Esophageal discomfort in patients with urticaria results from mucosal edema caused by an allergic reaction. This includes overactivation of the immune system, histamine release, increased vascular permeability, increased esophageal sensitivity, and worsening acid reflux.
The key mechanism behind the connection
The immune system is in overdrive
Urticaria is a type I allergic reaction in which IgE-mediated mast cell activation releases histamine and other inflammatory mediators. These substances can affect the mucosa of the digestive tract, leading to vasodilation and sensitization of nerve endings in the esophagus. This usually manifests as discomfort or a burning sensation in swallowing.
The dual effects of histamine
Histamine acts as the main mediator of inflammation, directly stimulating esophageal smooth muscle contraction while increasing vascular permeability. The resulting tissue edema may compress the esophageal lumen, causing difficulty swallowing. At the same time, histamine receptor activation lowers the pain threshold and amplifies normal gastric acid sensitivity.
Consequences of swelling of the mucous membranes
An allergic reaction triggers a leak of blood vessels throughout the mucosa of the upper gastrointestinal tract that may affect all esophageal layers. Submucosal edema narrows the esophageal passage, especially in natural contractions such as the cricopharyngeal muscle. Severe cases can seriously affect the flow of food.
Complications of reflux
About 30% of people with urticaria develop functional dyspepsia. Histamine-induced gastric acid secretion exacerbates reflux, while allergic disease weakens esophageal mucosal defenses. Nocturnal symptoms are often exacerbated by the recumbent position.
Enlargement of the nervous system
Patients with chronic urticaria may present with central sensitization, which amplifies visceral pain perception. Mild inflammation of the esophagus may manifest as intense discomfort, especially in anxious individuals, creating a cycle of escalating symptoms.
Management recommendations
During an attack, patients should follow a low-histamine diet, focusing on foods such as winter melon and pears, while avoiding spices and hot drinks. Loose-fitting clothing and keeping it at room temperature (20-24°C) can help reduce irritation. Chronic patients may benefit from a food diary to identify triggers and provide physician-directed antihistamine therapy if needed. Persistent chest pain or bloody vomiting requires immediate medical evaluation to rule out conditions such as eosinophilic esophagitis.
Related Topics:
