatment of wheals by homeopathic remedies can be very promising. As here, as usual for the homeopathic approach, the same is treated with the same, preparations are used, the wheal formation, itching and swelling have anchored in the user image:

• Formic acid (Acidum formicicum),
• Real valerian (Valeriana officinalis),
• Small nettle (Urtica urens),
• Real chamomile (Matricaria chamomilla L.)
• and peppermint (Mentha piperita).

The natural ingredients can all be applied locally and act directly on the skin. From medicinal herbs such as chamomile or peppermint can also be made a cooling envelope. Simply boil a cup of tea from the appropriate medicinal plants, let it cool down and then pour the liquid onto a piece of cloth. The soaked cloth can now be placed on the skin area with the wheals. The cooling effect relieves the itching and the ingredients soothe the irritated skin.

The underlying thesis is the assumption that a healthy intestinal flora has a regulating effect on the immune system and thus, among other things, allergies and intolerances can provide sufficient protection against the disease. In particular, the daily consumption of bifidobacteria and lactobacilli can achieve good results. Especially with regard to a longer-term antibiotic treatment, such a cure can already be started preventively. (Ma)