The case is centered around a 12-year-old boy suffering from urticarial, and although he is not experiencing any form of swelling or shortness of breath, the hives are apparent and persist for approximately half an hour. It is important to note that there are two sets of causes in regard to the hives, which are non-immunologically mediated, non-IgE immunologically mediated, or immunoglobulin E (IgE) mediated (Schaefer, 2017). The former group of causes includes parasitic infections, medications, insect venom, food allergens, contract allergens, and aeroallergens, whereas the non-IgE immunologically mediated set involves proteases, viral infections, vasculitis, lymphoma, fungal infections, cryoglobulinemia, bacterial infections, autoimmune diseases. The non-immunologically mediated causes are water, physical stimuli, medications, mastocytosis, light, food pseudo allergens, the elevation of core body temperature, and contact allergens (Schaefer, 2017). The case indicates that the boy began getting hives after he joined the soccer team, which means that the most likely cause is an elevation in core body temperature due to physical exercise or physical stimulation of the skin.
The cellular mechanism of urticaria revolves around mast cells and basophils releasing mediators, such as histamine. It is stated that “if the release occurs in the dermis, it results in urticaria, whereas if the release occurs in the deeper dermis and subcutaneous tissues, it results in angioedema” (Schaefer, 2017, p. 1). In other words, these cells release histamines in the dermis in response to a stimulus, which is temperature or physical stimuli, where histamines perform their function of causing inflammatory response by dilating blood vessels and increasing blood flow to the area. This results in hives and redness of the skin from which the boy is suffering.
Inflammation is an essential part of an immune response to possible threats, where the body increases the overall blood flow to the targeted location, which allows white blood cells to concentrate in order to combat the antigen. The issue becomes a problem when inflammation is triggered by relative non-harmful factors, where the body responds with excessive reaction. Since the patient has no past medical history and no history of allergies, it is evident that the cause is most likely linked to the soccer activity. The latter involves an increase in core body temperature and physical contact with a ball and other players, which can be the primary cause of inflammation in the dermis.
The non-pharmacological treatment revolves around trigger avoidance, which means that the patient needs to stop playing soccer and be involved in sports, where aggressive physical contact with the skin is made. If the cause is an elevation in core body temperature, then the patient needs to avoid any form of physical activity altogether. The pharmacological treatment focuses on antihistamines, which can include second-generation H1 antihistamines as well as “first-generation H1 antihistamines, H2 antihistamines, leukotriene receptor antagonists, high-potency antihistamines, and brief corticosteroid bursts” (Schaefer, 2017, p. 1). In the case of complications, urticaria can lead to the development of angioedema, which is a more severe issue where a person experiences swelling since the inflammation takes place in the deeper dermis and layers underneath. Therefore, it is important to provide some form of education to the parents and boys through informative teaching, where they need to learn and understand that this is an irreversible condition, which can be handled through avoidance of triggers and medications in case of return of urticaria.
Schaefer, P. (2017). Acute and chronic urticaria: Evaluation and treatment. American Family Physician, 95(11), 717-724. Web.