Epidemiological analysis of acute urticaria cases admitted to the adult emergency department

Objective: Urticaria is characterized by itchy, burning sensation and edematous papules/plaques with a central swelling of variable size surrounded by a reflex erythema of the epidermis. Acute urticaria (AU) and angioedema are frequently seen together, and sometimes patients may apply to the emergency department with anaphylaxis, which can be fatal. In this context, when emergency room physicians discharge patients who present with acute urticaria, they may experience anxiety about reapplying to the emergency department with a more severe clinical picture or anaphylaxis. In this study, it was aimed to investigate the epidemiological examination of cases who applied to the emergency department with acute urticaria in our region. Many studies in the literature include the pediatric age group or all age groups, and studies on the epidemiological examination of acute urticaria cases only in adults are limited. Materials and methods: 690 patients over 18 years of age who applied to the Adult Emergency Service of Ondokuz Mayıs University Medical Faculty Hospital between January 2015 and September 2022 with acute urticaria were included in this study. Demographic, history, family history and clinical characteristics of all patients (urticaria symptom duration, urticaria severity, presence and distribution characteristics of angioedema, treatments), possible triggering factors and physical examination findings were recorded in the Acute Urticaria Application and Follow-up Form. Results: 61.74% of the patients were female, 38.26% were male, and the mean age was 42.89±16.61. The most common cause of acute urticaria triggering factor was idiopathic origin. It was observed that the second most common cause was drug-related reasons. The mean age of drug-induced acute urticaria cases was significantly higher than the mean age of idiopathic acute urticaria cases due to food, insect/bee stings and other triggering factors (p=0.005). The development of drug-induced acute urticaria was statistically higher in patients aged 35 years and older than patients under 35 years of age (p=0.008). Drug-induced acute urticaria was statistically significantly more severe than non-drug triggering urticaria (p<0.001). Considering the drug relationship with urticaria; The most common cause of AU was anti-inflammatory drugs with a rate of 43.26%, and the second most common cause was anti-microbial drugs with a rate of 21.63%. Admission with angioedema, presence of anaphylaxis, history of urticaria and history of allergic disease were factors associated with urticaria severity. The development time of acute urticaria complaints was found to be significantly shorter in patients presenting with anaphylaxis (p<0.001). Conclusion: In our study, idiopathic causes were found to be the most common cause of acute urticaria. Drug-induced acute urticaria causes more severe clinical findings than acute urticaria due to non-drug triggering factors. In the literature, there are only a limited number of studies on the epidemiological examination of acute urticaria cases in adults. We think that our study contains valuable information that will contribute to the literature in this context.