Urticaria after stress: mechanism of development and methods of treatment

In the modern world, people often blame stress or emotional distress for all their illnesses. Although this view of the causes of diseases is somewhat simplified, in dermatological practice, doctors often encounter a number of rashes that have arisen after emotional upheavals, stress, or against their background. A striking example of such diseases is urticaria. And although we are used to classifying it as an allergic disease, there are many variants of this disease of a non-allergic nature, among which an important place is occupied by nervous urticaria (psychogenic urticaria).

Pathogenesis of urticaria due to stress

In fact, urticaria caused by stress is a non-specific reaction to an external stimulus. Those. anxiety, stress reaction, strong emotional experiences are a trigger that triggers an immune response, and, in a sense, an “allergen”; for the immune system. It should be noted that the skin belongs to the organs with a high degree of innervation.

Hives after stress can be considered a non-specific reaction of the immune system to irritation of the nervous system. 

In addition to the receptor function, the skin also receives signals from the central and peripheral nervous system (both from its somatic and vegetative parts), as a result of which a number of mediators are produced that provoke the development of an immune response. As a result of a provoked immune reaction and inflammation, vasodilation occurs, their permeability increases, fluid enters the endothelial cells in excessive amounts, which causes swelling of the papillary dermis, blistering and itching (due to the accumulation of mediators).

Interaction of the nervous and immune systems in urticaria after stress

The nervous and immune systems interact largely through the action of neuropeptides involved in the role of mediators between the nervous and immune links of regulation. Substance P is considered one of the main mediators among these mediators for the development of urticaria. Studies have shown that it is the level of this substance that increases to the greatest extent when urticaria occurs after stress. In addition, the accumulation of this mediator is associated with the development of depression and anxiety disorders, which, to some extent, "relates" skin manifestations and mental disorders. In part, the development of urticaria is associated with increased production of norepinephrine or acetylcholine (the so-called adrenergic and cholinergic urticaria), which are the main mediators of the sympathetic and parasympathetic systems, respectively,

Unlike urticaria of other etiologies, substance P is considered a specific marker of urticaria after stress.

Clinical characteristics of urticaria after stress

One of the important issues that arise before specialists who are faced with the problem of urticaria is its timely diagnosis and the establishment of the psychogenic nature of the development of this disease. First of all, urticaria is manifested by the formation of blisters with clear contours, which do not have a cavity, and tend to gradually increase, with the appearance of redness at the edges and blanching in the center. Blisters can form both on the skin and on the mucous membranes of all parts of the body, they are also able to migrate (disappear from some areas of the skin and appear on new ones).

Specific features of diagnosing urticaria after stress, its differences from other forms of urticaria

Urticaria after stress is not always acute, unlike allergic urticaria, which has an acute course. It was found that among the clinical manifestations in patients with urticaria, itching prevails over skin manifestations. The disease may also be accompanied by fever, general intoxication, increased irritability. Itching is primarily due to increased secretion of an inflammatory mediator. A number of researchers have even linked itching in urticaria to a modified perception of pain. It is also important to note that, in the case of diagnosing urticaria after stress, anamnesis plays an important role in its development. If the patient indicates that the appearance of rashes was preceded by conflict situations, significant emotional stress, psychotrauma, but, at the same time, neither allergic reactions nor contact with typical antigens, such as plant pollen, wool, food, to which the patient may be allergic, was not observed in the anamnesis, then the doctor may, with a high probability, suspect hives after stress in the patient. However, for the reliability of the diagnosis, it is recommended to conduct a number of laboratory tests: allergic tests to exclude the allergic genesis of the disease, and the detection of P & ndash; specific marker for psychogenic urticaria.

allergic tests to exclude the allergic genesis of the disease, and the detection by enzyme-linked immunosorbent assay in blood plasma of the substance P – specific marker for psychogenic urticaria.

allergic tests to exclude the allergic genesis of the disease, and the detection by enzyme-linked immunosorbent assay in blood plasma of the substance P – specific marker for psychogenic urticaria.

In the case of a psychogenic factor in the development of urticaria, patients will experience itching more than all other symptoms of urticaria.

Methods of treatment and emergency care for urticaria after stress

At the moment, there are several directions in the treatment of nervous urticaria:

The basic method of medical treatment of psychogenic urticaria, like any other type of urticaria, is the use of 2nd generation antihistamines, as well as, in especially severe and protracted cases, topical glucocorticoids;
pathogenetic therapy is also recommended, which affects precisely the stress factor in the development of urticaria. For these purposes, mild antipsychotics are used, which, together with the correction of mental disorders, can inhibit the secretion of the substance R.
it is possible to correct mental disorders that caused skin rashes in urticaria with various psychotropic drugs (neuroleptics, antidepressants, etc.).
along with the main methods of treatment of urticaria after stress, correction of mental disorders with the help of psychotherapy, as well as elimination of itching with the help of local anti-inflammatory and antihistamines are recommended.

Thus, the treatment of urticaria after stress should be aimed not only at the temporary elimination of itching, blisters and swelling, but also at correcting the main factor that provoked its development, i.e. to relieve stress or treat a mental disorder.