Hives / Urticaria: Types, Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Prevention

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A back of a man with hives

1Overview

One of the most annoying sensation is itchiness. People who experience skin conditions that cause itchiness may feel the urge to scratch the skin affected, leading to lesions and open wounds. Hives or urticaria are just one of the skin condition that is itchy and frustrating.

Hives are itchy and red welts that result from a skin reaction or an allergic reaction.
The other names for hives are urticarial, nettle rash, wheals, and welts. Hives often occur during an allergic reaction but may stay for a few hours or days. In some cases, they go away.

About 20 percent of people are affected by hives at some point in their lifetime.

2Types

Acute urticaria – Acute urticarial is the rash that goes away within six weeks.

Chronic urticaria – This is the rash that may continue or persist over six weeks. In rare cases, the rash can stay for years. Chronic hives can be uncomfortable and in some people, interfere with their daily activities. For most people, taking antihistamines may relieve the itch and rash.

3Symptoms

The major symptom of hives is the appearance of swellings or wheals that may look red or pink. These wheals are oval or round in shape and may range from small to large ones, which are extremely itchy.

The other symptoms include:

  • Wheals or welts that appear anywhere on the skin
  • Severe itching
  • Swelling of the skin that goes away within 24 hours
  • Red swellings that can be slightly raised

4Causes

Hives can be caused by any trigger that is present in the environment such as food, temperature, physical agents and medication. Here are the common triggers of hives or urticaria:

Food – Many types of food can trigger allergic reactions in people with sensitivities.
The common food triggers of hives include shellfish, food additives, nuts, eggs, wheat products and strawberries.

Common allergens – Common allergens may trigger hives including pollens, insect bites, animal dander, and latex.

Medications – Many types of medications may cause hives. The common drugs linked to an allergic reaction include aspirin, penicillin, ibuprofen, blood pressure drugs and naproxen.

Environmental factors – Some environmental factors like sunlight, water, cold, heat, exercise, emotional stress, and pressure on the skin may lead to hypersensitivity reactions.

Genetics – Angioedema, which is the swelling in the deep layers of the skin, may run in families.

Underlying medical conditions – Hives can happen in response to blood transfusions, some types of cancer like lymphoma, immune system disorders like lupus, and infections like hepatitis, cytomegalovirus, Epstein-Barr virus, and HIV.

Other causes and triggers:

  • Drinking alcohol or caffeine
  • Stress
  • Change in temperature
  • Dust Mites
  • Intestinal parasites
  • High body temperature
  • Cockroaches and their waste
  • Some plants like poison oak, poison ivy, and nettles
  • Some chemicals
  • Scratching
  • Water on the skin

5Risk Factors

Hives and angioedema are relatively common at can happen to anyone. However, some people are at a higher risk of developing hives than others. People who have hives or angioedema in the past, those who have other allergic reactions and those suffering from disorders like lymphoma, lupus, and thyroid disease are at a higher risk of having hives.

The other risk factors include:

Friction – If you scratch or rub the skin, rashes or hives may develop.

Pressure – Pressure may cause pressure gives, a condition wherein the skin experiences high pressure because of belts, straps and other materials.

Pregnancy – Hives can also be caused by pregnancy, in the last stages.

Swimming – Sometimes, swimming may increase the risk of urticaria or hives due to the water’s temperature. Also, in swimming pools, the chlorine content of the water may cause skin irritation and the development of hives.

6Complications

Severe angioedema or anaphylaxis are severe allergic reactions that can be life-threatening. These conditions can affect the whole body and can lead to serious breathing difficulties. Sometimes, it can also lead to loss of consciousness. They are medical emergencies that need urgent care.

The symptoms include nausea and vomiting, cold clammy skin, faintness or lightheadedness, and swelling of the lining of the tongue, throat, lips, and mouth, leading to breathing problems. Some people with hives may have a sudden feeling of severe anxiety.

7Diagnosis

When the trigger is obvious like eating seafood, food, and medicine, it is easily recognized as hives. Other cases, on the other hand, require investigation and detective work by the patient and the doctor.

