URTICARIA

Urticaria, commonly known as hives, manifests as sudden outbreaks of pale red bumps or welts on the skin, often accompanied by swelling known as angioedema. Various factors, such as allergic reactions, certain foods, insect stings, sunlight exposure, and medications, can trigger hives. Pinpointing the exact cause of hives can be challenging.

Types of Urticaria

Hives come in different forms:

Acute Urticaria: Lasting less than 6 weeks, commonly caused by foods, medications, infections, insect bites, or diseases.
- Common food triggers include nuts, chocolate, fish, tomatoes, eggs, fresh berries, and milk. Additionally, food additives and preservatives may contribute.
- Medications like aspirin, ibuprofen, certain blood pressure drugs, and painkillers like codeine can induce hives.
Chronic urticaria: lasting more than 6 weeks, it is often challenging to identify triggers. Possible causes include thyroid issues, hepatitis, infections, or cancer. It may affect various organs, such as the lungs, muscles, and gastrointestinal tract.
Physical Urticaria: Triggered by external stimuli like cold, heat, sun exposure, pressure, or exercise. These hives typically appear at the site of stimulation and can occur within minutes to hours after exposure.
Dermatographism is a common type of physical urticaria where hives appear after stroking or scratching the skin firmly.
Stress Hives: Result from stress-induced release of inflammation-causing chemicals in the body.
Hives in Babies: Similar to adults, babies can develop hives due to infections, drug reactions, food allergies, bee stings, or other allergic reactions.

Symptoms of urticaria

Raised Welts: These bumps can vary in size and are typically reddish, though they might be harder to discern on darker skin tones.
Intense Itching: Hives often bring along a maddening itch, particularly noticeable at night.
Temporary: The welts tend to appear and disappear over minutes to hours.

If you’re dealing with angioedema, you might also encounter:

Facial and Body Swelling: Areas like your face, eyelids, ears, mouth, hands, feet, and even genitals may swell up.
Asymmetrical Swelling: Sometimes, swelling may occur only on one side of your body.
Discomfort and Skin Changes: The swollen areas might feel uncomfortable, and the skin color might change.

Contact dermatitis and hives

Contact Dermatitis: This is a rash that arises when your skin comes into contact with something it’s allergic to (allergic contact dermatitis) or that irritates it (irritant contact dermatitis). While distinct from hives, some individuals might experience both conditions if they encounter an allergen.

Diagnosis of urticaria

Diagnosing hives involves a thorough examination and medical history review by your doctor

Doctor’s Evaluation: Your doctor will likely ask several questions to identify potential triggers for your hives. Since there aren’t specific tests for hives or associated angioedema, diagnosis often relies on your medical history and a comprehensive examination.
Testing: Depending on your situation, your doctor might conduct skin tests to pinpoint allergens or order blood tests to check for underlying illnesses.

Rash vs Hives

Hives fall under the category of rashes, which are characterized by unusual changes to the skin, resulting in spots, swelling, itchiness, or alterations in color.

Treatment for urticaria

The primary approach to treating hives involves identifying and eliminating the trigger, though this can be challenging. Typically, doctors prescribe antihistamines to alleviate symptoms. For best results, antihistamines should be taken regularly to prevent hives from recurring.

In cases of chronic hives, treatment may involve antihistamines or a combination of medications. If antihistamines fail to provide relief, oral steroids may be prescribed. Additionally, a biologic drug called omalizumab (Xolair) is approved for treating chronic hives in individuals aged 12 and older.

In severe instances of hives, an injection of epinephrine or a cortisone medication may be necessary.

Managing Hives

While waiting for hives and swelling to subside, consider the following tips:

Cool Compresses: Apply cool compresses or wet cloths to the affected areas to alleviate discomfort and reduce swelling.
Maintain Cool Environment: Opt to work and sleep in a cool room, as heat can exacerbate symptoms.
Comfortable Clothing: Wear loose-fitting, lightweight clothing to prevent further irritation to the skin.

When to Seek Medical Attention

If you experience hives accompanied by any of the following symptoms, it’s crucial to contact your doctor promptly:

Dizziness: Feeling lightheaded or dizzy.
Wheezing: Audible whistling or rattling sounds while breathing.
Difficulty Breathing: Struggling to breathe normally.
Chest Tightness: Sensation of pressure or tightness in the chest.
Swelling of Face or Airway: Swelling of the tongue, lips, or face, which can potentially obstruct the airway.

Key Points

Hives are itchy welts that can emerge anywhere on the skin, varying in duration from minutes to days. They may signal underlying health issues, especially if respiratory symptoms like trouble breathing occur. Hives result from the release of histamine in response to triggers such as foods, medications, insect bites, or infections. Treatment involves avoiding triggers, using antihistamines, and seeking medical attention if symptoms persist or worsen.

Sources

American Academy of Dermatology
American Academy of Allergy, Asthma, and Immunology
Cleveland Clinic
Scripps
Seattle Children’s
UpToDate
MedlinePlus Medical Encyclopedia