The doctor will often examine the welts or wheals if these are still present. Also, he will take the medical history of the patient to determine the possible causes of the reddish rash. In some cases, the physician may recommend an allergy skin test. This is often examined by an allergist, a doctor who specializes in the treatment of allergies. Skin tests, blood tests, and urine tests are used to identify the cause of the hives.

The following tests can check for underlying medical conditions that can cause hives:

  • Blood test for anemia
  • Thyroid function tests to determine the presence of overactive or underactive thyroid
  • Stool exam to test for parasites
  • Erythrocyte sedimentation rate (ESR) to determine the presence of autoimmune diseases like lupus.
  • Liver function tests to detect liver problems

8Treatment

For mild or moderate hives, the most common treatment is the prescription of antihistamines. These medicines should only be prescribed by doctors. In some cases, these hives go away on their own without treatment. However, some measures may be helpful in the relief of severe itching and discomfort. The treatment options include:

Medicines

Doctors may prescribe medicines to relieve hives, including:

Antihistamines – The most common drug used to relieve itching is antihistamines.
These are medications used to reduce swelling and itching.

Anti-inflammatory drugs – For severe hives, the doctors may prescribe oral corticosteroids to relieve redness, itching, and swelling.

Pain relievers – In some cases, the doctor will prescribe medicines to reduce pain and swelling. The most common medicines prescribed include non-steroidal anti-inflammatory drugs like leukotriene antagonists.

Drugs that suppress the immune system – If the antihistamines and corticosteroids do not work, the doctor may recommend using drugs that can calm the immune system.

For emergency situations or severe attacks, it is important to seek medical help right away or go to the nearest hospital for the injection of epinephrine, a type of adrenaline that can reverse the symptoms of anaphylaxis.

For patients with chronic hives and allergic reactions, they can carry an epinephrine pen with them for emergency situations.

Home remedies

In some cases, home remedies are used to relieve the symptoms without taking medications. These include:

  • Cold compress on the rash
  • Soaking the affected part in baking soda and warm water
  • Drink apple cider vinegar mixed with lemon juice and honey to relieve inflammation
  • Rinse the rashes with the oatmeal mixture to reduce inflammation, irritation and provide relief.
  • Apply aloe vera gel to the rashes
  • Drink aloe vera juice to boost the immune system.
  • Avoid cold temperatures when you’re allergic to dry and cold air
  • Avoid getting sweaty when you’re allergic to wet skin
  • Do not go near areas with many flowers when you’re allergic to pollen grains

9Prevention

Simple changes in lifestyle may help avoid having hives and may prevent recurrent hives. For individuals with allergies, knowing one’s triggers is important to avoid potential exposure to these factors. In some cases, allergy shots can help prevent sensitivity reactions.

For people who are allergic to high-humidity areas, wear loose clothing to prevent irritation. Also, if you know what triggers your allergy like eating eggs, shellfish or staying in cold areas, it is important to carry a preventive medicine all the time.

Even though hives can be uncomfortable because of itching, they are not severe and will eventually clear on its own after some time. Be aware, however, that some hives may go away but new ones may emerge, too.

The mild cases of hives are considered harmless and easily treated. On the other hand, some hive cases can be dangerous and may cause life-threatening conditions like the inflammation of the throat. Immediate and urgent treatment for severe hives is important for a good prognosis of the condition.

Hives and Angioedema

Hives or urticaria happens more commonly and less severely than angioedema. Angioedema is a more severe type of allergic reaction that can turn life-threatening.

Angioedema is a skin reaction similar to hives but is often characterized by a sudden and short-lived inflammation of the skin and mucous membranes. The swelling often occurs in the eyes and lips but can affect any part of the body. In serious cases, the internal lining of the throat and respiratory system may be affected, leading to breathing problems.

On the other hand, hives or urticaria are itchy, reddish and raised areas of the skin. Approximately a quarter of the population may have hives sometime in their lives. Also, hives often appear even without any sign of warming. It may also start at any time.

The treatment of hives and angioedema are almost the same. Since angioedema is severe, more drugs can be used and an epinephrine shot is needed when the symptoms cause breathing problems.